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Musical hallucinations
Musical hallucinations
Musical hallucinations
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Musical hallucinations (also known as auditory hallucinations, auditory Charles Bonnet Syndrome, and Oliver Sacks' syndrome[1]) describes a neurological disorder in which the patient will hallucinate songs, tunes, instruments and melodies. These hallucinations are not correlated with psychotic illness.[2] A majority of patients who have symptoms of musical hallucinations are older and have onset conditions predisposing them to the disease. While there is no set form of treatment, research has discovered medications and alternative therapies to be successful in alleviating the hallucinations.

Description

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In 73 individual cases reviewed by Evers and Ellger, 57 patients heard tunes that were familiar, while 5 heard unfamiliar tunes. Keshavan found that a consistent feature of musical hallucinations was that they represented a personal memory trace. Memory traces refer to anything that may seem familiar to the patient. Tunes ranged from religious pieces to childhood favorites and popular songs from the radio. Vocal and instrumental forms of classical music were also identified in most patients.[3][4]

An 84 year old in one case described her symptoms as pleasant, but also sought treatment because she felt distracted. The music she heard was similar to the hymns and songs sung at her wedding. She had been widowed for a while and had no signs of psychiatric disorders. However, she did have hypertension, hyperthyroidism, and osteoporosis, and it was theorized that the distress from these illnesses manifested the hallucinations. Researchers found that due to the unexpected origin of the hallucinations, there was no clear diagnosis or recommendation for treatment.

Another case, which studies a 74-year-old woman, described her symptoms as music that would play in short verses of patriotic and children's songs.[5] These symptoms would occur when the patient was alone and much more frequently when driving. Researchers suspected her hearing loss as a factor for developing the hallucinations. Moreover, through further analysis the patient was found to have a medical history of hypertension, hyperlipidemia, and atrial fibrillations.

Cases are commonly found in the elderly, but in one case a 29-year-old woman reported hearing music for one week. Prior to her hallucinations, the patient had undergone surgery for intraventricular and intracranial hemorrhages. Following her recovery, she mentioned the onset of hallucinations followed by headaches.[6] Doctors found no neurological impairments through scans. They prescribed her with quetiapine, which she responded well to. Her symptoms therefore only lasted a year.

Causes

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Musical hallucinations can occur in people who are physically and mentally healthy, and for them, there is no known cause.[7] Most people find their musical hallucinations obtrusive, and wish to be rid of them, while others welcome them. In addition, investigators have pointed to factors that are associated with musical hallucinations. Evers and Ellgers compiled a significant portion of musical hallucination articles, case studies etc. and were able to categorize five major etiologies:

Hypoacusis

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Hypoacusis is defined as impairment in hearing or deafness. It was the most common of the five etiologies in the case studies reviewed by Evers and Ellgers.[3] According to Sanchez et al. 2011, there have been suggestions that pontine lesions could alter the central auditory system's function, causing hypoacusis and musical hallucinations.[8][9]

Psychiatric disorders

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A case study by Janakiraman et al. 2006, revealed a 93‑year‑old woman with major depressive disorder who experienced musical hallucinations while treated with electroconvulsive therapy (ECT). Investigators found that the patient's depression symptoms were inversely related to her hallucinations and primarily stemmed from the ECT treatment. The patient had no known abnormalities in hearing, suggesting that musical hallucinations could arise from a variety of sources including psychiatric illnesses. After a complete course of ECT, her hallucinations dissipated, also suggesting that they can be acute.[10]

According to Evers and Ellgers, some other major psychiatric disorders that contribute to musical hallucinations include schizophrenia and depression. Some patients who have schizophrenia experience musical hallucinations due to their ongoing psychosis, but there are some cases that do so without psychosis. There are also a very small percentage of musical hallucination cases due to obsessive-compulsive disorder (OCD).[3]

Several different types of psychiatric disorders can be precursors for Musical Hallucinations. according to Blom and Coebergh, Bipolar Disorder and personality disorders can increase the chances of musical hallucinations. Likewise, cocaine dependence can elevate the symptoms.

Focal brain lesions

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Among the handful of cases that Evers and Ellgers studied, major lesion sites included the temporal cortex; however, the specific location and laterality (left vs. right temporal cortex) was variable. Many cases of focal brain lesions had comorbidity with hearing impairment (see hypoacusis), epileptic activity and intoxication.[3] There have also been several findings of acute musical hallucinations in patients with dorsal pons lesions post-stroke and encephalitis potentially due to disruption of connections between the sensory cortex and reticular formation.[11] Also, any kind of traumatic lesion imposed on the brain can be a risk factor for Musical Hallucinations.

Epilepsy

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Epileptic brain activity in musical hallucinations originates in the left or right temporal lobe.[3] In a specific case studied by Williams et al. 2008, a patient who received a left temporal lobectomy in order to treat epilepsy was diagnosed with musical hallucinations post-surgery. The patient also had multiple additional risk factors that could have accounted for the hallucinations including mild neuropsychiatric dysfunction and tinnitus.[12] The causation of hallucination through epilepsy is linked to seizure episodes. Through experiments, researchers have found that patients with epilepsy and hallucinations will respond to antiepileptics and surgery[13]

