Multidisciplinary Assessment of Patients with Musical Hallucinations, Tinnitus and Hearing Loss

Abstract

Background: Although auditory hallucinations are considered a psychopathological phenomenon, musical hallucinations have been reported in individuals without psychosis but with auditory symptoms (tinnitus and/or hearing loss). Thus, a possible different cognitive functioning may be involved in musical hallucinations. The aim of the study was to characterize patients with tinnitus and musical hallucinations through a multidisciplinary assessment, allowing a better understanding of these concomitant phenomena. Sampling and Methods: As this sample is rare to find, all consecutive patients with tinnitus, hearing loss and musical hallucinations were included over a 3-year period, excluding those unable to respond. All subjects underwent the following assessments: (1) otolaryngological and audiological assessment (physical examination and audiometry), (2) neurological assessment (cognition, electroencephalogram and imaging examination) and (3) psychiatric assessment (structured interview). Results: A total of 16 patients were included (87.5% women; mean age 61.43 ± 15.99 years). The otolaryngological examination was normal in all cases, but audiometry revealed that the degree of hearing loss was severe to profound in 68.75% of participants. Neurological assessment showed electroencephalogram changes in only 17.6% of cases, while 25% presented with mild attention deficit and 43.75% had small foci of gliosis or ischemia on the imaging examination. Psychiatric assessment showed that 68.75% of cases had depression, 6.25% had anxiety disorder and 25% had no psychiatric conditions. Conclusions: Musical hallucinations were strongly associated with female elderly adults and with mood disorders. Thus, in contrast to common auditory hallucinations, patients with musical hallucinations associated with tinnitus and hearing loss should be offered a more multidisciplinary assessment.

Musical hallucinations and their relation with epilepsy

“…Sometimes musical hallucinations have been ascribed to epilepsy when there were EEG abnormalities (not necessarily correlating with the clinical phenomenon) and/or a response to antiepileptics (i.e., pharmacological dissection); which is both questionable evidence of a relation. In another study, three out of 16 individuals with musical hallucinations (17.6%) had changes in the EEG (two with epileptiform activity in the left temporal region or in the midline/bilateral parasagittal region, and one with slow waves at the posterior temporal/left occipital regions), even though none of them exhibited symptoms of epileptic seizures [12]. A final example stems from Wengel et al [13] who noted that three out of their five patients with musical hallucinations showed temporal-lobe abnormalities on the EEG (one slow, one sharp-wave, and one alpha and theta transients).…”

The phenomenon of musical hallucinations: An updated review

“…According to the study in [70], Lewy body disease is the most common neurodegenerative condition, followed by Parkinson's disease and Parkinson's disease dementia. A [6] 225 General population 44 [8] 194 Audiology clinic 7 (3.6) [9] 123 Psychiatric hospital 5 (3.9) [68] 832 ENT-audiology clinics 52 [69] 16 Not specified 16 [70] 393 Mayo clinic medical records 393 [71] 24 Outpatient clinic 24 [72] 30 Psychiatric clinics handful of case reports have identified a link between MHs and structural abnormalities of the brain.…”

“…These findings are consistent with those of previous studies. A recently published study examined 16 older women and determined that MHs were substantially linked to mood disorders among them [69]. Psychogenic pain, adverse childhood experiences, adaptation impairment, borderline personality disorder, attentiondeficit/hyperactivity disorder, and phase of life impairment are other psychiatric disorders linked to the onset of MHs [9,11,56].…”

Musical hallucinations, musical imagery, and earworms: A new phenomenological survey

“…The study mainly reports on brain regions associated with MH, but does note that many individuals with psychiatric disorders found that the experiences were ‘mood-congruent’ (e.g., sad music when they were feeling depressed). Indeed, within psychiatric patients reporting MH, depression seems to be the most common diagnosis (69%), along with hearing loss or tinnitus ( Golden and Josephs, 2015 , Rocha et al, 2015 , Teunisse and Olde-Rikkert, 2012 ). A case series presented by Warner and Aziz (2005) of patients referred to old-age psychiatric services, though, only found a rate of hearing loss of 33% in patients with MH – perhaps surprisingly low given a mean age of 78 years.…”