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 plummet from 80 to 5 after one month of a simple, non-invasive neuromodulation therapy. This single case report, published by Francesca Proietti, Massimo Marano, and Emanuele Rizzo, suggests that stimulating the vagus nerve through the ear may offer a new path for treating misophonia characterized by extreme physical reactions.

A Severe Trigger and a New Target

For the patient in this study, the rhythmic thudding of a basketball was not just an annoyance; it provoked an intense, physiological crisis. Exposure caused acute anxiety, terror, palpitations, a choking sensation, shortness of breath, and an overwhelming urge to flee. This pattern of profound autonomic nervous system hyperarousal—the body’s fight-or-flight response going into overdrive—guided the researchers’ therapeutic approach. With current evidence for misophonia treatment remaining limited, the team hypothesized that directly modulating this dysregulated system might offer relief.

They chose bilateral transcutaneous auricular vagus nerve stimulation (taVNS). This non-invasive method involves placing small electrodes on the outer ear to deliver a mild electrical current, aiming to stimulate branches of the vagus nerve. This nerve is a major component of the parasympathetic nervous system, which counterbalances the body’s stress response. The patient, who was already on a stable dose of sertraline, underwent a one-month protocol, administering the 60-minute stimulation daily at a comfortable, non-painful intensity.

Measuring Dramatic Symptom Reduction

The researchers assessed outcomes using validated scales at three points: before treatment, immediately after the month-long protocol, and again one month later. The primary measure was the Duke Misophonia Questionnaire Symptoms Composite Scale, where a higher score indicates greater severity.

The change was stark. The score fell from a baseline of 80 to 9 after treatment, and improved further to 5 at the one-month follow-up. This represents a profound and sustained reduction in the core emotional and behavioral reactions to trigger sounds. Secondary measures showed broad psychological benefits: overall psychological distress, somatization, anxiety, hostility, and depressive symptoms all improved. The findings align with the concept that misophonia shares neurobiological links with other conditions involving anxiety and heightened threat perception.

A Complex Pattern of Recovery

Not all improvements followed the same trajectory, revealing a nuance in recovery. Sleep quality improved after treatment but returned to baseline levels by the follow-up assessment. More notably, while the patient’s functional impairment—how much misophonia limited her daily life—decreased right after treatment, it increased again at follow-up. This suggests a possible dissociation: the intense, automatic reaction to the sound can lessen well before an individual’s confidence in their ability to engage with the world fully recovers. It highlights that managing the physiological reflex may be a separate clinical challenge from addressing the anticipatory anxiety and avoidance behaviors that develop over time.

Implications for Misophonia Management

This case report is explicitly preliminary, but it generates a clear hypothesis. For a subset of patients with misophonia marked by severe autonomic hyperarousal, taVNS could serve as a feasible adjunctive therapy. By potentially calming an overactive stress response system, it may reduce the visceral intensity of reactions, creating a window for other therapies to be more effective. The patient remained on sertraline, indicating taVNS might complement existing pharmacological treatment rather than replace it.

The report also underscores a critical need for precision in misophonia research and treatment. “Misophonia” likely encompasses different subtypes; a therapy targeting autonomic dysregulation may only be relevant for patients who experience symptoms like racing heart or panic, as this patient did. This differs from presentations dominated more by disgust or anger. Furthermore, the partial return of functional impairment scores points to the importance of integrating neuromodulation with behavioral strategies. Cognitive Behavioral Therapy (CBT) has evidence for treating tinnitus and related sound tolerance issues, and could help address the maladaptive coping behaviors that persist even after the raw symptom intensity diminishes.

A Call for Controlled Research

The dramatic results in this single patient are promising but not conclusive. As the authors state, controlled studies are essential. Future research must compare taVNS to a sham (placebo) stimulation in a larger group of patients to confirm its specific effect. Studies should also aim to identify which patients are most likely to benefit—likely those with strong physiological components to their reactions—and determine optimal treatment protocols. The dissociation between symptom reduction and functional recovery also merits direct investigation.

This case adds to a small but growing body of evidence exploring neuromodulation for hearing-related disorders. The approach is being investigated for tinnitus and other auditory dysfunctions, with the vagus nerve being a common target due to its widespread influence on brain networks involved in perception, emotion, and arousal.

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