Timothy C. Hain, MD. Hearing Page Page last modified: April 25, 2018
Musical hallucinations constitute a complex type of auditory hallucination characterized by perception of melodies, music, or song. (Alvaraez Perez et al, 2017). According to Teunisse and Rikkert, 3.6% of patients 194 patients referred for testing had MH. This seems a very high figure to us, as in our experience, most patients are reluctant to endorse MH out of a fear of being labeled as having a psychiatric disorder. This was also the observation of Aziz (2009).
Warner and Aziz (2005) reported that in the Wales, the most popular tune was "Abide with Me".
As a general themes, MH are reported in patients with poor hearing, with psychiatric disorders, and in patients with parkinsonism (perhaps with too much dopamine).
Musical hallucinations are encountered in severe hearing disorders, psychiatric disorders as well as organic brain disorders. Golden and Josephs (2015) reported on 393 subjects. Their discussion was as follows:
"The mean age at onset of the hallucinations was 56 years, ranging from 18 to 98 years, and 65.4% of the subjects were female. Neurological disease and focal brain lesions were found in 25% and 9% of the total subjects, respectively. Sixty-five subjects were identified with a neurodegenerative disorder, with the Lewy body disorders being the most common. Visual hallucinations were more common in the group with neurological disease compared to the psychiatric, structural, and not otherwise classifiable groups (P < 0.001), whereas auditory hallucinations were more common in the psychiatric group compared to all other groups (P < 0.001).
Structural lesions associated with musical hallucinations involved both hemispheres with a preference towards the left, and all but two included the temporal lobe. Hearing impairment was common, particularly in the not otherwise classifiable category where 67.2% had documented hearing impairment, more than in any other group (P < 0.001). Those with an underlying neurodegenerative disorder or isolated hearing impairment tended to hear more persistent music, which was often religious and patriotic compared to those with a structural lesion, where more modern music was heard, and those with psychiatric disorders where music was mood-congruent. This case series shows that musical hallucinations can occur in association with a wide variety of conditions, of which neurological disease and brain lesions represent a substantial proportion, and that Lewy body disorders are the most commonly associated neurodegenerative diseases."
The core idea here is that hallucinations are due to a disconnection syndrome -- when the brain has no input from the ears, it may create something to fill in the loss. This is sometimes called the "auditory Charles Bonnet syndrome". (Colon-Rivera and Oldham, 2014). Niranjan et al (2017) reported a cfase of a patient with severe hearing loss.
The author of this page has encountered a patient who had a midbrain contusion resulting in complete deafness, that was replaced by musical hallucinations as hearing was gradually restored.
Of course, auditory hallucinations are a feature of schizophrenia. This mainly involves hearing voices. However, schizophrenia is not commonly reported in MH.
According to Rocha et al (2015), Psychiatric assessment showed that 68.75% of cases had depression, 6.25% had anxiety disorder and 25% had no psychiatric conditions.
According to Bergman et al (2014), "MHs represent a complex psychopathological phenomenon, hallucinatory in content and obsessive-compulsive (OC) in form, justifying trial with an antiobsessive agent." Bergman reported success with exsictalopram.
Bleich-Cohen et al (2011) reported a single patient with schozophrenia and OC, and proposed that this was an "obsessive musical hallucination".
Our take on this is that for the most part, medications don't cause auditory hallucinations, unless they induce psychiatric disorders.
For the most part, MH are reported in patients with damage to the auditory cortex (this makes some sense).
Auditory hallucinations are sometimes encountered in patients with no obvious cause. (e.g. Brunner and Amedee, 2015; Peritogiannis et al, 2016; Zabalza-Estevez, 2014).
As a general comment, MH associated with poor hearing are treated with hearing aids. Those with psychiatric disorders, generally with antipsychotic drugs, which are often dopamine blockers.
Coeberg et al (2015) reported on treatment attempts.
"A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology. RESULTS: Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment.
In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising.
Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication."