The Art of Musical Hallucinations

An 81-year-old with a history of high blood pressure heard folk songs from her childhood for hours every day. (Alvarez Perez, 2017). She was only able to hear the music from her left ear since her right ear had lost auditory function (Alvarez Perez, 2017). She assumed that this music was originating from the outside environment and could not imagine that its origin could be from her brain. After the woman’s symptoms progressed and the melodies increased in intensity, her concerned family consulted with physicians. Psychiatrists found that the woman was experiencing musical hallucinations (Alvarez Perez, 2017). Musical hallucination is an uncommon phenomenon that consists of a complex form of auditory hallucination (Alvarez Perez, 2017). These hallucinations are prevalent in specific groups, interacting with other neurological diseases to create concerning consequences. However, research has shown that there are a variety of possible treatments and solutions to musical hallucinations. 

Figure 1. This image is from a music teacher who experienced musical hallucinations. She used musical notation to produce her hallucinations. She stated that each set of bars repeated in intervals

Musical hallucination, commonly referred to as MH, is a unique type of auditory hallucination. Rather than hearing vibrations, whirring, or whistling like most auditory hallucination patients, MH patients generally hear familiar melodies which can be accompanied by singing. Many of these tunes tend to be hymns or carols from the patients’ childhood but there have also been reports of subjects hearing unfamiliar melodies (Golden, 2015). MH is most common in women over the age of 60. Currently, no underlying cause has been found for musical hallucination, but there is an association between MH and brain tumors, hearing loss, dementia, epilepsy, as well as drug withdrawal (British Tinnitus). Musical hallucinations are extremely rare. A study of 3678 patients at the Department of Psychiatry of 2 general hospitals found that only 0.16% of psychiatric patients experience musical hallucinations (Fukunishi, 1998). Additionally, a survey at an audiology clinic with 125 subjects ages 65+ found that only 2.5% of all auditory hallucinations were musical hallucinations (Cole, 2002). However, these statistics may not be fully representative as MH is under-reported due to subjects’ concerns about being perceived as “crazy” (Golden, 2015).

The intersection between musical hallucinations and other neurological processes is being studied by healthcare professionals. The Mayo Clinic Medical Records Linkage System identified all subjects who underwent evaluation for musical hallucinations from January 1st, 1996 to December 31st, 2013 for a total of 393 subjects in the study (Golden, 2015). The mean age of the subjects in the sample was 56 years, with 64.5% of the subjects being female, and 26.7% having hearing impairments prior to experiencing MH. The subjects were split into 5 groups based on pre-existing conditions: Psychiatric disorders (39%), neurologic disorders (25%), drug toxicity or withdrawal (12%), structural brain lesions (9%), and Not Otherwise Classifiable or NOC (15%). Interestingly, the linkage system showed that subjects in each group hallucinated different genres of music (Golden, 2015). Subjects in the psychiatric disorders group experiencing depression, bipolar disorder, schizoaffective disorder, and anxiety hallucinated songs based on their mood at the time. Subjects in the neurologic disorders group, experiencing symptoms associated with Alzheimer’s and Parkinson’s, hallucinated songs that were religious, patriotic, or tunes reminiscent of childhood. These individuals were also most likely to believe that their neighbors were playing the music rather than realizing that the music was a hallucination. Individuals in the drug and toxicity withdrawal group were most likely to hear elevator music. Subjects in the structural brain lesions group most frequently hallucinated modern genres of music such as rock and country-pop. Lastly, subjects in the NOC group, the category with the highest average age, heard similar music to subjects in the neurological disorders group (Golden, 2015). 

Figure 2. Mayo Clinic’s study of 393 subjects with musical hallucination were classified into five groups: neurological, psychiatric, structural, drug effect, and not otherwise classifiable

Though musical hallucinations are rare, individuals who struggle with this experience severe symptoms and have difficulty focusing on other aspects of their lives. Because the number of published MH cases is low and mechanisms affecting MH are very diverse, it has been difficult to find treatment options that are effective for all subjects (Coebergh, 2015). Regardless, scientific research has led to some treatment options that are currently being tested. A literature search yielding 175 articles with 516 cases found that MH can disappear without any intervention and pharmacological treatment methods such as antidepressants are effective when MH is associated with psychological disorders (Coebergh, 2015). Additionally, current research is focused on acetylcholinesterase inhibitors to treat MH associated with hearing loss. Acetylcholine inhibitors are neurotransmitters that inhibit the normal breakdown of acetylcholine (Blom, 2015). A study at the University of Groningen found that acetylcholinesterase inhibitors may be a faster and safer alternative to antidepressants and antipsychotics. However, these findings have only been tested on six patients thus far, requiring replicated trials to yield any fruitful efficacy (Blom, 2015).

Musical hallucinations, while rare, can be extremely obtrusive and overwhelming to patients experiencing them. These hallucinations are prevalent in specific groups and can interact with other neurological diseases to create worrisome consequences. Though research has shown that there are a variety of possible solutions for musical hallucinations, these treatments may not be fully effective. Because MH is not well understood, it tends to be severely stigmatized. In order to effectively combat musical hallucinations, de-stigmatization of the condition and increased research and funding are necessary. 

Edited by Aidan Spradlin

References

Erin C. Golden, Keith A. Josephs, Minds on replay: musical hallucinations and their relationship to neurological disease, Brain, Volume 138, Issue 12, December 2015, Pages 3793–3802, https://doi.org/10.1093/brain/awv286 

Alvarez Perez, Purificacion et al. “”Doctor, I Hear Music”: A Brief Review About Musical Hallucinations.” The open neurology journal vol. 11 11-14. 28 Feb. 2017, doi:10.2174/1874205X01711010011

Blom, Jan Dirk et al. “Musical hallucinations treated with acetylcholinesterase inhibitors.” Frontiers in psychiatry vol. 6 46. 7 Apr. 2015, doi:10.3389/fpsyt.2015.00046

Coebergh, Jan A., et al. “Musical Hallucinations: Review of Treatment Effects.” Frontiers in Psychology, vol. 6, 2015, https://doi.org/10.3389/fpsyg.2015.00814. 

BritishTinnitus. “Musical Hallucination (Musical Tinnitus).” British Tinnitus Association, https://www.tinnitus.org.uk/musical-hallucination. 

Fukunishi, Isao, et al. “Prevalence Rate of Musical Hallucinations in a General Hospital Setting.” Psychosomatics, vol. 39, no. 2, 1998, p. 175., https://doi.org/10.1016/s0033-3182(98)71368-4. 

Cole, Martin G., et al. “The Prevalence and Phenomenology of Auditory Hallucinations among Elderly Subjects Attending an Audiology Clinic.” International Journal of Geriatric Psychiatry, vol. 17, no. 5, 2002, pp. 444–452., https://doi.org/10.1002/gps.618. 

Image Citations

Kumar, Sukhbinder, et al. , 2012, “A Brain Basis for Musical Hallucinations.” Cortex, vol. 52, 2014, Retrieved January 27 2022 , https://doi.org/10.1016/j.cortex.2013.12.002. 

Erin C. Golden, Keith A. Josephs, 2015, Minds on replay: musical hallucinations and their relationship to neurological disease, Brain, Volume 138, Issue 12, Retrieved January 27 2022 https://doi.org/10.1093/brain/awv286 

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