Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review

IntroductionExcessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.MethodsThis review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946–2019) were included.ResultsA total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46±16 years (95% CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L/day (95% CI 8.9 to 12.2 L/day) and 118 mmol/L (95% CI 116 to 118 mmol/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases.ConclusionWater intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies.PROSPERO registration numberA pre-existing protocol in the international prospective register of systematic reviews was updated to incorporate any new amendments and reregistered at http://www.crd.york.ac.uk/PROSPERO (registration no. CRD42019129809).

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A systematic review and meta-analysis protocol examining the clinical characteristics and epidemiological features of olfactory dysfunction (OD) in coronavirus disease 2019 (COVID-19)

Systematic Reviews ◽

10.1186/s13643-021-01624-6 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Rosemond Qian-Xiu Tan ◽

Wai Tak Victor Li ◽

Wing-Zi Shum ◽

Sheung Chit Chu ◽

Hang-Long Li ◽

...

Keyword(s):

Systematic Review ◽

Clinical Data ◽

Systematic Reviews ◽

Clinical Characteristics ◽

Meta Analysis ◽

Olfactory Dysfunction ◽

Statistical Analyses ◽

Human Populations ◽

Meta Analyses ◽

Analysis Protocol

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has caused recurring and major outbreaks in multiple human populations around the world. The plethora of clinical presentations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been described extensively, of which olfactory dysfunction (OD) was established as an important and common extrapulmonary manifestation of COVID-19 infection. The aim of this protocol is to conduct a systematic review and meta-analysis on peer-reviewed articles which described clinical data of OD in COVID-19 patients. Methods This research protocol has been prospectively registered with the Prospective Register of Systematic Reviews (PROSPERO; CRD42020196202). CINAHL, ClinicalTrials.gov, Cochrane Central, EMBASE, MEDLINE and PubMed, as well as Chinese medical databases China National Knowledge Infrastructure (CNKI), VIP and WANFANG, will be searched using keywords including ‘COVID-19’, ‘coronavirus disease’, ‘2019-nCoV’, ‘SARS-CoV-2’, ‘novel coronavirus’, ‘anosmia’, ‘hyposmia’, ‘loss of smell’, and ‘olfactory dysfunction’. Systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. Articles will be screened according to pre-specified inclusion and exclusion criteria to extract studies that include new clinical data investigating the effect of COVID-19 on olfactory dysfunction. Included articles will be reviewed in full; data including patient demographics, clinical characteristics of COVID-19-related OD, methods of olfactory assessment and relevant clinical outcomes will be extracted. Statistical analyses will be performed using the Comprehensive Meta-Analysis version 3. Discussion This systematic review and meta-analysis protocol will aim to collate and synthesise all available clinical evidence regarding COVID-19-related OD as an important neurosensory dysfunction of COVID-19 infection. A comprehensive search strategy and screening process will be conducted to incorporate broad clinical data for robust statistical analyses and representation. The outcome of the systematic review and meta-analysis will aim to improve our understanding of the symptomatology and clinical characteristics of COVID-19-related OD and identify knowledge gaps in its disease process, which will guide future research in this specific neurosensory defect. Systematic review registration PROSPERO registration number: CRD42020196202.

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The Involvement of Hypothalamus–Pituitary–Adrenal (HPA) Axis in Suicide Risk

Brain Sciences ◽

10.3390/brainsci10090653 ◽

2020 ◽

Vol 10 (9) ◽

pp. 653 ◽

Cited By ~ 3

Author(s):

Isabella Berardelli ◽

Gianluca Serafini ◽

Natalia Cortese ◽

Federica Fiaschè ◽

Rory C O’Connor ◽

...

Keyword(s):

Hpa Axis ◽

Systematic Reviews ◽

Suicidal Behavior ◽

Suicide Risk ◽

Case Reports ◽

Number Of Patients ◽

Hpa Axis Dysregulation ◽

New Treatment ◽

Meta Analyses ◽

Hpa Axis Activity

Stress and Hypothalamic–Pituitary–Adrenal (HPA) axis dysregulation play a major role in various pathophysiological processes associated with both mood disorders and suicidal behavior. We conducted a systematic review with the primary aim of clarifying the nature and extent of HPA axis activity and suicidal behavior. The second aim of this review was to investigate whether potential biomarkers related to HPA axis abnormalities act as individual susceptibility factors for suicide. The PRISMA statement for reporting systematic reviews was used. Only articles published in English peer-reviewed journals were considered for possible inclusion; we excluded case reports, meta-analyses, and systematic reviews, and studies that did not clearly report statistical analysis, diagnostic criteria, or the number of patients included. Overall, 36 articles on HPA axis and suicide risk met inclusion criteria and were reviewed. Studies that investigated tests detecting biomarkers and the role of early life stressors in suicide risk were also included. We found that HPA axis activity is involved in suicide risk, regardless of the presence or absence of psychiatric conditions. The HPA axis abnormalities, mainly characterized by hyperactivity of the HPA axis, may exert an important modulatory influence on suicide risk. Impaired stress response mechanisms contribute to suicide risk. Targeting HPA axis dysregulation might represent a fruitful strategy for identifying new treatment targets and improving suicide risk prediction.

