Musical hallucinations in a deaf elderly patient

Abstract

A remarkably observant 89-year-old woman experienced the abrupt onset of musical hallucinations on the background of longstanding progressive hearing loss and in the absence of psychosis or major dementia. These hallucinations were nearly constant, wellformed perceptions of religious hymns, and their content could be altered by several mechanisms. The patient also occasionally heard voices recapitulating childhood experiences. One can speculate that the syndrome relates to sensory deprivation.

Musical hallucination associated with hearing loss

“…Considering hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information), the most accepted physiopathology of musical hallucinosis is the disinhibition of auditory memory circuits due to sensory deprivation. Hearing loss seems to be an important factor that predisposes to musical hallucination 32 , once this condition occurs after several years of hypoacusis or anacusis 33,34 . Sensory deprivation seems to be the most consistent finding associated to unilateral auditory hallucination, which is usually ipsilateral to the otological lesion 35 and suggests that in theses cases the etiology is organic 36 .…”

“…Gordon and Gilbert argued that otological diseases facilitate the occurrence of musical hallucination induced by drugs 43 and Gilbert described a deaf patient with musical hallucination induced by pentoxifillin who managed to voluntarily modify the hallucination by concentrating on a favorite melody that was not the one she has been listening 44 . Other authors also described some patients who were able to replace the ongoing musical hallucination with another melody by means of concentration or subvocalization [32][33][34] . Ross et al suggested that the cause of the auditory hallucination is not necessarily related to the auditory pathways 33 , and this poit of view was shared by Miller and Crosby, that described a case of a patient who could change the hallucination melody by means of visual stimuli (turning the pages of a books) 32 .…”

“…Other authors also described some patients who were able to replace the ongoing musical hallucination with another melody by means of concentration or subvocalization [32][33][34] . Ross et al suggested that the cause of the auditory hallucination is not necessarily related to the auditory pathways 33 , and this poit of view was shared by Miller and Crosby, that described a case of a patient who could change the hallucination melody by means of visual stimuli (turning the pages of a books) 32 . Functional imaging in musical hallucination -A group of authors evaluated three patterns related to musical perception and imagery: songs (with words), melodies and timbre [45][46][47] .…”

“…Some authors point out that the hearing aid can improve or even eliminate musical hallucination [32][33][34] . This improvement happens because auditory hallucination may be influenced by the external acoustical environment.…”

Musical Hallucinations in Schizophrenia

“…Only a depressed state was relatively common among them, and they ruled out any association with specific mental disorders. In general, investigators have pointed to an association with deafness [5,6,[9][10][11] and similarities to Charles Bonnet syndrome [12][13][14][15], and the principal concepts proposed to explain it appear to have been based on the theory of sensory deprivation [9,11,[14][15][16] and the 'fragility of cerebral function' due to aging [14,15].…”