Intoxication

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Intoxication accounts for a small percentage of musical hallucination cases. Intoxication leads to either withdrawal or inflammatory encephalopathy, which are major contributors to musical hallucinations. Some of the drugs that have been found to relate to musical hallucinations include salicylates, benzodiazepines, pentoxifylline, propranolol, clomipramine, amphetamine, quinine, imipramine, a phenothiazine, carbamazepine, marijuana, paracetamol, phenytoin, procaine, and alcohol. General anesthesia has also been associated with musical hallucinations.[3] In a case study by Gondim et al. 2010, a seventy–seven-year-old woman with Parkinson's disease (PD) was administered amantadine after a year of various other antiparkinsonian treatments. Two days into her treatment, she started to experience musical hallucinations, which consisted of four musical pieces. The music persisted until three days after cessation of the drug. Although the patient was taking other medications at the same time, the timing of onset and offset suggested that amantadine either had a synergistic effect with the other drugs or simply caused the hallucinations. Although the case wasn't specific to intoxication, it leads to the idea that persons with PD who are treated with certain drugs can experience musical hallucinations.[14]

Other risk factors

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In summary, musical hallucinations can be separated into five categories according to their cause: hypoacusis, psychiatric disorders, brain lesions, epilepsy, and substance use. However, certain factors can trigger hallucinations, these factors include, old age, social isolation and even gender.[15] Many cases highlight female patients who have the disease. Overall, psychiatric disorders and neurological disease lead to hallucinations, but certain factors, such as age and gender play a role in heightening the causation.

Imaging

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Positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) show that musical hallucinations activate a wide variety of areas in the brain including the following: auditory areas, motor cortex, visual areas, basal ganglia, brainstem, pons, tegmentum, cerebellum, hippocampi, amygdala, and peripheral auditory system.[16]

Treatment

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To date, there is no successful method of treatment that "cures" musical hallucinations. There have been successful therapies in single cases that have ameliorated the hallucinations. Some of these successes include drugs such as neuroleptics, antidepressants, and certain anticonvulsive drugs. A musical hallucination was alleviated, for example, by antidepressant medications given to patients with depression.[3] Sanchez reported that some authors have suggested that the use of hearing aids may improve musical hallucination symptoms.[9] They believed that the external environment influences the auditory hallucinations, showing worsening of symptoms in quieter environments than in noisier ones.[8][17][18] Oliver Sacks' patient, Mrs. O'C, reported being in an "ocean of sound" despite being in a quiet room due to a small thrombosis or infarction in her right temporal lobe. After treatment, Mrs. O'C was relinquished of her musical experience but said that, "I do miss the old songs. Now, with lots of them, I can't even recall them. It was like being given back a forgotten bit of my childhood again." Sacks also reported another elderly woman, Mrs. O'M, who had a mild case of deafness and reported hearing musical pieces. When she was treated with anticonvulsive medications, her musical hallucinations ceased but when asked if she missed them, she said "Not on your life."[19]

Researchers found that patients with musical hallucinations respond well to the drug Donepezil, making it another potential treatment for the condition. Donepezil, which belongs to a class of medication called acetylcholinesterase inhibitors, is most commonly used to treat dementia in patients with Alzheimer's disease. Although it cannot cure Alzheimer's, it can provide patients with a better quality of life by inhibiting the loss of function and improving the ability to think.[20] For patients with musical hallucinations, the medication keeps them more aware and stimulated to control the onset symptoms of hallucinations. Overall, with few adverse effects, research has found that donepezil is an effective and safe choice of treatment.[21]

History

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According to Oliver Sacks' Hallucinations, the first known medical report of musical hallucinations was published in 1846, by French alienist Jules Baillarger.[16] However, the first scientific description of the disorder was reported in the early 1900s. In the last three decades, Berrios has reported case studies in 1990 and 1991 along with Keshavan et al. in 1992. Berrios concluded that confirmed diagnoses of deafness, ear disease, brain disease, advanced age and drug use are all important factors in the development of musical hallucinations. After analyzing 46 cases, Berrios found a female predominance of 80% in women over the age of 60. The study concluded that musical hallucinations were more likely to be seen in elderly women affected by deafness or brain disease than in individuals with no psychiatric illness at all.[22][4]

Keshevan and Berrios were the first authors to identify classes of musical hallucinations. These classes consisted of hearing loss, coarse brain disease (i.e. tumors), epileptic disorder, stroke, and psychiatric disorder. Although no statistical analyses were performed, the authors stated that deafness was the most strongly related factor in musical hallucinations and that there was a female predominance, which could entail a genetic component.[3][22][4]

References

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Musical hallucinations

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Musical hallucinations are a form of complex characterized by the perception of melodies, , or songs in the absence of any external auditory stimulus. These perceptions typically involve familiar tunes, such as childhood songs or popular melodies, and can last from seconds to hours, often originating from one or both ears. They are relatively rare, with a reported prevalence of about 0.16% in populations, and more commonly affect older adults, particularly females, with an average onset age around 56 years. The etiology of musical hallucinations is multifaceted, frequently linked to auditory deprivation such as , where the compensates by generating internal sounds—a phenomenon sometimes termed or auditory syndrome. Neurological conditions play a significant role, including neurodegenerative disorders like and dementia, , lesions (often in the ), and , accounting for about 25% of cases. Psychiatric factors, such as or depression, as well as medication side effects (e.g., from antihypertensives or ) and toxic-metabolic issues, can also trigger them, though hearing impairment remains the most common association, present in up to 67% of unclassified cases. Clinically, musical hallucinations vary in emotional impact, ranging from neutral or pleasurable to distressing, and may be lateralized to the better-hearing ear in those with asymmetric . involves ruling out psychiatric or cognitive disorders through , audiological evaluation, and imaging like CT or MRI to identify underlying causes. There is no specific cure, but management focuses on treating the root cause—such as fitting hearing aids for auditory deprivation, discontinuing offending medications, or addressing neurological issues—while supportive measures like , environmental sound enrichment, or medications (e.g., or antidepressants) may alleviate symptoms in refractory cases. The content of the perceived music often reflects the individual's background, with religious or patriotic tunes common in neurodegenerative cases and mood-congruent selections in psychiatric ones, highlighting the interplay between and personal experience.