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A systematic review and meta-analysis protocol examining the clinical characteristics and epidemiological features of olfactory dysfunction (OD) in coronavirus disease 2019 (COVID-19)

10.21203/rs.3.rs-46723/v4 ◽

2021 ◽

Author(s):

Rosemond Qian-Xiu Tan ◽

Wai Tak Victor Li ◽

Wing-Zi Shum ◽

Sheung Chit Chu ◽

Hang-Long Li ◽

...

Keyword(s):

Systematic Review ◽

Clinical Data ◽

Systematic Reviews ◽

Clinical Characteristics ◽

Meta Analysis ◽

Olfactory Dysfunction ◽

Statistical Analyses ◽

Human Populations ◽

Meta Analyses ◽

Analysis Protocol

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has caused recurring and major outbreaks in multiple human populations around the world. The plethora of clinical presentations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been described extensively, of which olfactory dysfunction (OD) was established as an important and common extrapulmonary manifestation of COVID-19 infection. The aim of this protocol is to conduct a systematic review and meta-analysis on peer-reviewed articles which described clinical data of OD in COVID-19 patients. Methods This research protocol has been prospectively registered with the Prospective Register of Systematic Reviews (PROSPERO; CRD42020196202). CINAHL, ClinicalTrials.gov, Cochrane Central, EMBASE, MEDLINE and PubMed, as well as Chinese medical databases: China National Knowledge Infrastructure (CNKI), VIP and WANFANG will be searched using keywords including “COVID-19”, “coronavirus disease”, “2019-nCoV”, “SARS-CoV-2”, “novel coronavirus”, “anosmia”, “hyposmia”, “loss of smell”, and “olfactory dysfunction”. Systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. Articles will be screened according to pre-specified inclusion and exclusion criteria to extract studies that include new clinical data investigating the effect of COVID-19 on olfactory dysfunction. Included articles will be reviewed in full; data including patient demographics, clinical characteristics of COVID-19-related OD, methods of olfactory assessment, and relevant clinical outcomes will be extracted. Statistical analyses will be performed using the Comprehensive Meta-Analysis version 3. Discussion This systematic review and meta-analysis protocol will aim to collate and synthesise all available clinical evidence regarding COVID-19-related OD as an important neurosensory dysfunction of COVID-19 infection. A comprehensive search strategy and screening process will be conducted to incorporate broad clinical data for robust statistical analyses and representation. The outcome of the systematic review and meta-analysis will aim to improve our understanding of the symptomatology and clinical characteristics of COVID-19-related OD and identify knowledge gaps in its disease process, which will guide future research in this specific neurosensory defect.Systematic Review registration: PROSPERO registration number: CRD42020196202

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Psychogenic polydipsia: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1181 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S681-S682

Author(s):

G. Erzin ◽

K. ozdel ◽

H. Karadağ

Keyword(s):

Anxiety Disorder ◽

Water Intake ◽

Vital Signs ◽

Fluid Restriction ◽

Test Results ◽

Psychogenic Polydipsia ◽

Excess Water ◽

Competing Interest ◽

Married Female ◽

Excessive Thirst

IntroductionPsychogenic or primary polydipsia characterized by excessive thirst and compulsive water drinking is a common problem among psychiatric populations, affecting 6% to 20% of patients. It is frequent in chronic psychiatric diseases, particularly schizophrenia. We report a patient with excessive thirst and diagnosed as PIP syndrome.CaseA 54-year-old, married, female patient had normal vital signs. She has excessive water intake (10–12 L/day). She did not have edema, signs of dehydration or fever. The neurological examination, CT, MRI, and EEG was normal. The laboratory tests were normal. She had started using sertraline 100 mg, 7 months ago due to anxiety disorder. There is not any disease except the anxiety disorder, which is in remission due to the treatment. A total of, 2 μg desmopressin I.M. is applied in fluid restriction test. The urine density is determined as 1.008 mg/dL initially, 1.011 mg/dL one hour later, and 1.013 mg/dL two hours later in the urinary test. The diagnosis is psychogenic polydipsia (primary) according to patient history, the clinical examination, and the test results. The patient is recommended to continue the sertraline 100 mg treatment, and also assigned with fluid restriction behaviour.ConclusionSince excess water intake periods are correlated with psychotic exacerbations; psychosis and polydipsia might have similar physiopathologic mechanisms. Polydipsia might be due to anti-cholinergic side effect of some psychiatric drugs. The physiopathology of the polydipsia and polyuria is not totally enlightened in the psychiatric disorders. In some cases, the fluid intake occurs completely voluntary. Therefore, we decided to present this case.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Indoor mould exposure, asthma and rhinitis: findings from systematic reviews and recent longitudinal studies

