Transcutaneous Vagus Nerve Stimulation for Misophonia Relief

A 64-year-old woman with severe misophonia experienced a dramatic and sustained reduction in her symptoms after a one-month course of a non-invasive nerve stimulation therapy. Her primary trigger—the sound of a basketball bouncing—had previously caused panic attacks, a choking sensation, and severe avoidance behavior. Following treatment, her score on a standard misophonia severity scale plummeted from 80 to 9, an effect that held a month later. This single case report, led by researchers Francesca Proietti, Massimo Marano, and Emanuele Rizzo, suggests a potential new direction for managing misophonia, especially when it involves intense physical arousal.

Targeting the Body’s Alarm System

Misophonia is more than an annoyance; it is a condition marked by intensely negative emotional, behavioral, and physical reactions to specific, often ordinary sounds. Common triggers include chewing, tapping, or breathing. For the patient in this study, the rhythmic thud of a basketball provoked an extreme stress response: acute anxiety, terror, heart palpitations, a sensation of choking, and an overwhelming need to flee. These symptoms point to a core feature of many misophonia cases—autonomic hyperarousal, where the body’s fight-or-flight system activates inappropriately.

Existing treatment evidence is limited, and approaches that directly aim to regulate this autonomic dysregulation are not well studied. The research team proposed using a form of neuromodulation called transcutaneous auricular vagus nerve stimulation (taVNS). This non-invasive method involves placing small electrodes on the outer ear to deliver a mild electrical current, stimulating a branch of the vagus nerve. The vagus nerve is a primary component of the parasympathetic nervous system, which acts as the body’s “brake” to calm physiological arousal. The theory was that stimulating this nerve could help counter the excessive sympathetic “gas” response triggered by misophonic sounds.

Protocol and Measurement of Change

The patient, who was already on a stable dose of sertraline (an SSRI antidepressant), underwent a one-month treatment protocol. She self-administered bilateral taVNS daily for 60 minutes at an intensity she found noticeable but not painful. The researchers assessed her status at three points: before treatment, immediately after the month of stimulation, and again one month after treatment ended.

They used a battery of validated scales to measure change. The primary tool was the Duke Misophonia Questionnaire, which quantifies symptom severity and impact. They also measured general psychological distress, specific symptoms like anxiety and depression, sleep quality, and functional impairment. This multi-faceted approach allowed them to see not just if her reaction to the basketball sound changed, but how her overall mental and physical state was affected.

Symptom Severity Plummets, But Function Lags

The results were striking for the core misophonia symptoms. The patient’s score on the Duke Misophonia Questionnaire Symptoms Composite Scale fell from a severe 80 at baseline to 9 post-treatment. At the one-month follow-up, it was essentially unchanged at 5, indicating a sustained remission of her primary symptoms. Secondary measures also showed strong improvement: her levels of overall psychological distress, somatization (physical symptoms of distress), anxiety, hostility, and depression all decreased.

However, the outcomes were not uniformly positive across all areas, revealing a complex picture. Her sleep quality improved right after treatment but returned to baseline levels by the follow-up. More notably, her reported functional impairment—how much the condition limited her daily life—actually increased at the one-month follow-up, even while her symptom severity remained low. The researchers suggest this points to a dissociation between symptom reduction and functional recovery. The patient may have experienced profound relief from her physical terror but still carried the behavioral and psychological scars of long-term avoidance, needing additional support to re-engage with activities. This pattern has been observed in other conditions, such as the complex relationship between PTSD and Tinnitus, where symptom management is only one part of the healing process.

Implications for Future Misophonia Treatment

This case report is preliminary evidence, not proof of efficacy. It involves a single patient, and without a control group, it is impossible to rule out placebo effects or the natural fluctuation of symptoms. The authors are clear that their findings are “hypothesis-generating.”

Yet, they provide a compelling rationale for further investigation. The treatment appeared safe and feasible as an adjunct to medication. It directly targeted the autonomic nervous system dysfunction that is a hallmark of many severe misophonia cases but is seldom addressed by current therapies like cognitive behavioral therapy or sound therapy. The sustained reduction in core symptoms suggests taVNS may have produced a neurophysiological shift that outlasted the stimulation period. This aligns with broader research into how Vagus Nerve Stimulation Boosts Brain Function through modulation of key neural networks.

The mixed results on function and sleep are equally important. They indicate that even if a biological intervention like taVNS proves effective for symptom control, patients will likely need integrated care. A comprehensive treatment plan might combine neuromodulation to lower physiological reactivity with behavioral therapies to tackle avoidance and address secondary issues like the Tinnitus Anxiety Depression Links often seen in chronic hearing-related disorders.

Controlled clinical trials are the essential next step to determine if taVNS can reliably help others with misophonia. For now, this case offers a new and testable pathway for a condition with few validated treatment options.

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.