Introduction

Definition and Characteristics

Musical hallucinations (MH) are a type of complex characterized by the perception of , melodies, or songs in the absence of an external auditory stimulus. Unlike basic auditory perceptions, MH involve organized, structured sounds that mimic real music, often perceived as vivid and immersive. This phenomenon is distinct from voluntary musical imagery, as it occurs involuntarily and without conscious control. Key features of MH include their stereotypical and repetitive nature, where familiar tunes—such as childhood songs, religious hymns, or popular melodies—replay continuously or intermittently. The content is typically non-verbal but can incorporate instruments like or organ, and occasionally with , though purely forms are common. Duration varies widely, from brief episodes lasting seconds to persistent experiences extending for hours, days, or even continuously in chronic cases. In most instances, individuals retain insight, recognizing the music as internally generated rather than external, which differentiates MH from more delusional perceptual disorders. MH differ from simple tinnitus, which involves unorganized tones or noises without melodic structure, whereas MH feature recognizable, complex harmonies and rhythms. They also contrast with auditory verbal hallucinations, which primarily entail spoken words or voices rather than musical elements, though both fall under broader auditory hallucinations. Historically, MH associated with auditory deprivation, such as , have been termed auditory Charles Bonnet syndrome, analogous to visual hallucinations in the visually impaired.

Clinical Presentation

Patients with musical hallucinations typically perceive familiar tunes, songs, hymns, or instrumental music in the absence of external auditory stimuli, often describing the experience as hearing a radio or live performance internally. These perceptions are usually bilateral but can be louder in quieter environments or predominantly in the with greater hearing impairment. The content frequently includes recognizable pieces from the patient's past, such as childhood songs or popular melodies, and may last from seconds to hours. Subjective experiences vary, with the music sometimes evoking positive emotions like comfort or , while in other cases it triggers distress, anxiety, or frustration due to its intrusiveness. Most patients demonstrate preserved , recognizing the unreality of the sounds, though a subset—particularly those with comorbid —may lack awareness and attribute the music to external sources like neighbors or devices, potentially leading to secondary delusions. This often allows patients to differentiate the hallucinations from , reducing associated fear. Variations in presentation include simple forms, such as single notes or instrument tones, versus complex orchestrations with multiple layers, vocals, and rhythms. Episodes can be intermittent or continuous, with some persisting throughout the day without voluntary control, and unilateral manifestations occasionally occur in cases linked to focal lesions. Musical hallucinations are frequently associated with , which may exacerbate their prominence. The impact on daily life ranges from negligible, where patients adapt and even enjoy the experience, to significant interference with concentration, sleep, and social interactions in more severe instances, potentially causing isolation or relational conflicts. For example, bothersome tunes may disrupt conversations or lead to repeated checks for external sources, heightening emotional burden.

Epidemiology

Prevalence and Incidence

Musical hallucinations (MH) are considered rare in the general , with point estimates ranging from 0.16% in psychiatric inpatients at general hospitals to higher rates in community surveys of older adults. A seminal study screening 3,678 psychiatric patients reported a of 0.16%, highlighting MH as an uncommon presentation in clinical settings. In psychiatric outpatient settings, is notably higher; one study of 190 patients reported 26.8% experiencing musical hallucinations, rising to 41% among those with obsessive-compulsive disorder. In broader epidemiological contexts, lifetime in non-clinical populations remains poorly quantified due to underreporting, often attributed to misdiagnosis as or reluctance to disclose due to stigma associated with hallucinations. Incidence is notably elevated among specific at-risk groups, particularly those with hearing impairment. Among elderly individuals (aged 65 and older) presenting with audiological complaints, prevalence rates range from 0.86% to 2.5% based on systematic reviews of clinical surveys. In patients referred for audiometric evaluation, primarily with mild to moderate hearing loss, the prevalence reaches 3.6%, with associations to female gender and left-sided hearing asymmetry. A comprehensive review of 393 documented MH cases found that 67.2% involved hearing impairment, underscoring its role as the most common predisposing factor across etiologies. MH are exceedingly rare in children and adolescents, with case reports suggesting occurrences primarily in the context of neurological or psychiatric conditions rather than isolated auditory deprivation. Overall trends indicate increasing clinical recognition, driven by aging global populations and improved audiologic screening, though exact incidence rates remain elusive without large-scale prospective studies. A consistent female predominance is observed in aggregate data, though it appears more pronounced in hearing-impaired cohorts.

Demographic Patterns

Musical hallucinations predominantly affect older adults, with a mean age of onset around 60 to 70 years across multiple studies. For instance, in a review of 77 cases, the mean age was 68.1 years (range: 22–97 years), while a larger analysis of 226 subjects reported a mean of 67.9 years (range: 20–101 years). Cases under 50 years are rare, often linked to specific neurological or psychiatric conditions, and prevalence peaks in those over 80 years, particularly among individuals experiencing sensory decline such as hearing impairment. A slight female predominance is consistently observed, with women comprising 60% to 70% of reported cases. Studies show this pattern as 65.4% female in a cohort of 393 subjects, 66.8% in 226 cases, 70% in 132 patients, and 76.3% in 77 cases. This disparity may relate to women's longer average lifespan or differences in reporting behaviors, though direct causal links remain unestablished. Comorbidities are common among affected individuals, with high overlap for reported in approximately 71% of cases in certain cohorts, such as 67.2% among those without clear neurological classification. affects 10% to 20% of patients, including forms like Lewy body dementia, while psychiatric histories, such as depression or , appear in 20% to 47% of cases depending on the subgroup analyzed. Isolated musical hallucinations without these comorbidities occur but are less frequent, often in otherwise healthy elderly individuals. Cultural factors influence the content of musical hallucinations, which typically feature familiar tunes from the individual's background, such as religious hymns, childhood songs, or national anthems in their native language. In predominantly Western study populations, the perceived music often consists of classical or popular tunes from that cultural context, though no significant ethnic or racial disparities in overall prevalence have been identified.