European Respiratory Review ◽

10.1183/16000617.0137-2017 ◽

2018 ◽

Vol 27 (148) ◽

pp. 170137 ◽

Cited By ~ 42

Author(s):

Denis Caillaud ◽

Benedicte Leynaert ◽

Marion Keirsbulck ◽

Rachel Nadif

Keyword(s):

Longitudinal Studies ◽

Systematic Reviews ◽

Epidemiological Studies ◽

Population Based ◽

World Health ◽

Sufficient Evidence ◽

Institute Of Medicine ◽

Level Of Evidence ◽

Meta Analyses ◽

Indoor Mould

Starting from the Institute of Medicine (IOM) and World Health Organization (WHO) reports, this review provides an overview of the literature published from 2006 to 2017 on the associations between indoor mould exposure and asthma and rhinitis separately in children and adults with a focus on longitudinal epidemiological studies.A systematic search of peer-reviewed literature was performed, including systematic reviews and meta-analyses, longitudinal, incident case–control and panel studies. 61 publications were identified reporting visible mould or mould odour or quantitative assessment of culturable fungi or mould species.In children, visible mould and mould odour were associated with the development and exacerbations of asthma, providing sufficient evidence of a causal relationship. Results from population-based studies in adults were too few and divergent to conclude at more than a limited level of evidence. Exposure to mould in a work building was associated with the incidence and exacerbations of occupational asthma, and we concluded at a sufficient evidence for an association. Systematic reviews, meta-analyses and longitudinal studies on the relationships between mould exposure and allergic rhinitis provide sufficient evidence of an association.This review extended the conclusions of the IOM and WHO reports, and highlighted the need for further longitudinal studies on asthma in adults, and on rhinitis.

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A systematic review and meta-analysis protocol examining the clinical characteristics and epidemiological features of olfactory dysfunction (OD) in coronavirus disease 2019 (COVID-19)

10.21203/rs.3.rs-46723/v3 ◽

2021 ◽

Author(s):

Rosemond Qian-Xiu Tan ◽

Wai Tak Victor Li ◽

Wing-Zi Shum ◽

Sheung Chit Chu ◽

Hang-Long Li ◽

...

Keyword(s):

Systematic Review ◽

Clinical Data ◽

Systematic Reviews ◽

Clinical Characteristics ◽

Meta Analysis ◽

Olfactory Dysfunction ◽

Statistical Analyses ◽

Human Populations ◽

Meta Analyses ◽

Analysis Protocol

Abstract BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has caused recurring and major outbreaks in multiple human populations around the world. The plethora of clinical presentations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been described extensively, of which olfactory dysfunction (OD) was established as an important and common extrapulmonary manifestation of COVID-19 infection. The aim of this protocol is to conduct a systematic review and meta-analysis on peer-reviewed articles which described clinical data of OD in COVID-19 patients. MethodsThis research protocol has been prospectively registered with the Prospective Register of Systematic Reviews (PROSPERO; CRD42020196202). CINAHL, ClinicalTrials.gov, Cochrane Central, EMBASE, MEDLINE and PubMed, as well as Chinese medical databases: China National Knowledge Infrastructure (CNKI), VIP and WANFANG will be searched using keywords including “COVID-19”, “coronavirus disease”, “2019-nCoV”, “SARS-CoV-2”, “novel coronavirus”, “anosmia”, “hyposmia”, “loss of smell”, and “olfactory dysfunction”. Systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. Articles will be screened according to pre-specified inclusion and exclusion criteria to extract studies that include new clinical data investigating the effect of COVID-19 on olfactory dysfunction. Included articles will be reviewed in full; data including patient demographics, clinical characteristics of COVID-19-related OD, methods of olfactory assessment, and relevant clinical outcomes will be extracted. Statistical analyses will be performed using the Comprehensive Meta-Analysis version 3. DiscussionThis systematic review and meta-analysis protocol will aim to collate and synthesise all available clinical evidence regarding COVID-19-related OD as an important neurosensory dysfunction of COVID-19 infection. A comprehensive search strategy and screening process will be conducted to incorporate comprehensive clinical data for robust statistical analyses and representation. The outcome of this study will aim to improve our understanding of the symptomatology and clinical characteristics of COVID-19-related OD and identify knowledge gaps in its disease process, which will guide future research in this specific neurosensory defect.Systematic Review registration: PROSPERO registration number: CRD42020196202

