Transcutaneous Vagus Nerve Stimulation for Misophonia Relief

A 64-year-old woman with severe misophonia, whose primary trigger was the sound of a bouncing basketball, experienced a dramatic reduction in symptoms following a month of daily, bilateral transcutaneous auricular vagus nerve stimulation (taVNS). Her scores on the Duke Misophonia Questionnaire plummeted from 80 to 9 post-treatment, holding at 5 a month later. The case report, led by Francesca Proietti and colleagues in Italy and South Korea, suggests this neuromodulation technique may be a feasible adjunctive treatment for misophonia, particularly where autonomic hyperarousal is prominent [PMID: 42528723](https://pubmed.ncbi.nlm.nih.gov/42528723).

A Protocol Targeting Autonomic Dysregulation

The patient in this case had a history of severe misophonic reactions centered on rhythmic thudding sounds. Exposure triggered intense distress, acute anxiety, a sensation of terror, and physical symptoms including palpitations, a choking feeling, and shortness of breath. These autonomic responses led to significant avoidance behaviors and functional impairment. She was already on a stable dose of sertraline, an SSRI antidepressant.

Researchers from the University Campus Bio-Medico of Rome implemented a one-month intervention of bilateral taVNS. The patient self-administered the stimulation daily for 60 minutes at an intensity she found noticeable but not painful. The non-invasive treatment involves placing electrodes on the outer ear to stimulate branches of the vagus nerve, a major pathway influencing the parasympathetic nervous system and emotional regulation.

Assessments were conducted at three points: before treatment, immediately after the one-month protocol, and again one month later without further stimulation. The team used the Duke Misophonia Questionnaire Symptoms Composite Scale as the primary measure, alongside scales for psychological distress, anxiety, depression, sleep quality, and functional impairment.

Symptom Severity Plummets, But Functional Gains Lag

The results were striking for the core misophonia symptoms. The patient’s Duke Misophonia score fell from a baseline of 80 to 9 post-treatment, indicating a transition from severe to minimal symptoms. At the one-month follow-up, the score was 5, showing the improvement was largely sustained. Secondary measures also showed positive change: overall psychological distress, somatization, anxiety, hostility, and depressive symptoms all improved.

However, the data revealed a nuanced picture. Sleep quality improved after treatment but returned to baseline levels at follow-up. More notably, the patient’s reported functional impairment decreased right after treatment but increased again at the one-month follow-up, even as her misophonia symptoms remained low.

“This suggests a dissociation between symptom reduction and perceived functional recovery,” the authors note. It implies that while the intense emotional and physiological reaction to trigger sounds was greatly reduced, the patient’s confidence in engaging with previously avoided situations or her overall life participation may need additional, targeted rehabilitation.

Practical Implications and Future Research Directions

This single case report offers a preliminary but compelling signal. It proposes that bilateral taVNS, which targets autonomic nervous system regulation, could be a useful adjunct for a subset of people with misophonia—specifically those whose reactions are heavily laden with physical symptoms of hyperarousal. For individuals whose primary struggle is anger or irritation without strong autonomic components, the relevance is less clear.

The dissociation between symptom score and functional outcome is a critical observation for clinicians and patients. It highlights that effective treatment for misophonia may require a multi-pronged approach. Reducing the limbic and autonomic “fire alarm” response via a tool like taVNS could be one component, potentially paired with cognitive behavioral therapy (CBT) to address maladaptive thoughts and behaviors, and gradual sound exposure to rebuild tolerance and reduce avoidance.

The study has clear limitations as a single case report, a fact the authors stress. The patient remained on sertraline, and while her dose was stable, the interaction between medication and taVNS is unknown. The open-label design means placebo effects cannot be ruled out. The findings are, in the authors’ words, “preliminary and hypothesis-generating.”

This work points directly to the need for controlled clinical trials. Future studies should compare taVNS to a sham stimulation in a larger group of patients, ideally off of stable psychotropic medications, to isolate the effect of the neuromodulation. Research should also continue to explore other neuromodulation techniques for hearing-related sensitivities, such as the approaches discussed in our articles on repetitive transcranial magnetic stimulation (rTMS) for tinnitus and neurofeedback.

A Cautious Step Forward

The case presented by Proietti, Marano, Rizzo, Song, Di Lazzaro, and Albergo provides a concrete example of how neuromodulation might address the physiological core of some misophonic reactions. The dramatic drop in the patient’s symptom score from 80 to 9 is a tangible result that merits scientific follow-up.

For individuals struggling with misophonia, this research underscores that the condition involves complex brain-body interactions and that future treatments may move beyond sound masking or talk therapy alone. The lagging functional recovery also serves as a reminder that managing a chronic condition often requires work on multiple fronts—calming the nervous system, changing behavior patterns, and rebuilding a life less constrained by fear of sound.

The full study, “Bilateral transcutaneous auricular vagus nerve stimulation for misophonia symptoms: a case report and review of the literature,” is available with its peer-reviewed data in Frontiers in Psychology [DOI: 10.3389/fpsyg.2026.1903444](https://doi.org/10.3389/fpsyg.2026.1903444).