Etiology

Auditory Deprivation

Musical hallucinations arising from auditory deprivation primarily occur in individuals with significant , where the brain compensates for reduced sensory input through spontaneous neural activity in the . This phenomenon is analogous to Charles Bonnet syndrome in the visual domain, where leads to perceptual experiences without external stimuli. The deafferentation hypothesis posits that the loss of peripheral auditory input results in central hyperactivity within the auditory pathways, lowering the threshold for spontaneous firing and generating perceived music in the absence of real sound sources. Evidence strongly links auditory deprivation to musical hallucinations, with up to 67% of cases without identifiable neurological or psychiatric causes associated with hearing impairment, often confirmed by audiometric testing. These hallucinations tend to worsen in cases of profound , as the greater degree of sensory loss amplifies the brain's compensatory mechanisms, and they are commonly termed "" when tied to hypoacusis. A specific subtype involves unilateral hearing loss, which frequently produces ipsilateral musical hallucinations, localized to the side of the impaired ear. For instance, case reports describe children and adults experiencing auditory perceptions exclusively on the affected side, supporting the role of localized deafferentation in triggering these symptoms. Improvement is observed in many cases through restoration of auditory input; hearing aids can lead to partial or complete resolution in some affected individuals by reducing sensory deprivation, while cochlear implants show variable but often beneficial outcomes in severe cases.

Neurological Disorders

Musical hallucinations can arise from various structural and functional abnormalities in the , particularly those affecting the auditory processing pathways. Focal lesions, such as those resulting from or tumors in the , are among the common neurological causes, often involving irritation or disruption of key auditory regions like Heschl's gyrus. These lesions may lead to "release hallucinations," where inhibitory mechanisms fail, allowing spontaneous activation of stored musical memories without external stimuli. In a retrospective review of 393 cases, approximately 9% of musical hallucinations were attributed to focal lesions, predominantly in the left , highlighting their role in generating complex auditory percepts. Epilepsy, especially temporal lobe seizures, represents another significant neurological etiology, where musical hallucinations may manifest as an ictal aura, interictal phenomenon, or postictal event. Mechanisms involve aberrant electrical activity in the auditory cortex and limbic structures, often detectable via EEG as spike-wave discharges or desynchronization in temporal regions. A systematic review identified 24 detailed cases linking epilepsy to musical hallucinations out of 983 epilepsy patients, with temporal lobe involvement predominant; for instance, patients reported hearing familiar songs like Italian tunes during seizures originating from mid-temporal spikes. In some epileptic cases, symptoms mimic familiar music and resolve with antiepileptic medications such as carbamazepine or surgical intervention, underscoring the reversible nature of seizure-related hallucinations. Migraines with occasionally feature auditory components, including rare instances of musical hallucinations, likely due to transient affecting auditory pathways or serotonin-mediated perceptual alterations. Case series document auditory hallucinations during attacks, with durations typically under one hour and improvement alongside prophylaxis in over half of affected individuals; while voices predominate, musical elements have been reported in select cases without progression from visual auras. Overall, neurological disorders account for about 25% of musical hallucinations in large cohorts, with EEG abnormalities and lesion-specific imaging providing diagnostic correlates.

Psychiatric Conditions

Musical hallucinations (MH) occur in association with several psychiatric disorders, most notably , , and obsessive-compulsive disorder (OCD), though they are less common overall in psychiatric populations compared to neurological etiologies. In a systematic analysis of 294 reported cases, psychiatric conditions accounted for 28.9% of MH instances, with representing 30.6% of those psychiatric cases and or related psychoses comprising 47.1%. Prevalence within specific disorders varies; for example, a study of 100 schizophrenic inpatients found that 16% experienced MH, often as part of broader auditory phenomena. In contrast, MH appear in approximately 26.8% of psychiatric outpatients across diagnoses, rising to 41% among those with OCD, where they may correlate with comorbid anxiety or social phobia. Anxiety disorders show lower associations, with only 2.4% of psychiatric MH cases linked to them in the same review. Mechanisms underlying MH in psychiatric contexts likely involve disruptions in neural circuits related to auditory processing and emotional regulation. In , dopaminergic hyperactivity in mesolimbic pathways may contribute to the release of stored musical memories, akin to general auditory hallucinations, though MH specifically engage structures like the . For mood disorders such as depression, stress-induced alterations in the , potentially exacerbated by medication non-compliance (e.g., abrupt cessation of antidepressants), can trigger MH as a secondary symptom. These hallucinations often arise with preserved insight, distinguishing them from typical verbal hallucinations in psychosis, where patients may lack awareness of internal origin; individuals with MH frequently recognize the percepts as unreal and report them as less intrusive or ego-dystonic. Evidence from clinical studies highlights MH as a potential indicator of underlying mood fluctuations in psychiatric patients, particularly the elderly. In one cohort of 81 patients with MH, approximately 6% exhibited rare secondary delusions tied to the hallucinated content, such as attributing religious hymns or carols to external sources during manic episodes, leading to temporary lack of . Unlike more distressing verbal hallucinations, MH in these settings are often bearable and may resolve with treatment of the primary disorder, such as antipsychotics like , underscoring their role as a marker rather than a core psychotic feature. This preserved and lower distress level facilitate differentiation and management in psychiatric care.

