External Vagus Nerve Stimulation (VNS)
at the ear for Long Covid

Vagus nerve stimulation is not new. It was identified back in the 1920’s as a nerve that can regulate the parasympathetic nervous system to release Acetylcholine neurotransmitter. In general, the autonomic nervous system is made up of these two opposing sides, kind of like a Ying and Yang:

It is not necessary to spend thousands of dollars on invasive needle probe vagus nerve stimulators or expensive TENS units. This can be performed in our office over 15-30 minutes or even at home if you simply have a good and adjustable TENS unit. I’m talking about the ones that you can vary the milliamps (mA), pulse width, and frequency. Some units come with selectable “programs “and are preprogrammed for certain actions setups only. Those are not good for what we want to do here. Those units are for Electric Muscle Stimulation (EMS) even though they call themselves a TENS unit.
We like the "TENS 7000" because you can adjust the frequency, pulse with/duration of pulse, and intensity and its inexpensive, under $40 from most vendors. You can find it on Amazon or being sold on the web. You will also need 2 ear clips with a 2mm female attachment.

Do NOT use if you have a pacemaker or defibrillator, are pregnant, or have a sick heart.

Which ear is better / Safer to Use?

With low intensity stimulation as suggested under 1.5mA, its likely using both ears are safe. However, the left ear is less likely to cause bradycardia or slowing of your heart. Limit stimulation to 30 minutes until you know how the stimulation effects you.

How does Vagus nerve stimulation (VNS) work?

This non-invasive electrical stimulation of the “somatic” (i.e., external ear) afferent branch of the vagus nerve activates both “visceral” and “somatic” vagal projections in the brain and increases activities on the parasympathetic nervous system as described above.

What are the TENS parameters that should be used for cymbae conchae stimulation?

New TENS 7000 settings:
  1. Put red lead ear clip or use dual contact ear clip on left ear tragus. Black clip can go anywhere on ear where comfortable or can use a skin pad on shoulder or neck area.
  2. Set pulse width to 250 microseconds
  3. Set frequency to 25Hz. Can change frequency between 20-30Hz once a week.
  4. Set intensity between 1-2 on dial. On tragus 4mA to 8mA is fine.
  5. Nothing should hurt.
  6. Do it daily 15-30 minutes.
  7. Don't use TENS on vagus nerve if you have a sick heart, have a implanted pacemaker/defibrillator sick sinus syndrome, arrhythmias, or are pregnant. Usual disclaimer.
Check out video to see how to work the TENS 7000 and set it up.

Where do I put the electrodes?

The main areas we want to target are the cymba conchae, cymba, and cavum. If you are not able to attach the electrode to these areas, use the tragus or the antihelix of the ear. Please only stimulate one ear at a time. Remember you must use 2 electrodes to complete the circuit. We recommend placing both electrodes on one ear. If you are not able to, you can place one pad on the neck or upper back area with a pad instead. Stimulation wont work with just one lead/electrode.

How can this treatment help with long covid syndrome or long haulers syndrome?

As it is currently thought that the main problem with anosmia, parosmia, and brain fog is a result of autonomic dysfunction, perhaps adding external vagus nerve stimulation may be beneficial together with an SGB. In summary, if we activate the parasympathetic nervous system while downregulating the sympathetic nervous system, this may yield better results compared to what we have been trying.