ArticleFrontiers in psychology2026
Bilateral transcutaneous auricular vagus nerve stimulation for misophonia symptoms: a case report and review of the literature.
Article in Frontiers in psychology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Misophonia is characterized by a markedly decreased tolerance to specific sounds, often accompanied by intense emotional, behavioral and autonomic responses. Current treatment evidence remains limited, and neuromodulation-based approaches targeting autonomic dysregulation are largely unexplored. This case report describes a 64-year-old woman with severe misophonic symptoms, whose main trigger was the rhythmic thudding sound of a basketball being bounced nearby. Exposure to this sound elicited intense distress, palpitations, choking sensation, dyspnea, acute anxiety, terror and an overwhelming urge to escape, leading to avoidance and functional impairment. The patient was receiving stable sertraline treatment and underwent a 1-month protocol of bilateral transcutaneous auricular vagus nerve stimulation, delivered daily for 60 min at an individually adjusted, non-painful intensity. Misophonia severity, psychological distress, anxiety, depressive symptoms, sleep, circadian rhythm and mood-related symptoms were assessed at baseline, after treatment and at 1-month follow-up. The Duke Misophonia Questionnaire Symptoms Composite Scale decreased from 80 at baseline to 9 after treatment and 5 at follow-up, indicating sustained reduction in symptom severity. Overall psychological distress, somatization, anxiety, hostility and depressive symptoms also improved. Sleep quality improved after treatment but returned to baseline at follow-up. Conversely, functional impairment decreased immediately after treatment but increased at follow-up, suggesting a dissociation between symptom reduction and perceived functional recovery. This case suggests that bilateral transcutaneous auricular vagus nerve stimulation may be a feasible adjunctive intervention for misophonia characterized by prominent autonomic hyperarousal. Findings are preliminary and hypothesis-generating and controlled studies are needed to clarify its therapeutic role.
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