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Other
VNS causes stimulation of the superior and recurrent laryngeal nerves and is associated with problems ranging from alteration of voice(66%), coughing(45%), pharyngitis(35%) and throat pain(28%) and hoarseness (very common) to frank laryngeal muscle spasm and upper airway obstruction (rare). Additionally, VNS has been shown to cause vocal fold paresis. The left vagus has proportionally lesser number of cardiac efferent fibers and placing the stimulator on this side potentially limits the arrhythmogenic effects of vagal stimulation but reversible bradyarrhythmias associated with vagal nerve stimulators have been well described. Other nonspecific symptoms such as headache, nausea, vomiting, dyspepsia, dyspnea and paresthesia.

Approval and endorsement
In 1997, the United States Food and Drug Administration (FDA) approved the use of VNS as an adjunctive therapy for partial-onset epilepsy. In 2005, after rejecting it initially on the grounds that Cyberonics had failed to completely investigate and evaluate the cause of each medically adverse event, the FDA approved the use of VNS for treatment-resistant depression.

Although the use of VNS for refractory depression has been endorsed by the American Psychiatric Association, the FDA's approval of VNS for refractory depression remains controversial. According to Dr. A. John Rush, vice chairman for research in the Department of Psychiatry at the University of Texas Southwestern Medical Center at Dallas, results of the VNS pilot study showed that 40 percent of the treated patients displayed at least a 50 percent or greater improvement in their condition, according to the Hamilton Depression Rating Scale. Many other studies concur that VNS is indeed efficacious in treating depression. However, these findings do not take into account improvements over time in patients without the device. In the only randomized controlled trial VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on. The consumer advocacy group Public Citizen sent several letters to the FDA in 2005 and 2006 calling for the reversal of the FDA's approval of the device. In the letters, Public Citizen questions the approval of the device considering the well below average 15% response rate early on in the D02 trials. The report also notes that the device was initially approved by the FDA's Neurological Devices Panel, but then rejected due to Cyberonics's failure to completely investigate the cause of each medically adverse event that was reported. Shortly after the rejection, Cyberonics sent a response to the FDA and the device was approved.