Pharmacological and Toxic Factors

Musical hallucinations can arise as an of various pharmacological agents, disrupting normal auditory processing through alterations in systems. Common triggers include antidepressants, which account for approximately 18.5% of reported drug-induced cases, often involving selective serotonin inhibitors (SSRIs) and antidepressants like , , , and . These medications enhance serotonin, norepinephrine, or activity, potentially leading to hyperexcitability in auditory cortical regions. Antipsychotics have also been implicated in isolated cases, though less frequently, with mechanisms tied to modulation. Benzodiazepine withdrawal represents another key pharmacological factor, inducing rebound excitation due to diminished GABA-mediated inhibition, which can manifest as auditory phenomena including music. Specific agents like , , , and have been associated with such symptoms during abrupt cessation. Alcohol withdrawal, often progressing to , similarly triggers hyperexcitability in auditory pathways, with musical elements reported in ; for instance, one case series documented songs and hymns emerging 2-3 days post-abstinence. Illicit drugs contribute sporadically, with (an NMDA antagonist) linked to states featuring familiar tunes like "," comprising 11.1% of intoxication cases in a review. and may induce broader hallucinatory experiences, but musical specificity remains rare in documented reports. Evidence from case reports underscores rapid onset, often within days of initiating or withdrawing from these agents, affecting a mean age of 58.3 years and predominantly females (67.9%). Resolution occurs in 88.9% of instances upon discontinuation or dose adjustment, higher than in non-pharmacological etiologies, supporting . Opioids (e.g., , ) and antifungals like also feature prominently, at 11.1% each, via enhancement or central penetration, respectively. Elderly patients face elevated risk due to , amplifying imbalances and interactions that sensitize auditory networks. Toxic exposures, such as , can provoke auditory hallucinations through hypoxia-induced cortical dysfunction, though musical variants are less commonly specified. Overall, these factors highlight the role of reversible pharmacological perturbations in musical hallucinations, distinct from structural brain changes.

Other Risk Factors

Metabolic disturbances represent a less common but documented contributor to musical hallucinations, often through systemic impacts on neural function. has been associated with auditory hallucinations in case reports of neuropsychiatric presentations, potentially due to demyelination and altered neuronal excitability in auditory pathways, though specific musical content is infrequently detailed. Thyroid dysfunction, particularly in the context of , can precipitate musical hallucinosis by inducing autoimmune-mediated inflammation that disrupts processing, as evidenced in isolated cases where symptoms resolved with thyroid hormone replacement and immunosuppression. Electrolyte imbalances, such as or hypercalcemia, may exacerbate neural hyperexcitability, leading to auditory phenomena including music-like perceptions, typically in the setting of broader metabolic derangements. These factors account for a minority of cases, estimated at under 5% in clinical series of auditory hallucinations, with occasionally implicated in rare reports of perceptual distortions that mimic hallucinatory experiences. Infectious processes, such as , have been linked to musical hallucinations through direct involvement, altering activity via inflammation or post-infectious sequelae. For instance, rhomboencephalitis and can trigger persistent musical percepts by affecting structures responsible for auditory gating, with case showing resolution upon antimicrobial treatment. Post-viral states may contribute via residual that heightens spontaneous neural firing in auditory networks, though such associations remain anecdotal and represent fewer than 10% of reported etiologies in systematic reviews of triggers. Age-related decline, independent of profound , increases susceptibility to musical hallucinations, particularly in multimorbid elderly individuals where and subtle sensory-cognitive impairments converge. Inhibitory deficits in prefrontal and temporal regions can lead to of stored musical memories, manifesting as involuntary tunes without external stimuli, with up to 2.5% in older adults undergoing audiometric evaluation. This vulnerability is heightened in those with or mild cognitive changes, where systemic effects like reduced neural reserve amplify perceptual errors, comprising a notable subset of community-based cases among seniors. Emerging evidence points to transient triggers like and as precipitating factors for musical hallucinations even in otherwise healthy individuals, likely by impairing auditory processing and lowering the threshold for spontaneous activations in memory circuits. In non-clinical populations, severe sleep loss has been reported to induce music-like auditory experiences, resolving with rest, underscoring the role of temporary neural exhaustion in modulating hallucination risk.

