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In India earrings are worn through holes pierced in any of the external parts of the ear. Piercing is the only indigenous system to hold ear ornaments. Studs can be attached to any part of the ear, but especially the helix, tragus and lobe; the shank passes through the ear and is held in place by a simple or ornamental screw or pressure fitting. The forms and sizes of ear ornaments vary enormously. They can be decorated in an immense number of ways, including embellishments with enamel, stones or pearls. Almost any type can have additional decorative chains and hanging miniature pendants, often in leaf shapes, balls or bells.