Objective To evaluate whether listening to music through binaural headphones contributes to the perception of pain and anxiety in patients undergoing closed nasal bone fracture reductions. Study Design Randomized controlled trial. Subjects and Methods We recruited patients from San Juan de Dios Hospital with displaced nasal fractures who required a reduction and assigned them to a control group or a music group. For both groups, a protocolized closed reduction of the nasal fracture with local anesthesia was performed. The music group heard music through headphones during the pre-, intra-, and postprocedural periods of the intervention. Physiological variables (blood pressure and heart rate) were measured. An anxiety survey (State-Trait Anxiety Inventory) and the visual analog scale for measuring pain were also applied. Results The music group exhibited significantly lower levels of systolic blood pressure ( P = .0001), anxiety ( P < .0001), and pain ( P = .0004) than the control group. Conclusion Listening to music through headphones—a safe and low-cost intervention—appears to aid in pain and anxiety management associated with procedures that are usually uncomfortable, such as the reduction of nasal bone fractures with local anesthesia. We believe that this effect is achieved by the modulation of pain and anxiety on an emotional-affective dimension at a central level. Given its safety, feasibility, and low cost, music therapy should be considered a complementary treatment for pain and anxiety management for nasal fracture reduction performed with local anesthesia, as well as for other medical procedures of similar pain levels conducted without general anesthesia.

We read with interest the article Ortega et al 1 and thank the authors for bringing up the use of music as an anxiolytic and analgesic before performing nasal bone fracture reduction. We have interest in this area as we are also working in this field and want to share our thoughts related to this study. We agree music has appreciable anxiolytic potential in clinical medicine, especially when used for certain surgical procedures. 2 Similarly, its use as a complementary strategy for the relief of acute, procedural, and cancer/chronic pain in the medical setting has been well described. 3 The purpose of this letter, however, is to outline certain features in this study design that may have affected the results and overall study conclusion. We believe the lack of patient choice in terms of music preference, opting instead to use a preselected playlist, is one such fault. Although studies comparing the effects of patient-preferred music vs preselected music on patient anxiety levels perioperatively have varied in outcome, it has been repeatedly demonstrated that patients who choose their preferred music while undergoing a painful stimulus report significantly less pain intensity as well as improved pain tolerance and control over the perceived experience of pain. 4 Referring to this form of intervention as ''music therapy'' is misleading. It is rather a form of ''music medicine,'' defined as ''pre-recorded music listening experiences administered by medical personnel,'' whereas music therapy is classified as an intervention ''involving a relationship between client and therapist, a therapeutic process'' with a carefully planned music experience. 5