Diagnosis

Clinical Evaluation

The clinical evaluation of musical hallucinations begins with a thorough history taking to characterize the auditory symptoms, their onset, potential triggers, level of , and functional impact. Patients typically describe hearing melodies, songs, or music without an external source, often familiar tunes such as childhood songs or popular melodies, which may loop repetitively or vary in complexity. The onset is frequently insidious but can be sudden, particularly in association with auditory deprivation or neurological events, and symptoms may last from minutes to hours daily. Triggers commonly include periods of silence, removal of hearing aids, or stress, with many patients reporting exacerbation in quiet environments due to underlying . is often preserved, allowing individuals to recognize the music as internally generated rather than real, though some may initially attribute it to external sources like radios or neighbors, leading to social embarrassment or isolation. Assessment should also explore the emotional distress and interference with daily activities, such as sleep disruption or concentration difficulties, to gauge severity and need for intervention. A comprehensive physical and neurological examination follows, prioritizing audiometric testing to evaluate hearing status, as is present in up to 60-80% of cases and serves as a key etiological clue. Standard , including pure-tone thresholds and , helps quantify deficits, such as moderate to severe bilateral loss, which may correlate with symptom intensity. The assesses insight into the hallucinatory nature of the experience, screens for concurrent delusions or affective symptoms, and evaluates cognitive function using tools like the Mini-Mental State Examination (MMSE) to rule out dementia-related contributions. A focused neurological screening is essential to detect focal signs, such as or sensory deficits, that might suggest underlying lesions, , or vascular events, while an ear, nose, and throat () evaluation excludes peripheral auditory pathologies. Differential diagnosis requires distinguishing musical hallucinations from similar conditions through targeted history and examination findings. Unlike simple , which involves non-musical tones or buzzing without melodic structure, musical hallucinations feature complex, organized auditory content; and symptom description aid this differentiation. Seizures, particularly , must be excluded via clinical history of ictal features and, if indicated, EEG, as musical phenomena rarely occur in isolation without other epileptic signs. is ruled out by assessing for fluctuating , inattention, and acute confusional states absent in isolated musical hallucinations. Other considerations include obsessive-compulsive disorder with musical obsessions, characterized by intrusive thoughts rather than perceptual experiences, evaluated using scales like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for resistance and compulsions. The Psychotic Symptom Rating Scales (PSYRATS), particularly the auditory hallucinations subscale, can quantify severity dimensions such as frequency, duration, and distress in broader hallucinatory contexts, though adaptation for musical content may be needed. Red flags prompting urgent evaluation include sudden onset, particularly with accompanying neurological symptoms like , focal , or altered , which may indicate acute cerebrovascular events or tumors; lack of insight suggesting possible psychiatric ; or rapid progression impacting daily functioning, necessitating prompt if indicated.

Neuroimaging and Laboratory Findings

plays a crucial role in identifying structural and functional abnormalities associated with musical hallucinations (MH), particularly to detect underlying neurological etiologies. (MRI) and computed tomography (CT) scans are commonly employed to evaluate for lesions, with frequent involvement of temporal and occipital regions observed in cases linked to cerebrovascular or tumors. For instance, structural lesions such as ischemic infarctions in the left , right frontotemporal strokes, or pontine lacunar infarcts have been documented in MH patients. In a of 393 cases, approximately 9% exhibited structural lesions correlating with the hallucinations. Functional imaging techniques, including (PET) and functional MRI (fMRI), reveal hyperactivity in the during MH episodes, supporting theories of aberrant neural . Hypometabolism in temporal regions has been noted in PET studies of MH related to auditory deprivation, such as in profound , while hyperperfusion in auditory and frontal areas appears in epileptic cases. is often normal in up to half of isolated auditory deprivation cases, underscoring the role of deafferentation without overt . A 2024 review of highlighted widespread in the , , and , emphasizing deafferentation patterns in hearing-impaired patients. Laboratory investigations typically include toxicology screens to identify pharmacological triggers, such as or selective serotonin reuptake inhibitors, alongside assessments of electrolytes, , and thyroid function to rule out metabolic contributors. These tests are generally unremarkable in primary MH but essential for excluding deficiencies or toxicities that may precipitate symptoms, as B12 deficiency has been linked to auditory s in broader contexts. Electroencephalography (EEG) is utilized to detect epileptiform activity, particularly in suspected , though findings are normal in many non-epileptic cases and abnormalities do not always correlate directly with hallucination onset. Overall, these objective tests guide etiological by confirming lesions in a minority of cases and highlighting functional correlates of deafferentation, integrating with clinical history to differentiate MH from other auditory phenomena. Recent studies, including a 2024 analysis, advocate for advanced to better delineate neural mechanisms in deafferentation-driven MH.

Treatment and Management

Addressing Underlying Causes

Addressing the underlying causes of musical hallucinations is the primary therapeutic approach, as targeted interventions often yield the highest rates of symptom resolution by correcting the precipitating factor. This strategy is particularly effective for reversible etiologies, where success rates can exceed 80% upon resolution of the root condition. Recent research from 2024-2025 emphasizes etiology-specific , with otologic treatments showing notable improvements in auditory deprivation cases. In cases stemming from auditory deprivation, such as profound , the provision of hearing aids or cochlear implants aims to restore sensory input and mitigate the deafferentation that triggers hallucinations. Digital hearing aids are recommended as an initial, non-invasive option to amplify external sounds, while cochlear implants are considered for severe, bilateral sensorineural loss unresponsive to amplification. A 2025 study of nine patients with post-lingual hearing loss reported subjective symptom improvement in 67% of cases following audiological rehabilitation, including hearing aids in eight patients and cochlear implantation in one. For neurological disorders, treatments focus on stabilizing aberrant neural activity or removing structural abnormalities. Antiepileptic drugs, such as , are effective for musical hallucinations associated with , particularly those involving foci, with a mean treatment response indicating partial to complete resolution in reviewed cases. Surgical resection of epileptogenic lesions or tumors has led to complete disappearance of symptoms in approximately 70% of documented instances involving . may be employed for inoperable lesions, though evidence is more limited and typically combined with pharmacological management. In migraine-related musical hallucinations, prophylactic agents like topiramate or can parallel the resolution of episodes with auditory symptoms, as auditory hallucinations often abate with control. Psychiatric conditions and pharmacological or toxic factors require adjustment of underlying contributors, such as mood disorders or substance exposure. Medication review and discontinuation of offending agents— including certain antidepressants with properties or other drugs like opioids and antiparkinsonian agents—are prioritized, often leading to rapid symptom cessation. protocols are essential for intoxication cases, with supportive care to manage withdrawal. If mood disturbances are comorbid, selective serotonin reuptake inhibitors like may be initiated to address depressive elements, showing moderate in targeted psychiatric presentations. A 2024 analysis of 27 drug-induced cases found complete resolution in 88.9% following dose reduction, termination, or switching of the causative . Overall, etiology-specific interventions demonstrate high , with up to 97% resolution in reversible pharmacological causes and 67-70% in otologic and neurological cases per systematic reviews and recent cohort studies. When the underlying cause remains unclear, symptomatic therapies may provide adjunctive relief.

