Musical ear syndrome

Musical ear syndrome (MES) describes a condition seen in people who have hearing loss and subsequently develop auditory hallucinations. It is comparable to Charles Bonnet syndrome (visual hallucinations in visually impaired people)^[1] and some have suggested this phenomenon could be included under this diagnosis.^[2]

The occurrence of MES has been suggested to be very high among the hearing impaired.^[3]

Sufferers typically hear music or singing and the condition is more common in women. The hallucinatory experiences differ in phenomenology from that commonly experienced in psychotic disorders although there may be some overlap. The most important distinction is the realization that the hallucinations are not real. Delusional beliefs associated with the hallucinations may occur, but some degree of insight should be preserved. There should not be any other psychotic symptoms present, especially hallucinations in other modalities. There should be an absence of serious mental illness, although mild cognitive impairment is often associated with MES.

The likely cause is a small cerebrovascular event affecting the auditory cortex.^{[by whom?]} This "hole" in the hearing range is "plugged" by the brain confabulating a piece of information - in this case a piece of music. A similar occurrence is seen with strokes of the visual cortex where a visual field defect occurs and the brain confabulates a piece of visual data to fill the spot. This is described by sufferers as an image in the visual field which is patently nonsensical.

The hallucinations are usually not unpleasant but may cause irritation due to their persistent nature. It is common for sufferers to have a history of tinnitus.^[4] The condition may be associated with early stages of dementia.^{[citation needed]}

It is postulated that MES is caused by hypersensitivity in the auditory cortex caused by sensory deprivation, secondary to their hearing loss.^[3]

Investigations such as magnetic resonance imaging or CT scanning and electroencephalograms (EEGs) may be worthwhile, but will rarely show any serious pathology.

Treatment entails reassurance and maximizing hearing with hearing aids. Medications can be helpful, such as antipsychotics, benzodiazepines or antiepileptics, but there is very limited evidence for this.

Several historical descriptions exist that may possibly be explained by musical ear syndrome. Towards the end of his life, Robert Schumann said he heard angelic music and music from other composers, which formed the basis for his violin concerto. An alternative explanation is that his symptoms were caused by syphilis or mercury poisoning used for its treatment.

References

• "Musical Ear Syndrome". Archived from the original on 2008-03-04. http://web.archive.org/web/20080304053336/http://www.drf.org/hearing_health/archive/2004/winter04_musicalear.htm. Retrieved 2008-07-12. 

Footnotes

1. ^ Berrios GE and Brook P (1982) The Charles Bonnet Syndrome and the Problems of Visual Perceptual Disorder in the Elderly. Age and Ageing 11: 17-23
2. ^ Yuksel FV, Kisa C, Aydemir C, Goka E (2004). "Sensory deprivation and disorders of perception". Can J Psychiatry 49 (12): 865–6. PMID 15679215. https://ww1.cpa-apc.org/Publications/Archives/CJP/2004/december/lettYuksel.asp. 
3. ^ ^{a b} Goycoolea M, Mena I, Neubauer S (April 2006). "Spontaneous musical auditory perceptions in patients who develop abrupt bilateral sensorineural hearing loss. An uninhibition syndrome?". Acta Otolaryngol 126 (4): 368–74. doi:10.1080/00016480500416942. PMID 16608788. http://www.informaworld.com/openurl?genre=article&doi=10.1080/00016480500416942&magic=pubmed. 
4. ^ Berrios GE (1990) Musical hallucinations: a historical and clinical study. British Journal of Psychiatry, 156: 188-194