Musical hallucinations

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

For the case of an 84 year old widow who complained of hearing sounds, she described her symptoms as pleasant, but also sought for treatment because she felt distracted. The music that played over her head was similar to the hymns and songs sung at her own wedding. Moreover, had been widowed for a while and had no signs of psychiatric disorders. However, she did have hypertension, hyperthyroidism, and osteoporosis. From these diagnosis it was theorized that the distress from the illnesses manifested the hallucinations. Through further analysis, researchers found that due the unexpected origin of the hallucinations, there is no clear diagnosis or treatments to carry out.

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 had a medical history of hypertension, hyperlipidemia, and atrial fibrillations.

Oftentimes, cases are commonly found in the elderly, but a 29-year-old female 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] Through scans, doctors found no neurological impairments, but prescribed her with medication. For her, the symptoms only lasted a year due to the treatment of quetiapine, which she responded well to.

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
• Psychiatric disorders
• Focal brain lesion
• Epilepsy
• Intoxication

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]

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]

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]