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Prevalence of Metabolic Syndrome in Iranian Hemodialysis Patients: A Systematic Review and Meta-analysis

International journal of basic science in medicine ◽

10.34172/ijbsm.2019.02 ◽

2019 ◽

Vol 4 (4) ◽

pp. 131-136

Author(s):

Amin Afsharimoghaddam

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Metabolic Syndrome ◽

Systematic Reviews ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Hemodialysis Patients ◽

Study Protocols ◽

Meta Analyses

Introduction: Metabolic syndrome as one of the risk factors for cardiovascular diseases has recently been the focus of clinical studies. This study was conducted to determine the prevalence of metabolic syndrome in hemodialysis patients in Iran. Methods: The present systematic review was done using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Case-control, cohort and crosssectional studies conducted in Iran were included. Clinical trials, case reports, letters to editors, systematic reviews, study protocols, narrative reviews, and case series were excluded. Subgroup analysis was conducted for determining the heterogeneity based on the participants as well as their gender. Meta-analysis was conducted using STATA version 14.0. Results: The prevalence of metabolic syndrome among 799 patients was 50% (95% CI: 47.0, 53.0, I2=50.6). The analysis of subgroups was conducted for determining the heterogeneity based on the participants as well as their gender. Based on the analysis of the subgroups using a random effects model, the prevalence of metabolic syndrome was found to be 44% and 55% in Iranian men and women undergoing hemodialysis, respectively. Conclusion: Given the high prevalence of metabolic syndrome in hemodialysis patients, it is advisable and logical that patients with chronic renal failure should be regularly evaluated for metabolic syndrome and cardiovascular risk factors both at the diagnosis time and afterwards.

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A systematic review and meta-analysis protocol examining the clinical characteristics and epidemiological features of olfactory dysfunction (OD) in coronavirus disease 2019 (COVID-19)

10.21203/rs.3.rs-46723/v2 ◽

2020 ◽

Author(s):

Rosemond Qian-Xiu Tan ◽

Wai Tak Victor Li ◽

Wing-Zi Shum ◽

Sheung Chit Chu ◽

Hang-Long Li ◽

...

Keyword(s):

Systematic Review ◽

Clinical Data ◽

Systematic Reviews ◽

Clinical Characteristics ◽

Meta Analysis ◽

Olfactory Dysfunction ◽

Statistical Analyses ◽

Human Populations ◽

Meta Analyses ◽

Analysis Protocol

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has caused recurring and major outbreaks in multiple human populations around the world. The plethora of clinical presentations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been described extensively, of which olfactory dysfunction (OD) was established as an important and common extrapulmonary manifestation of COVID-19 infection. The aim of this protocol is to conduct a systematic review and meta-analysis on peer-reviewed articles which described clinical data of OD in COVID-19 patients. Methods This research protocol has been prospectively registered with the Prospective Register of Systematic Reviews (PROSPERO; CRD42020196202). CINAHL, ClinicalTrials.gov, Cochrane Central, EMBASE, MEDLINE and PubMed, as well as Chinese medical databases: China National Knowledge Infrastructure (CNKI), VIP and WANFANG will be searched using keywords including “COVID-19”, “coronavirus disease”, “2019-nCoV”, “SARS-CoV-2”, “novel coronavirus”, “anosmia”, “hyposmia”, “loss of smell”, and “olfactory dysfunction”. Systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. Articles will be screened according to pre-specified inclusion and exclusion criteria. Included articles will be reviewed in full; data including patient demographics, clinical characteristics of COVID-19-related OD, methods of olfactory assessment, and relevant clinical outcomes will be extracted. Statistical analyses will be performed using the Comprehensive Meta-Analysis version 3. Discussion This systematic review and meta-analysis protocol will aim to collate and synthesise all available clinical evidence regarding COVID-19-related OD as an important neurosensory dysfunction of COVID-19 infection. A comprehensive search strategy and screening process will be conducted to incorporate comprehensive clinical data for robust statistical analyses and representation. The outcome of this study will aim to improve our understanding of the symptomatology and clinical characteristics of COVID-19-related OD and identify knowledge gaps in its disease process, which will guide future research in this specific neurosensory defect.Systematic Review registration: PROSPERO registration number: CRD42020196202