Symptomatic Therapies

Symptomatic therapies for musical hallucinations are employed when the underlying is unclear, untreatable, or insufficiently responsive to causal interventions, aiming to alleviate the perceptual experience directly. These approaches include both pharmacological and non-pharmacological strategies, with primarily derived from case reports and small series due to the rarity of the condition. Treatment selection often considers age, comorbidities, and symptom severity, prioritizing low-risk options to avoid adverse effects, particularly in older adults. Pharmacological options focus on modulating activity to reduce intensity. Low-dose antipsychotics, such as (typically 0.5–2 mg daily), have shown efficacy in multiple cases, leading to symptom reduction within days to weeks; for instance, resolved musical hallucinations in a with vascular depression and in elderly individuals with hearing impairment. Antidepressants, including selective serotonin reuptake inhibitors like and tricyclic agents such as , have been effective in cases linked to obsessive-compulsive features or mood disorders, with complete resolution reported in up to 50% of treated instances in reviews of hypoacusis-related cases. Benzodiazepines, like , have provided short-term relief in some reported cases of musical hallucinations by enhancing inhibition, though their use is limited to brief durations to prevent dependence. inhibitors, such as donepezil or , demonstrate promise in persistent cases associated with cognitive decline, achieving symptom improvement in over 70% of reported hypoacusis patients. should be avoided in the elderly to minimize risks like and falls. Non-pharmacological interventions emphasize coping mechanisms and sensory modulation. (CBT) helps patients develop strategies to manage distress and preserve insight into the hallucinatory nature of symptoms, with case reports indicating reduced severity in psychiatric contexts; recent analyses underscore its role in maintaining psychological well-being without pharmacological side effects. Sound therapy, involving generators or ambient radio/music to mask internal perceptions, provides partial relief in 40–60% of hypoacusis cases by enriching auditory input. Emerging non-invasive techniques, such as repetitive transcranial magnetic stimulation (rTMS), have shown promise in isolated medication-resistant cases. Reassurance that musical hallucinations are typically benign and non-psychotic fosters adaptation, often leading to spontaneous attenuation without further intervention. These methods are particularly suitable for mild, persistent symptoms. Overall evidence for symptomatic therapies is variable, with improvement rates ranging from 20–60% across pharmacological and non-drug approaches, based on aggregated case outcomes rather than controlled trials. Many episodes self-limit within months, rendering long-term management unnecessary, though rare persistent cases may require ongoing multimodal care. Addressing underlying causes remains the first-line strategy when feasible.

History and Research

Historical Descriptions

Musical hallucinations have been documented in since the mid-19th century, with early reports often associating the phenomenon with psychiatric conditions or neurological disorders such as . The first known description appeared in 1844, when French psychiatrist Jules-Gabriel-François Baillarger reported cases of auditory hallucinations involving melodies in patients with mental illness. By 1881, Emmanuel Régis, another French psychiatrist, explicitly termed these experiences "musical hallucinations," noting their occurrence in individuals with hearing impairment or . In 1883, James Ormerod described a case of a 61-year-old woman with progressive and who perceived songs and spoken words as hallucinatory auditory experiences, highlighting an early link between the condition, , and disorders. These initial accounts frequently misinterpreted musical hallucinations as symptoms of , leading to psychiatric misdiagnosis, though some clinicians recognized their association with or organic brain pathology. In religious and cultural contexts predating formal , similar experiences were often interpreted as divine encounters, such as hearing angelic choirs or heavenly music, as recounted in historical spiritual narratives. During surgeries in the , neurosurgeon advanced understanding by electrically stimulating the temporal lobes of awake patients, eliciting vivid auditory hallucinations including fragments of music and familiar tunes, which supported the role of the temporal cortex in generating such percepts. The 1970s brought increased attention to musical hallucinations in deaf individuals, with case reports emphasizing their emergence amid profound rather than . For instance, Rosenbaum and Siegel documented two elderly patients with longstanding who suddenly "heard" elaborate orchestral music, underscoring the phenomenon's non-delusional nature and its prevalence in . A key milestone in the and early 1990s was the work of German Berrios, who in 1990 analyzed 46 cases from historical and new observations, classifying musical hallucinations as typically non-psychotic and often tied to , aging, or brain lesions in the non-dominant hemisphere, thereby shifting focus from psychiatric stigma to neurological evaluation and reducing misdiagnosis rates. This foundational historical perspective laid the groundwork for later refinements in classification and etiology.

