Ear stapling: A risky and unproven procedure for appetite

suppression and weight loss

by Leslie K. Winter, MD and Jeffrey H. Spiegel, MD, FACS
Issue Date: January 2010, Posted On: 1/1/2010

In an effort to achieve weight loss, many people are pursuing alternative medical
interventions. Widely available as a variant of acupuncture, ear stapling (in which a
surgical staple is placed in the conchal bowl of the ear) is reported by practitioners to
decrease the appetite and induce weight loss. This practice lacks proven efficacy and has
a significant risk of infection and deformity. We report a series of 3 patients who
developed complications from ear stapling and present this article to describe the practice
so that physicians will be prepared when encountering a staple in the ear.

Ear stapling is loosely based on an ancient acupuncture technique for weight loss.
The auricle is an area of intense study, with an entire subspecialized form of acupuncture
relying on the external ear as a representation of the human body; two sites-the tragus and
conchal bowl-are associated with appetite suppression (figure 2).

Figure 2. Photo shows two acupuncture sites frequently targeted for appetite suppression (white
stars)

In acupuncture guides, the tragus appears most frequently as the weight control
center; therefore, it is surprising that each of our patients was stapled in the left conchal
bowl. We speculate that stapling the tragus is more painful and conspicuous, so
practitioners (not all of whom are trained acupuncturists) select the conchal bowl as a
target. Stapling is used as a substitute for acupuncture as it supposedly provides long-
term, continuous stimulation of the specific ear points that induce weight loss. It also is
simpler to perform, and individuals untrained in traditional Chinese medicine are offering
the service under the guise of classic acupuncture.

Ear stapling is common enough that a July 2007 Google search for “ear stapling” in
Boston showed seven paid advertisements for practitioners offering the service and
offering to train others in it. A general Internet search yields hundreds of Web sites for
businesses offering the service, in addition to thousands of articles and blogs discussing
the procedure.

The services offered via these Web sites are often not provided by physicians or
by licensed acupuncturists. For example, some Web sites are for chiropractic practices
offering ear stapling, and others are for services provided by nurses. One site, which
states that it is operated by a “doctor,” does note that leaving ear staples in place for more
than 4 weeks carries an increased risk of infection and embedding. The legality of these
practices varies from state to state, and many of those providing the procedure describe
having a state license to provide adjunct medical therapy.

Attempts have been made to elucidate the pathway by which ear-stimulus-

mediated weight loss is thought to work. Some authors suggest that acupuncture or
acupressure is a potentially helpful adjunct in the treatment of obesity and
hypercholesterolemia. One unblinded, randomized, placebo-controlled study of 96 obese
adults compared the use of an auricular acupressure device that claimed to help with
weight loss and a placebo wrist-acupuncture device that made no such claims. They
found no difference in weight loss between subjects over the course of 12 weeks.

Another study examined a tragus clip device, measuring gastric peristalsis time.
This study demonstrated prolonged gastric peristalsis time with the clip in place. The
mechanism proposed was that inhibition of the tragal branch of the vagus nerve through
pressure or needle insertion induces slowed gastric peristalsis, producing a sense of
satiety. This may explain how auricular stimulation may help with weight loss. Although
it is an intriguing finding, it is hardly adequate support for a surgical staple to be placed
within the conchal bowl.

The risks of having a foreign body in the ear cartilage for a long time relate to
sequelae of infection or hematoma. Infection may lead to marked ear deformity with loss
of cartilage, leaving a significant cosmetic defect. Until more significant scientific
evidence is presented, ear stapling must be considered a risky and ineffective intervention
for weight loss.

In conclusion, otolaryngologists, emergency medicine physicians, internists, and

primary care physicians should be aware of the increasing prevalence of ear stapling and
its inherent risks. It is likely that more and more patients will present to their physicians
with problems resulting from this procedure as the popularity of this weight loss
intervention increases.
by Leslie K. Winter, MD and Jeffrey H. Spiegel, MD, FACS

Introduction
Approximately 127 million adults in the United States are considered overweight, with
roughly half of those people qualifying as obese (body mass index >30).1 In fact, obesity
is the second leading cause of preventable death in the United States despite $30 to 50
billion spent annually on weight loss programs, products, and schemes.1,2 Increasingly,
these have come to include conchal bowl acupuncture.

Acupuncture is a form of traditional Chinese medicine wherein solid (not hollow) needles
are inserted into the body at specific points with the intent of restoring balance to the flow
of energy, or chi, within the body. Chi is said to flow along channels (called meridians)
within the body, and any imbalance in flow is said to result in a disease state. Meridians
and specific treatment points are displayed on anatomic maps that an acupuncturist may
consult in developing a treatment plan for a given malady.

While acupuncture has been practiced in China for thousands of years, it was virtually
unknown in the United States until 1971 when James Reston, a reporter for The New
York Times who was following President Nixon's trip to China, wrote about his
experience with acupuncture to treat abdominal pain after an appendectomy.3 Since then,
acupuncture has increased in popularity in the United States, with more than 20,000
certified acupuncturists recorded in 2000 (nearly one third of whom also have MD
degrees).4 Acupuncture was considered a sufficiently promising treatment to be worthy
of further investigation in a 1997 National Institutes of Health (NIH) Consensus Panel
report, with clinical trial pilot grants offered in 1998.5

For obesity, needle stimulation within the conchal bowl of the ear is thought to provide
appetite suppression and stimulate weight loss. Many practitioners believe that the effect
is most significant only when the needle is present in the conchal bowl; upon removal of
the needle, appetite suppression is attenuated. As a result, many practitioners have been
offering “long-lasting” acupuncture stimulus to the external ear by placing a surgical
staple in the conchal bowl. This surgical staple remains in place for a month or longer to
provide continuous appetite suppression. As acupuncture is not a standard part of the
curriculum of most United States medical schools, many physicians are unaware of this
procedure and its potential dangers.

Case reports
Over a 3-month period, 3 patients presented to the Otolaryngology Clinic at Boston
Medical Center with complaints related to conchal staples placed by an acupuncturist.
Patient 1. A 21-year-old woman who had had a surgical staple placed in her left conchal
bowl 2 months earlier presented at the clinic with increasing pain, erythema, and pruritis
at the site. On examination, she was found to have left auricular cellulitis (figure 1). The
staple was removed with a standard disposable staple remover and she was placed on
antibiotics. She was markedly improved after 2 days and had no further problems.

Figure 1. Photo shows a surgical staple

embedded in the left conchal bowl, with
evidence of auricular cellulitis

Patient 2. A 30-year-old man had a staple in his left conchal bowl for 3 months prior to
developing auricular cellulitis and chondritis. After staple removal, he was treated with
both fluroquinolone antibiotics and a 7-day course of oral steroids. He improved after 1
week and had no further problems.

Patient 3. A 62-year-old male presented for removal of a staple from his left conchal
bowl. He was not experiencing any symptoms of infection or pain, but he had not had any
weight loss and therefore wanted the staple removed. The staple was partially embedded
beneath the skin of the conchal bowl. Removal was accomplished without complication,
and the patient had no further problems.

None of these patients reported any weight loss during the period that their ear staple was
in place.