Vagus Nerve Stimulation for Misophonia Relief

A 64-year-old woman with severe misophonia experienced a dramatic reduction in her symptoms after a one-month course of transcutaneous auricular vagus nerve stimulation (taVNS). Her score on a key misophonia severity scale dropped from 80 to 9, with effects sustained a month after treatment ended, according to a new case report published in *Frontiers in Psychology*.

## A Severe Trigger and a Novel Approach

For the patient in this study, the primary trigger was the rhythmic thudding sound of a basketball being dribbled nearby. Exposure to this sound did not just cause irritation; it provoked an intense physical and emotional storm. She reported acute anxiety, terror, palpitations, a choking sensation, shortness of breath, and an overwhelming urge to flee. This reaction led to significant avoidance behaviors and impaired her daily functioning.

The research team, led by Francesca Proietti, Massimo Marano, and Emanuele Rizzo, noted that treatment evidence for misophonia remains limited. Given the patient’s pronounced autonomic symptoms—the racing heart and breathlessness—they hypothesized that a treatment targeting nervous system regulation might help. They opted for a non-invasive neuromodulation approach: transcutaneous auricular vagus nerve stimulation (taVNS). This technique applies a mild electrical current to the outer ear, an area rich in vagus nerve fibers, to influence brain networks involved in emotional and physiological regulation. You can read more about the basis of this approach in our article on Transcutaneous Vagus Nerve Stimulation for Misophonia Relief.

## Treatment Protocol and Measurement Strategy

The patient, who was already on a stable dose of the antidepressant sertraline, underwent a one-month intervention. She used a taVNS device at home daily for 60 minutes, with the stimulation intensity set to a level she could feel but that was not painful. The stimulation was applied bilaterally, meaning to both ears.

To track changes, the researchers conducted a comprehensive assessment at three points: before treatment, immediately after the month-long protocol, and again one month after treatment ended (follow-up). They used the Duke Misophonia Questionnaire Symptoms Composite Scale as the primary measure of misophonia severity. They also evaluated broader psychological symptoms, including overall distress, anxiety, depression, hostility, and somatization, as well as sleep quality and functional impairment.

## Marked Symptom Reduction with a Complex Functional Picture

The results, detailed in the source paper (10.3389/fpsyg.2026.1903444), were striking for the core misophonia symptoms. The patient’s severity score fell from 80 at baseline to 9 post-treatment. Critically, this benefit was largely maintained at the one-month follow-up, with a score of 5. This indicates a sustained reduction in the intensity of her reactions to triggering sounds.

Improvements extended beyond misophonia. Scores for general psychological distress, somatization, anxiety, hostility, and depressive symptoms all moved in a positive direction. Sleep quality also improved immediately after the treatment period. However, not all changes were stable. The gain in sleep quality was lost by the follow-up assessment, suggesting the direct effects on sleep may require ongoing stimulation.

A particularly interesting finding involved functional impairment. While the patient’s misophonia symptoms stayed low, her reported difficulty with day-to-day life showed a different pattern. Functional impairment decreased right after treatment but then increased again at the one-month follow-up. The authors propose this may indicate a “dissociation between symptom reduction and perceived functional recovery.” In simpler terms, the physical and emotional reaction to the sound improved dramatically and lastingly, but rebuilding confidence and re-engaging with avoided activities may take more time and possibly different therapeutic support. This aligns with broader understandings of how conditions like Misophonia, Emotions, and Hearing Health interact.

## Implications and Future Directions for Misophonia Management

This single case report offers a compelling, if preliminary, signal. It suggests that bilateral taVNS may be a feasible and potentially effective adjunctive intervention for individuals with misophonia, especially those whose symptoms include strong autonomic hyperarousal—the “fight-or-flight” responses. The treatment was well-tolerated alongside medication.

The authors are clear that their findings are hypothesis-generating. The observed dissociation between sustained symptom relief and fluctuating functional impairment highlights the complexity of treating misophonia. It implies that a combined approach might be most effective: neuromodulation to dampen the core physiological over-reaction, paired with behavioral or cognitive therapies to address the learned avoidance and distress that impact quality of life. For instance, strategies similar to those discussed in CBT and Sound Therapy Outperform Sound Therapy Alone could complement such a physical intervention.

Controlled clinical trials with more participants and longer follow-up periods are now needed. These studies must clarify the therapeutic role of taVNS, identify which patients are most likely to benefit, and determine optimal treatment protocols. For now, this case provides a new direction for research into a condition where many feel they have nowhere to turn.