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Background Post‐COVID syndrome (PCS) is a condition that occurs after COVID‐19 infection that lasts for more than three months and adversely affects the autonomic nervous system (ANS). The aim of this study was to investigate and compare the effectiveness of transcutaneous auricular vagus nerve stimulation (taVNS) and sham taVNS in fatigue in individuals with PCS. Methods Forty‐two patients (20 male, 22 female) with PCS participated in this study. The severity of fatigue was assessed with the fatigue severity scale (FSS). Heart rate variability (HRV) was measured in participants at baseline and after taVNS. The participants were randomly divided into two groups (taVNS and sham taVNS). taVNS was applied for 20 consecutive days for 30 min each (10 Hz, 300 μs). Results The groups were similar in FSS and HRV at baseline (p > 0.05). After the intervention, FSS decreased in taVNS (p = 0.018) and sham taVNS (p = 0.036). RMSSD increased in taVNS (p = 0.010), with no change in sham taVNS (p > 0.05) from baseline to after treatment. Stress index showed no change in both groups (p > 0.05). PNS index increased in taVNS (p = 0.007) and sham taVNS (p = 0.049). The SNS index and low frequency (LF) power decreased in taVNS (p = 0.001, p = 0.017, respectively), with no change in sham taVNS (p > 0.05). High frequency (HF) power showed no change within groups (p > 0.05). LF/HF decreased in taVNS (p = 0.002), with no change in sham taVNS (p > 0.05). Pre‐ and Post‐tests showed taVNS was more effective than sham taVNS in decreasing FSS (p = 0.022) and LF power (p = 0.029), in increasing PNS index (p = 0.016). There was a difference in HF power between groups after treatment (p = 0.042). Conclusion Both taVNS and sham taVNS were effective in reducing the severity of fatigue, with sham taVNS being superior to taVNS. The observed effect size was smaller than anticipated. This suggests that larger‐sample‐size studies are required to verify these results. Trial Registration: ClinicalTrials.gov identifier: NCT05679505.

Background/Objectives: Transcutaneous auricular vagus nerve stimulation (TaVNS) is a non-invasive method of electrical stimulation used to autonomic neuromodulation. Position and form of the electrodes are important for the effectiveness of autonomic modulation. This study was aimed to investigate the effect of TaVNS in-ear and behind-ear on autonomic variables. Methods: A total of 76 healthy participants (male: 40, female: 36) were randomized into four groups as in-ear TaVNS, behind-ear TaVNS, in-ear sham, and behind-ear sham. The TaVNS protocol included bilateral auricular stimulation for 20 min, 25 hertz frequency, a pulse width of 250 μs, and a suprathreshold current (0.13–50 mA). Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), and heart rate variability (HRV) were measured baseline and after stimulation. The parameters RMSSD (root mean square of consecutive differences between normal heartbeats), LF power (low-frequency), and HF power (high-frequency) were assessed in the HRV analysis. Results: HR decreased in the in-ear TaVNS after intervention (p < 0.05), but did not change in behind-ear TaVNS and sham groups compared to baseline (p > 0.05). SBP and DBP decreased and RMSSD increased in the in-ear and behind-ear TaVNS groups (p < 0.05), but did not change in sham groups compared to baseline (p > 0.05). There was no significant difference in LF and HF power after TaVNS compared to baseline in all groups (p > 0.05). SBP was lower and RMSSD was higher in-ear TaVNS than behind-ear TaVNS after intervention (p < 0.05). Conclusions: In-ear TaVNS appears to be more effective than behind-ear TaVNS in modulating SBP and RMSSD, but this needs to be studied in larger populations.