Transcutaneous Vagus Nerve Stimulation for Misophonia Treatment

A 64-year-old woman with severe misophonia, whose main trigger was the sound of a bouncing basketball, saw her symptom severity score drop from 80 to 9 after a one-month trial of non-invasive brain stimulation. The case report, published in *Frontiers in Psychology*, provides some of the first evidence for using transcutaneous auricular vagus nerve stimulation (taVNS) to treat the condition.

Targeting the Body’s Alarm System

Misophonia is more than an annoyance; it is characterized by a marked decrease in tolerance to specific sounds, sparking intense emotional, behavioral, and physical reactions. For the patient in this study, the rhythmic thud of a basketball caused acute anxiety, terror, palpitations, a choking sensation, and an overwhelming urge to flee. These symptoms point to significant autonomic nervous system dysregulation—the body’s “fight-or-flight” alarm being triggered excessively.

Current treatment options are limited. The research team, led by Francesca Proietti, proposed that neuromodulation—using gentle electrical stimulation to influence nerve activity—could be a logical approach. They focused on the vagus nerve, a major pathway that helps regulate the autonomic nervous system and calm physiological arousal. By using a transcutaneous auricular vagus nerve stimulation device, which stimulates the nerve through the skin of the ear, they aimed to directly address the hyperarousal at the core of the patient’s distress.

Protocol and Immediate Outcomes

The patient, who was on a stable dose of sertraline, underwent a four-week protocol. She used the taVNS device daily for 60 minutes at a personally adjusted, non-painful intensity. Researchers measured her status at three points: before treatment, immediately after the month of stimulation, and again one month later.

The primary measure was the Duke Misophonia Questionnaire Symptoms Composite Scale. The change was substantial. Her score fell from a baseline of 80 to 9 post-treatment, indicating a dramatic drop in symptom severity. At the one-month follow-up, it was 5, showing the improvement was sustained. Secondary measures also showed positive shifts: overall psychological distress, somatization, anxiety, hostility, and depressive symptoms all improved. Sleep quality got better after treatment, though it returned to baseline levels by follow-up.

A Divergence Between Symptoms and Function

One of the most instructive findings was a noted dissociation. While the core misophonic reaction and psychological symptoms improved steadily, the patient’s self-reported functional impairment followed a different path. It decreased right after treatment but then increased slightly at the one-month follow-up.

This suggests that reducing the intense physiological and emotional reaction to a sound trigger is a separate process from rebuilding confidence and re-engaging with avoided activities or environments. The brain and body may calm, but the learned patterns of avoidance and the anticipation of distress can persist. This highlights a potential need for combined treatment approaches, where neuromodulation manages arousal and therapy addresses behavioral change. This complexity mirrors findings in other hearing-related conditions where neurological and psychological factors intersect, such as the shared neurological links seen in PTSD and tinnitus.

Implications and Future Research Directions

This single case report offers a compelling proof of concept. It indicates that bilateral taVNS is a feasible and potentially effective adjunctive intervention for misophonia, particularly for cases dominated by strong autonomic hyperarousal. The approach fits within a growing interest in neuromodulation for hearing and neurological health, similar to research on tDCS for tinnitus which also explores brain plasticity.

The authors are clear: these findings are preliminary and hypothesis-generating. They do not prove taVNS is effective for all misophonia patients. Controlled clinical trials with larger groups are essential to clarify its therapeutic role, determine optimal dosing protocols, and identify which patients are most likely to benefit. The dissociation between symptom reduction and functional recovery also points to a critical area for study—whether combining taVNS with cognitive-behavioral therapy or sound therapy could yield more complete outcomes.

For patients and clinicians, this research opens a new avenue for consideration. It provides a scientific rationale for exploring non-invasive, device-based treatments that target the underlying physiological dysregulation in misophonia, moving beyond purely behavioral or pharmacological strategies.

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.