Transcutaneous Vagus Nerve Stimulation for Misophonia

A 64-year-old woman with severe misophonia saw her symptom severity score drop from 80 to 9 after one month of a novel, non-invasive nerve stimulation therapy. This single case report, led by researchers Francesca Proietti, Massimo Marano, and Emanuele Rizzo, provides the first documented evidence for using transcutaneous auricular vagus nerve stimulation (taVNS) to treat the intense distress and autonomic hyperarousal linked to certain sounds.

Targeting the Vagus Nerve to Calm Autonomic Storms

Misophonia is more than simple annoyance. It is characterized by a markedly decreased tolerance to specific, often ordinary sounds, which trigger intense emotional and physiological reactions. For the patient in this study, the rhythmic thudding of a nearby basketball caused acute anxiety, terror, palpitations, a choking sensation, and an overwhelming urge to flee. These symptoms point to a core feature of the condition: autonomic nervous system hyperarousal.

Current treatment evidence is limited, often focusing on behavioral strategies. The research team proposed a different approach: directly modulating the autonomic nervous system. They used bilateral transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive method that applies a mild electrical current to the outer ear, where a branch of the vagus nerve is accessible. The vagus nerve is a primary component of the parasympathetic nervous system, which governs the body’s “rest and digest” state, counteracting the “fight or flight” stress response that appears to be overactive in misophonia. This approach aligns with other neuromodulation research for hearing-related disorders, such as work on cervical stimulation effects.

Method: A Month of Daily Ear Stimulation

The patient, who was already on a stable dose of sertraline, underwent a one-month treatment protocol. She self-administered the taVNS device daily for 60 minutes at an intensity she found noticeable but not painful. The stimulation was applied bilaterally to both ears.

Proietti and colleagues assessed a range of outcomes at three points: before treatment, immediately after the month-long protocol, and again one month after treatment ended. They used the Duke Misophonia Questionnaire to measure core symptom severity, along with standardized scales for psychological distress, anxiety, depression, and sleep quality. This allowed them to track not just the misophonia, but its broader impact on mental health and daily function.

Findings: A Dramatic Drop in Symptoms, But a Complex Recovery

The results on the primary measure were striking. The Duke Misophonia Questionnaire Symptoms Composite Scale score fell from a severe baseline of 80 to just 9 after treatment, and improved further to 5 at the one-month follow-up. This indicates a profound and sustained reduction in the distress caused by trigger sounds.

Secondary measures showed broad psychological benefit. Scores for overall psychological distress, somatization, anxiety, hostility, and depressive symptoms all improved. Sleep quality also improved immediately post-treatment. These co-occurring improvements are notable, given the established links between auditory conditions, anxiety, and depression.

However, the data revealed a critical nuance. While sleep scores improved, they had returned to baseline levels by the follow-up. More importantly, the patient’s self-reported functional impairment—how much the condition limited her daily life—decreased after treatment but increased again at follow-up, even though her symptom severity score remained very low. The authors describe this as a “dissociation between symptom reduction and perceived functional recovery.” It suggests that even when the physiological and emotional reaction to a sound is controlled, the long-term patterns of avoidance and anticipatory anxiety may take longer to resolve, a challenge also seen in managing conditions like PTSD.

Practical Implications and Future Research

This single case report is explicitly preliminary. As the authors state, its purpose is hypothesis-generating. It does not prove taVNS is an effective treatment for misophonia, but it provides a strong rationale for conducting controlled clinical trials.

For clinicians and patients, the case highlights two important points. First, neuromodulation targeting autonomic regulation is a plausible new avenue for misophonia research, particularly for individuals with strong physical panic-like responses. Second, treatment success may need to be measured in two distinct ways: reduction of the immediate symptom severity and active rehabilitation of functional behavior. A therapy that blunts the autonomic response could become a powerful tool, potentially used in conjunction with behavioral therapies like CBT to help patients re-engage with situations they have long avoided.

The path forward requires controlled studies to determine if these effects are reproducible and specific to the stimulation. Future research must also define optimal treatment protocols—duration, frequency, and stimulation parameters—and identify which patients with misophonia are most likely to benefit from this biological intervention.

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.