Transcutaneous Vagus Nerve Stimulation for Misophonia Relief

A 64-year-old woman with severe misophonia, triggered by the sound of a bouncing basketball, saw her symptom severity score drop from 80 to 5 after a month of a non-invasive nerve stimulation treatment. The case study, led by Francesca Proietti, Massimo Marano, and Emanuele Rizzo, provides a first look at how transcutaneous auricular vagus nerve stimulation might help manage a condition marked by intense emotional and physical reactions to specific sounds.

Targeting the Vagus Nerve to Calm Autonomic Storms

Misophonia is more than an annoyance. For those affected, specific “trigger” sounds—like chewing, pen clicking, or, in this case, a bouncing ball—can provoke intense distress, anxiety, anger, and pronounced physical reactions. These often include symptoms of autonomic hyperarousal: racing heart, shortness of breath, and a feeling of panic. The research team hypothesized that calming this overactive autonomic response could be key to treatment.

They focused on the vagus nerve, a major pathway that helps regulate the body’s “rest and digest” functions and counteracts the stress response. While invasive vagus nerve stimulation is an established therapy for epilepsy and depression, non-invasive methods are now being studied. Transcutaneous auricular vagus nerve stimulation (taVNS) applies a mild electrical current to the outer ear, where branches of the vagus nerve are accessible. This method is being explored for various conditions linked to nervous system dysregulation, including misophonia and tinnitus.

A One-Month Protocol and Its Measurable Effects

The patient, a 64-year-old woman on a stable dose of sertraline, underwent a daily treatment protocol. For one month, she self-administered bilateral taVNS for 60 minutes each day at an intensity she found noticeable but not painful. Researchers assessed her condition at three points: before treatment, immediately after the month-long protocol, and again one month later.

They used a battery of standardized questionnaires. The primary measure was the Duke Misophonia Questionnaire Symptoms Composite Scale, where a higher score indicates greater severity. Secondary measures looked at broader psychological health, including anxiety, depression, hostility, and sleep quality.

Dramatic Drop in Symptom Severity, With a Functional Caveat

The results were striking. The patient’s misophonia severity score plummeted from 80 at baseline to 9 immediately after treatment. Even more promising, this improvement held at the one-month follow-up, with a score of 5. This suggests the effects were not just temporary.

Broader psychological measures followed a similar positive trend. Scores for overall distress, somatization, anxiety, hostility, and depressive symptoms all improved. Sleep quality got better right after treatment, though it returned to baseline levels by follow-up.

A critical finding, however, was a noted dissociation. While her core misophonia symptoms stayed vastly reduced, her score for functional impairment—how much the condition interfered with her daily life—increased slightly at the one-month follow-up after an initial improvement. The authors suggest that reducing the intense physiological terror associated with the sound is one step, but fully reintegrating into avoided situations may require additional time or complementary strategies like cognitive behavioral therapy.

Implications and the Path Forward for Neuromodulation

This single case report offers a compelling, if preliminary, signal. It indicates that non-invasive vagus nerve stimulation may be a feasible adjunctive treatment for misophonia, especially for individuals whose primary experience is dominated by severe autonomic hyperarousal. The treatment appeared safe and well-tolerated alongside existing medication.

The study directly contributes to a growing area of research into how neuromodulation can influence hearing health from cochlea to cortex. By targeting the nervous system’s regulatory centers, approaches like taVNS may help “reset” maladaptive circuits involved in conditions like misophonia, hyperacusis, and tinnitus, which often involve similar pathways of emotional and sensory processing.

Francesca Proietti and colleagues are clear that their findings are hypothesis-generating. The dramatic response in one patient does not prove efficacy. It underscores a pressing need for controlled clinical trials with more participants. Future research must determine optimal treatment parameters, identify which patients are most likely to benefit, and investigate how to combine neuromodulation with behavioral therapies to ensure functional gains match symptomatic relief.

For individuals struggling with the intense, body-wide panic of misophonia, this case provides a new direction for scientific inquiry and a note of cautious hope that regulating the body’s stress response may be a key part of future solutions.

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