Transcutaneous Vagus Nerve Stimulation for Misophonia Relief

A 64-year-old woman with severe misophonia saw her symptom severity score drop from 80 to 9 after one month of a simple, non-invasive nerve stimulation therapy. The findings, from a new case report by Francesca Proietti, Massimo Marano, and Emanuele Rizzo, suggest a potential new direction for treating a condition where specific sounds trigger extreme distress and physical reactions.

## A Severe Case of Sound Intolerance

The patient’s main trigger was the rhythmic thudding of a basketball being bounced nearby. Exposure to this sound did not cause mere annoyance. It provoked an acute autonomic storm: heart palpitations, a choking sensation, shortness of breath, intense anxiety, terror, and an overwhelming urge to flee. These reactions led to significant avoidance behaviors and impaired her daily functioning. Her condition was severe, persistent, and occurred despite stable treatment with the antidepressant sertraline.

This clinical picture highlights the core of misophonia: a marked decrease in tolerance to specific, often ordinary sounds, paired with strong emotional, behavioral, and autonomic nervous system responses. Current treatment options are limited, and approaches directly targeting the apparent autonomic dysregulation are not well established.

## The taVNS Treatment Protocol

The research team proposed using transcutaneous auricular vagus nerve stimulation (taVNS) as an intervention. 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. The vagus nerve is a major component of the parasympathetic nervous system, which helps calm the body’s “fight-or-flight” response.

The patient underwent a one-month protocol of **bilateral taVNS**, meaning both ears were stimulated. She used the device daily for 60 minutes at an intensity she found noticeable but not painful. The goal was to see if regularly modulating this key nerve pathway could reduce the exaggerated autonomic and emotional reactions to her trigger sound.

## Dramatic Reduction in Misophonia Severity

The primary outcome was measured using the Duke Misophonia Questionnaire Symptoms Composite Scale. The change was substantial. Her score dropped from a baseline of 80 to 9 immediately after the one-month treatment. Critically, this benefit was sustained at the one-month follow-up, with a score of 5.

Secondary measures also showed improvement. Scores for overall psychological distress, somatization (physical symptoms from distress), anxiety, hostility, and depressive symptoms all decreased after treatment. Sleep quality improved post-treatment, though it returned to baseline levels by follow-up.

An interesting and important dissociation emerged, however. While her core misophonia symptoms remained greatly reduced at follow-up, her self-reported functional impairment decreased right after treatment but increased again slightly one month later. This suggests that even with a major drop in the intensity of her reactions, the patient’s perception of her ability to engage in daily life did not fully recover in tandem. It points to a potential need for combined therapies that address both the physiological reaction and the subsequent behavioral and psychological impacts.

## Implications for Future Misophonia Treatment

This single case report offers a compelling, if preliminary, proof of concept. It indicates that **bilateral transcutaneous auricular vagus nerve stimulation** may be a feasible and effective adjunctive intervention for individuals with misophonia, particularly when symptoms include prominent autonomic hyperarousal. The mechanism is thought to involve calming an overactive sympathetic nervous system response, which aligns with the patient’s experience of reduced palpitations and anxiety.

The authors are clear that these findings are hypothesis-generating. They call for controlled studies to clarify the therapeutic role of taVNS for misophonia. Key questions remain: How many patients would respond? What is the optimal treatment duration? How does it compare to cognitive behavioral therapy or other interventions?

This research adds to a growing body of work exploring neuromodulation for hearing-related sensitivities. For instance, other studies are investigating cervical stimulation for hearing disorders and transcutaneous vagus nerve stimulation for misophonia relief. The overlap in neural pathways involved in conditions like PTSD and tinnitus further supports investigating treatments that target shared mechanisms of heightened arousal and emotional processing.

**Source:** Proietti F, Marano M, Rizzo E. Bilateral transcutaneous auricular vagus nerve stimulation for severe misophonia: a case report. *Front Psychol*. 2026;17:1903444. doi:10.3389/fpsyg.2026.1903444.