![]() ![]() 3, 6 As mentioned earlier, the majority of patients are both cognitively and psychiatrically normal. 4, 5 Musical hallucinations can occur either acutely or gradually and are commonly perceived as frightening, rather than pleasant. 2 Usually the music is familiar to the patient and the hallucinations are unilateral. 1 However, there are some reports of patients hearing unfamiliar songs. Normally they consist of well-known music to the patient, such as pop or religious songs, and are generally non-psychotic in nature. 3 However, the cause for these sporadic memory traces is still unknown. 3 Another theory is that, as patients commonly hear familiar songs, musical hallucinations are derived from memory and spontaneously released in the absence of a specific brain stimulus. 2, 5 As musical hallucinations are more intense when the surrounding noise is low, they can be interpreted as a deafferentation phenomenon and it has therefore also been suggested that they must exclusively be associated with an inner-ear disease leading to ‘a hyperactive state of the ear’. Many believe that both visual and musical hallucinations represent a release phenomenon, that is, the sensory deprivation stops input into the auditory system causing spontaneous activity to occur. 4 Similar to the classic Charles Bonnet syndrome in which patients with impaired sight have visual hallucinations, patients with hearing impairment have musical hallucinations. These include: 3, 5ĭespite many studies, the aetiology is still unclear. 2Īside from a hearing deficit, there have been other neurological and psychiatric conditions reported to cause musical hallucinations. 3 General risk factors include advanced age, social isolation, and female sex (up to 70–80%). ![]() 2 The hallucinations have been shown to be more intense when the background noise is low. The most commonly accepted predisposing condition for the development of musical hallucinations, in up to 67% of patients, has been shown to be hearing impairment. 3, 4 Later on, Smetana developed severe hearing loss, thought to be secondary to syphilis, and experienced further musical hallucinations such as a chord in A’s major that can be heard in the last movement of his second string quartet. Robert Schumann was said to have incorporated musical hallucinations into his Violin Concerto in D Minor and Bedřich Smetana reported his musical hallucinations were in the form of two male voices in G major. Interestingly, many famous composers have been reported to have had musical hallucinations. 3 It is likely that these are under-reported because of patients concerned about seeming ‘crazy’, or because the hallucinations are not bothersome. 3 They are thought to be under-reported in a sample of older patients with audiological problems, 2.5% reported musical hallucinations when asked. The first reports on musical hallucinations were published in 18, and the first scientific descriptions in 19. 2 In the literature this condition is also reported as Oliver Sacks syndrome, musical ear syndrome, and musical hallucinosis. 1 Patients can perceive the music either continuously or intermittently. Musical hallucinations are auditory hallucinations experienced by a patient in the absence of an external auditory stimulus. She was referred to neurology who diagnosed her with Charles Bonnet syndrome. Full neurological examination was normal, except for reduced hearing bilaterally. On examination she looked well, with no concerns regarding cognitive or psychiatric function. She was fully independent and lived alone. Her regular medication included amlodipine, apixaban, atorvastatin, thyroxine, and metoprolol. She had a past medical history of atrial fibrillation and three strokes, which affected her speech and limb functioning, but had made a good recovery. There were no other neurological symptoms apart from a long-term problem with her hearing, requiring hearing aids. She had some frontal headaches over the last 3 months and some occasional dizziness. There was no concern from the patient or her family about her memory or mood. She stated that she didn’t hear any other voices speaking and didn’t have any visual hallucinations. She had a religious upbringing and many of the songs she heard had religious connotations. An 81-year-old female attended surgery claiming she could hear people singing hymns in her house.
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