Transcutaneous Auricular Vagus Nerve Stimulation for Misophonia

A 64-year-old woman with severe misophonia saw her symptom severity score drop from 80 to 9 after a month of daily, non-invasive vagus nerve stimulation, with benefits sustained a month after treatment stopped. The case report, published in *Frontiers in Psychology*, provides early evidence that targeting the body’s stress response system may help manage a condition defined by extreme reactions to trigger sounds.

Targeting the Body’s Alarm System

Misophonia is more than simple irritation. For those affected, specific sounds like chewing, tapping, or breathing can set off a cascade of intense emotional and physical distress. The condition often involves strong autonomic nervous system reactions—the “fight-or-flight” response—including increased heart rate, sweating, and muscle tension. Current treatment options are limited and often focus on psychological coping strategies. Researchers Francesca Proietti, Massimo Marano, and Emanuele Rizzo explored a different angle: directly modulating the nervous system pathway that helps regulate this stress response.

Their hypothesis centered on the vagus nerve, a major nerve that connects the brain to the body and helps control heart rate, digestion, and the transition out of a stressed state. Non-invasive stimulation of this nerve, known as transcutaneous auricular vagus nerve stimulation (taVNS), has been investigated for conditions like depression, epilepsy, and chronic pain. The team proposed it might help calm the exaggerated autonomic reactions central to misophonia. This approach aligns with a growing understanding of how auditory and emotional brain networks interact in sound tolerance disorders.

A Protocol for Calming the Nervous System

The patient was a 64-year-old woman with a 20-year history of severe misophonia. Her primary trigger was the rhythmic thudding of a basketball being bounced nearby. Exposure led to acute anxiety, a choking sensation, difficulty breathing, palpitations, terror, and an overwhelming urge to flee. These reactions caused significant avoidance behavior and impaired her daily function. She was already on a stable dose of sertraline, an SSRI antidepressant.

The intervention was a 1-month protocol of bilateral taVNS. The patient self-administered the stimulation daily for 60 minutes using an ear clip device that delivered a mild, non-painful electrical current to the outer ear. The intensity was set individually to a level she could feel but that was not uncomfortable. The researchers assessed her condition at three points: before treatment, immediately after the month-long protocol, and again one month after treatment ended. They used validated scales to measure misophonia severity, general psychological distress, anxiety, depression, sleep quality, and functional impairment.

Dramatic Drop in Symptom Severity

The results were striking. The primary measure, the Duke Misophonia Questionnaire Symptoms Composite Scale, plummeted from a baseline score of 80 (indicating severe symptoms) to 9 after treatment. This improvement held at the one-month follow-up, with a score of 5. This represents a profound and sustained reduction in the intensity of her misophonic reactions.

Secondary measures also showed positive changes. Scores for overall psychological distress, somatization (physical symptoms of distress), anxiety, hostility, and depressive symptoms all improved. Sleep quality got better immediately after treatment, though it returned to baseline levels by the follow-up assessment. An interesting and important finding was a dissociation between symptoms and function. While her subjective reaction to trigger sounds faded dramatically, her self-reported functional impairment did not improve in lockstep. It decreased right after treatment but increased again at follow-up, suggesting that relearning to engage in previously avoided activities may take more time than the symptom reduction itself.

What This Case Means for Treatment

This single case report is preliminary, but it is hypothesis-generating. It provides a clear signal that neuromodulation targeting the autonomic nervous system deserves formal study as a potential treatment for misophonia. The sustained effect after treatment stopped is particularly encouraging. The authors suggest taVNS may be most applicable for individuals whose misophonia is characterized by prominent autonomic hyperarousal—those who experience strong physical panic-like responses. This physiological overlap is also seen in other conditions; for instance, research has explored shared neurological links between PTSD and tinnitus involving threat and arousal networks.

Next Steps and Cautious Optimism

The findings from Proietti and colleagues are not a recommendation for immediate clinical use. They are a call for controlled research. A single case cannot rule out placebo effects or natural variation in symptoms. The next essential step is a randomized, sham-controlled clinical trial where some participants receive real taVNS and others receive a fake, non-active stimulation. This would clarify if the nerve stimulation itself is responsible for the benefit.

If future studies confirm the effect, taVNS could become a useful adjunct to existing therapies. It might be combined with sound therapy or cognitive behavioral approaches that help patients manage their reactions. The case also reinforces the value of viewing misophonia through a neurophysiological lens, not just a behavioral one. Understanding the biological pathways involved, much like advances in brain imaging for hearing disorders, is key to developing effective interventions.

For now, this report offers a new direction and a measure of hope. It suggests that calming the body’s overactive alarm system may help quiet the intense distress caused by trigger sounds.

Source: Proietti, F., Marano, M., & Rizzo, E. (2026). Bilateral transcutaneous auricular vagus nerve stimulation for severe misophonia: a case report. Frontiers in Psychology. DOI: 10.3389/fpsyg.2026.1903444