Key result
Auricular vagal nerve stimulation mechanisms involve complex, overlooked neural networks including sympathetic nerves and intrinsic auricular muscles, challenging the monolog concept of the vagus nerve.
Why the study?
AVNS mechanisms have traditionally been interpreted through a monolog concept of the auricular branch of the vagus nerve alone, overlooking other complex neural networks that may explain vagal and non-vagal nucleus activations.
A detailed anatomical understanding of auricular neural networks is necessary to overcome misinterpretations in AVNS research and guide future neuromodulation studies.
Requires anatomical precision in AVNS protocols; leaves open validation of complex networks for future trials.
Auricular vagal nerve stimulation (AVNS) is an evolving neuromodulation technology that has a wide range of therapeutic applications across multiple disciplines of medical science. To date, AVNS results had been interpreted in the context of a monolog concept of the auricular branch of the vagus nerve (ABVN): that this is the sole network of the mechanism of action and/or structure in the auricular area of the stimulation in the context of activations in the brainstem nuclei, including the nucleus tractus solitarius (NTS), locus coeruleus (LC), trigeminal brainstem nuclei, and the nucleus cuneatus. This review considers the overlooked aspects of neural networks, connections, hijacking axons from cranial nerves and cervical sympathetic ganglions, the inhomogeneous distribution of perivascular sympathetic nerves, and intrinsic/extrinsic auricular muscles in the auricular zone that can explain the vagal and non-vagal nucleus activations in AVNS. In addition, the unique cortical representation of the human ear and interspecies differences in the auricula are discussed. The detailed auricular anatomy of the AVNS zone explored in the present study references structural and functional neural network information to overcome default designs and misinterpretations of existing research on AVNS to provide a better foundation for future investigations that use this modality.
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Yusuf Özgür Çakmak (2019) conducted a review in Auricular vagal nerve stimulation. Auricular vagal nerve stimulation was evaluated. Auricular vagal nerve stimulation mechanisms involve complex, overlooked neural networks including sympathetic nerves and intrinsic auricular muscles, challenging the monolog concept of the vagus nerve.
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