Vagus Nerve Training: Which Ear Do I Use?
I have done a couple of blogs recently on training the vagus nerve, and one of the things we’ve talked about is what’s called transauricular vagus nerve stimulation, noninvasive, and we’ve talked about a couple different ways to do it. One is using electricity, and one is using vibration. And as I mentioned in the previous blog, I really like vibratory stimulation, but a lot of questions have come in. Okay, cool, but which ear do I use and why? So we’re gonna actually do a little bit of science here, and I’m gonna give you my perspectives on this, and then it will be up to you.
Now, before I get into it, if you are a doctor, a therapist, coach of any kind, you deal with movement for a living, you help people perform better, get out of pain, move better, and you’re interested in bridging what you’re already great at with applied neuroscience, I’d like to figure out if what we do is a good fit for what you do. We’d love to chat with you.You can go to the pinned comment and get in contact with us, and join, at this point, almost 17,000 other professionals worldwide who are going through our curriculum. So, again, if that’s of interest, make sure to get in contact with us.
Now, back to the vagus nerve. I’m not gonna spend a lot of time rediscussing the vagus nerve other than to give you some highlights. People, you know, right now, the vagus nerve, everyone goes, oh, it’s the rest and digest nerve, and I need to improve my vagal function. Well, yeah, kinda yes, kinda no.
A lot of this has turned into Instagram memes and short YouTube videos, because it sounds cool and it sounds like brain stuff, and the vagus nerve is super interesting, but it is a very complex topic. The vagus nerve is huge. Its name is taken from what means wandering, the wandering nerve, because it passes through so many different tissues and affects so many different things in the body, and it is highly regulating for our autonomic nervous system.
So, basically, the balance between our sympathetic and our parasympathetic function. I’ve mentioned previously in some of the other blogs that, hey, the vagus nerve is really important, because, number one, it has a strong anti-inflammatory system built into it. It’s called an anti-cytokine system.
And I think this is some of the strongest evidence in the literature, is that for people with chronic autoimmune or inflammatory conditions, ranging from rheumatoid arthritis to asthma and other things like that, that regular vagus stimulation can be a very powerful tool. People with pain, chronic pain, headaches, more and more we are seeing a strong association between chronic pain and vagus nerve irregularities or autonomic irregularities. So, there’s a lot of mechanisms that are in play here.
So, I’m not saying that everyone needs this, and I don’t think we should ever buy into everyone needs this all the time, because anytime you say always in human physiology, you’re probably lying to some degree. But it is a very powerful tool, and it is very useful for many people. So, I’ve talked about lots of different ways to stimulate the vagus nerve, from a specific neuromechanic or nerve flossing exercise for the vagus nerve that was just published on in 2021.
Actually, it’s a test, and we’ve modified it to be used as an exercise, to a facial cold plunge, to humming, gargling, different breathing patterns, resonance frequency breathing, as well as, again, via the ear. And in fact, vagus nerve stimulation through the ear has probably been one of the most consistent and longest lasting approaches that has been looked at in the research literature. So, here’s kind of where things stand on, which ear do I choose, from a scientific perspective.
When I was first learning about transauricular stimulation, we were taught at that time to always and only, only, only, only ever stimulate the left ear. Now, that was a complete misreading of the original research, because that is derived from research about implanted vagal stimulators, not through the ear. An implanted vagal stimulator does things very differently and can have a very dramatic influence on heart function.
So, whenever you’re dealing with a heart and you’re trying to deal with certain bradycardic issues, you have to be very careful with just working on stimulating the left vagus nerve. Now, having said that, the way that ear stimulation impacts the vagus nerve is really kind of a different mechanism altogether. So, there have been studies looking at, do we stimulate the left ear, the right ear, both ears? And to date, here’s the findings, no one knows.
There’s actually no defined clinical evidence that says one ear versus the other ear is better. So, it’s kind of dealer’s choice, you get to pick, but I hate giving you that kind of freedom without a little bit of direction. So, let me tell you what I do and how I work with clients.
One thing that we should see, generally speaking, is that when we stimulate the vagus nerve and the vagus nerve is responding normally, in most cases, we should see an acute, meaning during the training session, drop in heart rate and potentially an improvement or upregulation in their HRV, their heart rate variability. If you have the money and time, you can invest in a device like the HeartMath Institute device that tracks your breathing and your heart rate in real time because it’s giving you biofeedback. If you don’t wanna do that, instead, what a lot of my clients will opt for is to buy a simple pulse oximeter.
A pulse oximeter is gonna measure your heart rate, it’s also gonna measure your oxygen saturation levels in your blood and your fingertip. There’s some vagaries in how these things work, but that’s generally what they do. So, what I will have clients generally do is put on the device on their right side and we will stimulate their right vagus nerve and we watch.