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A Systematic Review and Meta-analysis Protocol Examining the Clinical Characteristics and Epidemiological Features of Olfactory Dysfunction in Coronavirus Disease 2019 (COVID-19)

10.21203/rs.3.rs-46723/v1 ◽

2020 ◽

Author(s):

Rosemond Qian-Xiu Tan ◽

Wai Tak Victor Li ◽

Wing-Zi Shum ◽

Sheung Chit Chu ◽

Hang-Long Li ◽

...

Keyword(s):

Systematic Review ◽

Clinical Data ◽

Systematic Reviews ◽

Clinical Characteristics ◽

Meta Analysis ◽

Disease Process ◽

Olfactory Dysfunction ◽

Human Populations ◽

Common Symptom ◽

Meta Analyses

Abstract BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has caused recurring and major outbreaks in multiple human populations around the world. The plethora of clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been described extensively, of which COVID-19-related olfactory dysfunction (OD) has been recognised as an important and common symptom of COVID-19 infection. The aim of this study is to conduct a systematic review and meta-analysis of peer-reviewed articles, which described clinical data of smell disturbances and OD in COVID-19 patients.MethodsThis research protocol has been prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020196202). Accordingly, PubMed (MEDLINE) articles published from 1st January 2020 to 10th June 2020 will be searched using the following keywords: COVID-19, SARS-CoV-2, 2019-nCoV, or novel coronavirus. Systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. Articles will be screened according to the pre-specified inclusion and exclusion criteria. Included articles will be reviewed in full; data including patient demographics, clinical characteristics of COVID-19-related OD, methods of olfactory assessment, and relevant clinical outcomes will be extracted. Statistical analyses will be performed using the Comprehensive Meta-Analysis version 3.DiscussionThis systematic review and meta-analysis will exclusively evaluate OD as a symptom of COVID-19 infection. We aim to collate and synthesise all available clinical evidence regarding COVID-19-related OD. A comprehensive search strategy and screening process will be used to ensure that all relevant clinical data are included for statistical analysis and representation. The outcome of this study will improve our understanding of the symptomatology and clinical characteristics of COVID-19-related OD and serves to identify knowledge gaps in its disease process, which will guide future research regarding this specific neurosensory impairment.Systematic Review registration: PROSPERO registration number: CRD42020196202

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Risks and Safety of Extended Auricular Therapy: A Review of Reviews and Case Reports of Adverse Events

Pain Medicine ◽

10.1093/pm/pnz379 ◽

2020 ◽

Vol 21 (6) ◽

pp. 1276-1293

Author(s):

Arya Nielsen ◽

Sezelle Gereau ◽

Heather Tick

Keyword(s):

Adverse Events ◽

Systematic Reviews ◽

Case Reports ◽

Cost Effective ◽

Auricular Acupuncture ◽

Cochrane Central Register ◽

Group Setting ◽

Auricular Acupressure ◽

Meta Analyses ◽

Auricular Therapy

Abstract Objective Auricular acupuncture (AA) and extended auricular therapy (AT) are a part of acupuncture practice shown to benefit patients with pain, anxiety, and other conditions, with cost-effective access enhanced when given in a group setting. Yet there are safety concerns and risks, perhaps unnecessary risks, that attend embedded, indwelling needles applied to the ear as a means of extended AT. Methods Electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) for “auriculotherapy,” “auricular acupuncture” or “auricular acupressure,” “safety,” “adverse events,” “chondritis,” and “perichondritis,” with additional manual review of titles, links, and reference lists. Individual auricular therapy adverse event (AE) case reports were included, as well as systematic reviews and or meta-analyses if they evaluated AEs associated with AT. Results Nineteen auricular AE case reports and nine safety reviews of or including auriculotherapy were included. Ten systematic reviews of AT with eight specific reviews of auricular acupressure (AP) were also included. Conclusions The primary AE risks is infection, perichondritis, and chondritis stemming from embedded or indwelling needles or potential inadvertent needlesticks from contaminated roaming sharps. Extended AP i.e., application of spheres, preferably seeds (natural, nontoxic botanical Vaccaria seeds) provides clinical benefit without the risks associated with embedded needles. More research is needed to establish if embedded needles at the ear are even necessary or have any advantage over in-session auricular acupuncture for immediate pain relief followed by ear acupressure.

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