Auricular versus Cervical Vagus Nerve Stimulation: A Narrative Perspective on Safety, Mechanisms, and Clinical Applicability

Abstract

The field of vagus nerve stimulation (VNS) is rapidly evolving, with expanding evidence for therapeutic benefits across a wide spectrum of conditions and rising demand for safer, non-invasive alternatives. While cervical VNS has established clinical credibility, its surgical invasiveness and risk of off-target effects limit broader adoption. In contrast, transcutaneous auricular vagus nerve stimulation (taVNS), which targets the auricular branch of the vagus nerve, provides a non-invasive, anatomically precise, and well-tolerated approach.

This review synthesises current knowledge on taVNS mechanisms, safety, clinical feasibility, and future directions, with emphasis on device-specific outcomes. Evidence consistently shows that taVNS is not associated with serious adverse events, even in high-risk populations such as patients with heart failure, atrial fibrillation, and post-viral dysautonomia. Meta-analytic safety data and mechanistic studies support its fibre selectivity and broad applicability, highlighting key distinctions from both implanted and transcutaneous cervical VNS.

As healthcare moves towards decentralised and patient-led care models, taVNS emerges as a promising cornerstone of bioelectronic medicine. Its favourable safety profile, at-home usability, and expanding clinical evidence base position auricular neuromodulation not merely as a safer alternative, but as a scalable and patient-centred innovation shaping the next generation of personalised therapeutics.