Bilateral Auricular Vagus Nerve Stimulation for Misophonia

A 64-year-old woman with severe misophonia, whose primary trigger was the sound of a bouncing basketball, saw her symptom severity score drop from 80 to 9 after a month of a non-invasive nerve stimulation therapy. The findings from this single case report, published by Francesca Proietti and colleagues, suggest a new path for managing a condition where treatment options are limited.

### A Case of Severe Sound Intolerance
The patient, a 64-year-old woman, experienced debilitating reactions to a specific trigger: the rhythmic thudding of a basketball being bounced. This sound provoked more than just irritation. It triggered intense autonomic and emotional responses, including heart palpitations, a choking sensation, shortness of breath, acute anxiety, terror, and an overwhelming urge to flee. These reactions led to significant avoidance behaviors and functional impairment in her daily life. She was already on a stable dose of sertraline, an SSRI antidepressant, but her misophonic symptoms remained severe.

### Methodology: Targeting the Vagus Nerve
Proietti’s team proposed a one-month intervention using bilateral transcutaneous auricular vagus nerve stimulation (taVNS). This non-invasive technique involves placing electrodes on the outer ear to deliver a mild electrical current, aiming to stimulate branches of the vagus nerve. The goal is to modulate the autonomic nervous system, which governs the “fight-or-flight” response that was so hyperactive in this patient. The therapy was administered daily for 60 minutes at an intensity the patient found noticeable but not painful. Her progress was tracked using several validated scales at three points: before treatment, immediately after the one-month protocol, and again one month later.

### Findings: Symptom Severity Plummets
The primary outcome was measured by the Duke Misophonia Questionnaire Symptoms Composite Scale. The change was stark. Her score fell from 80 at baseline to 9 immediately post-treatment, and it decreased further to 5 at the one-month follow-up. This indicates a profound and sustained reduction in the intensity of her misophonic reactions. Secondary measures also showed improvement: her overall psychological distress, somatization, anxiety, hostility, and depressive symptoms all decreased. Sleep quality improved after treatment, though it returned to baseline levels by follow-up.

A notable and puzzling finding involved functional impairment. While her symptom severity remained very low at follow-up, her self-reported difficulty with daily functioning increased. The authors suggest this may point to a “dissociation between symptom reduction and perceived functional recovery,” meaning that learning to re-engage with life after long-term avoidance may take additional time and support, even after physical reactions have diminished.

### Practical Implications and Future Research
This case report offers a proof of concept. It suggests that for individuals with misophonia characterized by strong autonomic hyperarousal—the palpitations, terror, and urge to escape—taVNS could be a feasible adjunctive therapy. The approach directly targets the physiological dysregulation that often accompanies the emotional distress. It builds on growing interest in neuromodulation for hearing-related disorders.

The findings are preliminary, stemming from a single patient. However, they are strong enough to generate a clear hypothesis for future research. Controlled clinical studies with larger groups are now needed to determine if taVNS consistently produces these effects, to identify which patients are most likely to benefit, and to establish optimal treatment protocols. The dissociation between symptom control and functional recovery also underscores that comprehensive care for misophonia likely requires a multi-faceted approach, potentially combining neuromodulation with behavioral strategies that address avoidance and emotional regulation.

### A New Direction for a Complex Condition
Francesca Proietti, Massimo Marano, and Emanuele Rizzo have documented a compelling response in a patient with severe, treatment-refractory misophonia. By focusing on the body’s autonomic nervous system with a non-invasive tool, they opened a new line of inquiry. While not a silver bullet, bilateral taVNS emerges as a promising candidate worthy of systematic investigation. For a condition like misophonia, which shares some overlapping features with PTSD and tinnitus in its hyperarousal and distress components, expanding the therapeutic toolkit is an urgent need. This case provides a specific, data-driven starting point for that work.

**Source:** Proietti F, Marano M, Rizzo E. *Bilateral transcutaneous auricular vagus nerve stimulation for misophonia: a case report*. Front Psychol. 2026. DOI: [10.3389/fpsyg.2026.1903444](https://doi.org/10.3389/fpsyg.2026.1903444).