If you've ever had a catchy tune play over and over again in your head, you can identify with this 21-year-old:
I began hearing phantom music when I was very young (quite possibly before I reached 10 years of age). I vividly remember hearing a distinct pianist serenading me to sleep on many occasions. I would sit up in my bed, listening intently, but as soon as I sat up the sound would disappear. Once I returned to my previous position in bed, the music would continue. As far as I can recall the music stopped as I entered adolescence.
Recently, however, the single pianist seems to have decided to get fancy. Earlier this week I was settling down to bed in my new apartment, and I could have sworn that a full orchestra was being carried to my ears over the air conditioning vent. I did notice that when I sat up the sound ceased, just like in my childhood. Similarly, as soon as the air conditioner turned off, the music went with it.1
Auditory hallucinations, as experienced by the writer above, are defined as the perception of an auditory event such as voices or music in the absence of an external stimulus.
Such hallucinations, especially the hearing of distinct, commanding voices, are often connected with psychiatric disorders such as schizophrenia; however, musical hallucinations are usually nonpsychiatric in nature and linked to conditions such as hearing loss, brain lesions, diseases such as epilepsy, injuries, drugs and alcohol withdrawal.
Musical Ear Syndrome
Once considered rare, auditory hallucinations, especially the perception of phantom music, are so common among people with hearing loss that Neil G. Bauman, PhD, recommends the more neutral term "musical ear syndrome" or MES to refer to the condition. 2 In his speaking engagements, up to 30 percent of his audiences will publicly admit to having heard "strange phantom voices, ethereal music or other spooky sounds that no one else hears."
According to Bauman in a 2004 article in Hearing Health , many with hearing loss are reluctant to disclose to others the hearing of phantom sounds because of the history and use of the term "hallucination," which "conjures up visions of padded cells and professionals in white coats talking in hushed tones."
In other words, auditory and other forms of hallucinations are often equated with "going crazy." This pervasive and detrimental myth needs to be silenced. Pun intended.
In 2006, Chilean researchers published research in Acta Otolaryngologica on spontaneous musical auditory perceptions in 32 patients who developed abrupt bilateral sensorineural hearing loss.3 Surprisingly, all of the subjects had experienced such perceptions following their hearing loss in the second ear or when hearing loss in both ears occurred simultaneously.
Two of the patients were image tested for brain activity with single photon computerized emissions tomography (neuroSPECT) while they were having these phantom perceptions.
Increased activity was found in Brodmann's area 39 within the parietal lobe, especially on the right side of the brain, along with both frontal lobes at the middle gyrus. Decreased activity occurred in area 38 of Brodmann within the temporal lobe on both sides. This pattern of excitation and inhibition of brain regions is also seen in normally hearing volunteers stimulated with pure tones.
The researchers hypothesize, "When an individual has abrupt bilateral sensorineural hearing loss, stored musical memory can be released and this person can have musical perceptions without an external source. It is likely that an abrupt bilateral loss of inner ear function might uninhibit neuronal groups storing auditory memory."
In an earlier 2000 study in Brain , a neurologist at Newcastle University studied six subjects with musical hallucinations following acquired deafness.4 Brain imaging was carried out to identify areas where activity increased as a function of the severity of the hallucination. The researcher found clusters of correlated activity in the posterior temporal lobes, the right basal ganglia, the cerebellum and the inferior frontal cortices, which is "similar to that previously demonstrated during the normal perception and imagery of patterned-segmented sound."
In 2005, Welsh researchers published in the International Journal of General Psychiatry an analysis of 30 cases of musical hallucinations.5 One-third of cases concerned people who were deaf or hard-of-hearing. Patients reported hearing a wide variety of songs, among them "Don't Cry for Me Argentina" and "Three Blind Mice." In two-thirds of the cases, the music was religious, with six people reporting hearing the hymn "Abide with Me."
In an interview with the NewYork Times, coauthor Victor Aziz, MD, a psychiatrist at St. Cadoc's Hospital in Wales, said he believes that people tend to hear songs they have heard repeatedly or that are emotionally significant to them. "There is meaning behind these things," he said.6
In the news article, Aziz also noted that two-thirds of his subjects were living alone and thus were not getting much stimulation. One patient experienced fewer musical hallucinations when she entered a nursing home setting, "because then she was talking to people, she was active."
There is no standard procedure for treating musical hallucinations. Antidepressant or antipsychotic drugs are used with some success, along with cognitive behavioral therapy to help patients understand what's going on in their brains. "Sometimes simple things can be the cure," Aziz said. "Turning on the radio may be more important than giving medication." Despite these treatments, many people find little relief.
Aziz suspects that musical hallucinations will become more common in the future, with people today awash in music from radio, television, cell phones and iPods.
Perhaps the projected increase in musical hallucinations is already evident in the phenomenon of phantom ringing, called "ringxiety," that many cell phone users experience. Two-thirds of cell phone users who rely on mobile phones for mood regulation and maintaining relationships reported hearing their phone ring or feeling it vibrate when it had not actually rung. The more frequently a person uses the phone, the more often he or she reported hearing a phantom ring.7
A Positive View
Bauman, who coined the term "musical ear syndrome," takes the mos positive view, stating, "Auditory hallucinations aren't all bad. Many people actually find them pleasant. They allow you to experience often beautiful music without hearing aids, assistive devices, players, headphones or other paraphernalia."2
Jess Dancer is professor emeritus of audiology at the University of Arkansas at Little Rock . Contact him at firstname.lastname@example.org with your personal or professional experience with auditory hallucinations.
1. Musical Ear Syndrome. Available at http://hearinglosshelp.com/weblog/?cat=8 . Accessed May 19, 2008.
2. Bauman N. Hearing Health. 2004. Available at www.drf.org/hearing_health/archive/2004/winter04_musicalear.htm . Accessed May 19, 2008.
3. Goycoolea M, Mena I, Neubauer S. Spontaneous musical auditory perceptions in patients who develop abrupt bilateral sensorineural hearing loss. An ininhibition syndrome? Acta Otolaryngologica. 2006.126(4):368-374.
4. Griffiths TD. Musical hallucinosis in acquired deafness. Phenomenology and brain substrate. Brain. 2000.123(Pt 10):2065-2076.
5. Warner N, Aziz V. Hymns and arias: musical hallucinations in older people in Wales . International Journal of General Psychiatry. 2005. 20(7):658-660.
6. Zimmer, C. Neuron network goes awry, and brain becomes an ipod. New York Times. 2005. Available at www.nytimes.com/2005/07/12/health/psychology/12musi.html ? Accessed May 19, 2008.
7. Cell users experience phantom ringing; suffer from ringxiety. Science Daily. September 17, 2007. Available at www.sciencedaily.com/releases/2007/09/070914165302.htm . Accessed May 19, 2008.