And over the course of two to three minutes, I expect the stimulation, if the vagus nerve is responding relatively normally, to create a drop in their heart rate. And then I will test that on the opposite side. Now, the reason I’m doing right side and left side is I’m also looking at their oxygen saturation because typically, if the vagus nerve is being stimulated and we’re getting a nice parasympathetic response, which is what we should get, that tends to also increase the amount of blood flowing to your fingertips and will often make your oxygen saturation numbers go up as well.
Now, that’s a little bit more technical, but that’s one of the other reasons that I will use that and I will test right side and left side. And we just see what we get. In general, if both ears, if I do the vibration on the right side and the left side, and I get the same type of response on both sides, where I’m getting a drop in heart rate, maybe an improvement, that tells me, in general, that their vagus nerve is at least doing some of what it’s supposed to do.
And if there is something in their history that is suggestive of, hey, you should do this, then we will just actually do stimulation on the right side and left side on the same day. So we do both. However, if one side does not seem to induce a drop in heart rate or a change in oxygen saturation or a change in their HRV if they’re measuring it, then that tells me that that area may need additional stimulation.
So for instance, if the heart rate doesn’t go down when I’m testing the right side for two or three minutes, I’m probably gonna focus more of the vibration practice on that right side until I can get a normalized response. And I’ll also, I may be doing other stuff along with that, but that’s kind of my general approach. Once again, I can’t point to a certain study that says this is exactly how it works because there is variability in this.
I’m just giving you now my experience, and that approach generally has worked well for us. Finally, if I am working with someone and all of that seems too complicated, either because it’s too much for them to manage, it seems too complicated for them, if I generally have to opt, I have two different ways of doing so. I just have to pick an ear.
I will revert back in some cases, and although this is not hugely accurate, and I understand that, it is something I’ve found useful. I will opt for sensory testing, the skin of the ear. So I will test in the ear where I’m generally gonna be doing the vibration.
We will compare one side to the other. The side with less sensation, if there is one, is often the area that I will spend the time applying the vibratory stimulus to. So if I feel normally on the left side, and I don’t feel as much on the right side, I’m gonna use the vibratory stimulus on the right side. That simple.
Now, like I said, there are some complications in that because of how the sensory input feeds into the vagus nerve, so that’s not a completely true test of the vagus function, and I understand that, but I’m saying from a practical perspective, it’s something that we found to be effective. And then the last thing is this.
If you wanna skip everything that I’ve said, and if I wanna skip everything that I’ve been talking about with a client, I tend to just do their right ear. The reason for that is because in the research literature, because that I can actually point to, in the research literature, right ear stimulation was responsible for very quick changes in blood markers of inflammation, things like C-reactive protein. That is a big deal for me because I think a lot of the people that I work with on a regular basis, and that most movement professionals work with on a regular basis, are probably carrying some degree of excess inflammatory response in their body, from their food or their stress or whatever.
So I like to use something that I know for sure has been shown to improve inflammatory markers, and that’s the right ear. So like I said, this is my attempt to give you a little bit of guidance on right ear versus left ear because these questions keep coming in. You have a few tests that you can run, and then you also have some very simplified options based off the client’s history.
Ultimately, the best way to know about this is to spend time on it. And remember, four to six weeks, you have to keep tracking because this is not an overnight fix or change. This is something that the body and brain, nervous system are gonna have to adapt to.
Now, the final caveat to all this is how much do I need to do? As I mentioned previously, if you’re doing vibratory stimfor people with rheumatoid arthritis, it showed this really positive effect. It was 10 minutes per day, five minutes one session, five minutes a second session, morning and night. I tend to use 10 minutes of vagal training as a guidepost for pretty much everyone that I work with.
Some people can get a great response in three to four minutes. Other people need 20 to 30. It depends on their general response to the stimulation and other things that are going on in their body.
So for now, I would say, if you’re gonna go after this and do it for real, aim for 10 minutes per day, see how your results or how the body responds over the next, like I said, four to six weeks. Don’t get frustrated if you’re not seeing the response that you want. It may mean that you need more intensity.
You may need more time or you may need to use a different stimulus. So once again, this is kind of a pushback from my side on all the social media, here’s how to fix your vagus nerve posts that I see. That’s a gross oversimplification.
And I think the people that we work with and our own ethics should make us be honest about it. It’s powerful, it’s useful, but it’s not simple. It is complex.
You need to understand it. And that’s one of the reasons that we’ve spent the last almost three decades trying to understand more about the nervous system and how we as movement professionals can apply this kind of material effectively.
So with that said, if you are a doctor, therapist, coach, movement professional of any kind, from yoga, Pilates, martial arts, personal trainer, CrossFit, Feldenkrais, had a Feldenkrais practitioner recently, and you’re interested in seeing if what we do would blend well with what you do, please go to the pinned comment and get in touch with us. We’d love to share it with you. Other than that, good luck and let us know how it goes.