Recent Advances

In the 2010s, functional neuroimaging studies provided key evidence supporting deafferentation as a core mechanism in musical hallucinations, particularly in cases linked to hearing loss, where reduced sensory input leads to spontaneous auditory cortex activity. A 2017 review of 23 cases highlighted activations in the superior temporal sulcus and other cortical regions, consistent with release from inhibitory controls due to peripheral deafferentation. This was further corroborated in a 2021 study using magnetoencephalography, which demonstrated heightened spontaneous activity in the auditory cortex following deafferentation in patients with schizophrenia-spectrum disorders experiencing auditory hallucinations, including musical variants. These findings shifted understanding from purely psychiatric models toward integrated sensory-neural explanations. Recent studies from 2023 to 2025 have advanced distinctions between musical hallucinations and related phenomena, such as —a variant characterized by repetitive, non-distressing musical percepts often tied to otologic factors—and (aCBS), where deafferentation from profound triggers complex . A 2024 prospective study of 15 patients with (mean age 74.1 years, 80% female) linked it primarily to age-related , with no active psychiatric comorbidities in most cases, differentiating it from symptomatic musical hallucinations. Concurrently, a 2025 analysis reported , including musical elements, in up to 16% of adults with , often resolving or modulating post-cochlear implantation, underscoring aCBS as a deafferentation-driven entity. Treatment efficacy for otologic causes has shown promise, with a 2024 study demonstrating 86.7% subjective improvement in musical tinnitus symptoms after two years of tinnitus counseling and sound therapy (e.g., hearing aids), far surpassing pharmacotherapy's 32% response rate. Psychiatric overlaps were illuminated in a 2023 of 81 patients, where 6% experienced musical hallucinations accompanied by secondary delusions (e.g., attributing music to external sources like neighbors) and complete lack of insight, often tied to and ; (1-1.5 mg/day) reduced symptoms in three cases, while aided one. Research gaps persist, including a of randomized controlled trials (RCTs) due to the condition's rarity and heterogeneous etiologies, limiting robust evidence for interventions beyond case series. Studies remain predominantly Western-focused, with underrepresentation of non-Western populations, potentially overlooking cultural variations in musical percepts or prevalence. Emerging applications of AI for analyzing patterns, such as through speech-to-text modeling of auditory reports, hold potential but lack clinical validation. Future directions emphasize functional connectivity research via resting-state fMRI to map auditory-memory network disruptions, as seen in 2025 studies linking improved hallucinations to targeted . Personalized therapies, tailored to (e.g., otologic restoration for deafferentation cases versus antipsychotics for delusional variants), are prioritized to enhance outcomes.

References

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC5420178/
  2. https://my.clevelandclinic.org/health/diseases/musical-ear-syndrome
  3. https://academic.oup.com/brain/article/138/12/3793/413249
  4. https://www.ejgm.co.uk/download/the-phenomenon-of-musical-hallucinations-an-updated-review-13522.pdf
  5. https://www.sciencedirect.com/science/article/pii/S1053810018301600
  6. https://pubmed.ncbi.nlm.nih.gov/23732881/
  7. https://link.springer.com/article/10.1007/s44337-024-00052-4
  8. https://psychiatryonline.org/doi/10.1176/appi.neuropsych.13110327
  9. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1253625/full
  10. https://pubmed.ncbi.nlm.nih.gov/15003072/
  11. https://pubmed.ncbi.nlm.nih.gov/9584545/
  12. https://pubmed.ncbi.nlm.nih.gov/11994933/
  13. https://pubmed.ncbi.nlm.nih.gov/22327620/
  14. https://pmc.ncbi.nlm.nih.gov/articles/PMC3029617/
  15. https://www.wjgnet.com/2220-3206/full/v14/i9/1386.htm
  16. https://www.sciencedirect.com/science/article/abs/pii/S0022510X04002734
  17. https://www.sciencedirect.com/science/article/pii/S0010945220304469
  18. https://consultqd.clevelandclinic.org/phantom-concerts-decoding-musical-ear-syndrome-in-older-adults
  19. https://jnnp.bmj.com/content/62/3/302.1
  20. https://hearingreview.com/hearing-loss/hearing-loss-prevention/risk-factors/review-uncovers-associative-links-hearing-loss-mental-health
  21. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2015.00814/full
  22. https://pmc.ncbi.nlm.nih.gov/articles/PMC6517562/
  23. https://pubmed.ncbi.nlm.nih.gov/31928560/
  24. https://pubmed.ncbi.nlm.nih.gov/25480808/
  25. https://psycnet.apa.org/record/1997-38232-001
  26. https://openneurologyjournal.com/VOLUME/11/PAGE/11/
  27. https://pmc.ncbi.nlm.nih.gov/articles/PMC4656967/
  28. https://pmc.ncbi.nlm.nih.gov/articles/PMC11150696/
  29. https://pmc.ncbi.nlm.nih.gov/articles/PMC4468361/
  30. https://www.sciencedirect.com/topics/neuroscience/cocaine-induced-psychosis
  31. https://emedicine.medscape.com/article/819987-clinical
  32. https://pmc.ncbi.nlm.nih.gov/articles/PMC11651228/
  33. https://pubmed.ncbi.nlm.nih.gov/12814119/
  34. https://pubmed.ncbi.nlm.nih.gov/9043753/
  35. https://pubmed.ncbi.nlm.nih.gov/12940329/
  36. https://pmc.ncbi.nlm.nih.gov/articles/PMC11206231/
  37. https://pubmed.ncbi.nlm.nih.gov/10473315/
  38. https://www.cambridge.org/core/journals/cns-spectrums/article/musical-hallucinations-a-brief-review-of-functional-neuroimaging-findings/5EB67FC514DAF98F7E3147777F5B1419
  39. https://pmc.ncbi.nlm.nih.gov/articles/PMC11684554/
  40. https://pmc.ncbi.nlm.nih.gov/articles/PMC12287728/
  41. https://journals.sagepub.com/doi/10.1177/0333102414563088
  42. https://doi.org/10.3389/fpsyg.2015.00814
  43. https://pmc.ncbi.nlm.nih.gov/articles/PMC5006484/
  44. https://doi.org/10.5152/iao.2025.231398
  45. https://jamanetwork.com/journals/jama/fullarticle/359668
  46. https://pubmed.ncbi.nlm.nih.gov/2180526/
  47. https://pubmed.ncbi.nlm.nih.gov/27989258/
  48. https://pmc.ncbi.nlm.nih.gov/articles/PMC12318152/
  49. https://pmc.ncbi.nlm.nih.gov/articles/PMC11999755/
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