Obsessive-compulsive disorder presenting with musical obsessions in otosclerosis: a case report

Abstract

IntroductionMusical obsessions consist of intrusive recollections of music fragments that are experienced as unwanted. Otosclerosis is caused by an abnormal bone homeostasis of the otic capsule and represents a frequent cause of hearing impairment. Many conditions causing hearing loss have been associated with musical hallucinations, but the association between musical obsessions and hearing loss is frequently overlooked.Case presentationWe present the case of a 51-year-old Caucasian woman with a history of obsessive-compulsive disorder who developed musical obsessions soon after being diagnosed with otosclerosis. She was referred to our obsessive-compulsive disorder outpatient unit by her general psychiatrist. At the time of our first evaluation, she had severe musical obsessions that interfered with her social functioning and made her unable to follow conversations. She was started on 40mg of paroxetine and 2.5mg of aripiprazole, which led to significant improvement of her symptoms and of her social and work functioning.ConclusionsTo the best of our knowledge, this is the first report of musical obsessions in a patient with hearing loss due to otosclerosis and a history of obsessive-compulsive disorder. This case suggests that a differential diagnosis of obsessive-compulsive disorder should be carefully considered in patients with hearing impairment who complain of involuntary musical imagery, especially in those patients who have a previous history of obsessive-compulsive disorder.

Musical hallucinations and their relation with epilepsy

“…We excluded all reports of musical illusions, palinacusis, hypnagogic or hypnopompic hallucinations, and obsessions (i.e., ‘earworms’). Incidentally, our interpretation of obsession versus hallucination (i.e., ‘earworm’ versus musical hallucination) rarely differed from that of the original authors (e.g., Islam et al [15]). Epilepsy was deemed the main cause when the onset of musical hallucinations was temporally linked to a seizure, e.g., an aura/ictal episode or post- or interictal episode, when the hallucinations improved with surgical treatment for likely epileptic foci, and/or when epileptiform EEG abnormalities disappeared which had been present prior to treatment (in the appropriate clinical context).…”

Musical hallucinations: review of treatment effects

“…We then excluded all reports of musical illusions, pseudohallucinations, palinacusis, hypnagogic or hypnopompic hallucinations, and obsessions (i.e., “earworms”); only rarely did our interpretation of obsession vs. hallucination (i.e., “earworm” vs. MH) differ from that of the original authors (e.g., Islam et al, 2014). A total number of 276 cases in 147 articles met these inclusion criteria (Colman, 1894; Penfield and Erickson, 1941; David et al, 1944; Mulder and Daly, 1952; Rozanski and Rosen, 1952; Arieff and Brooks, 1958; Rennie, 1964; Ross et al, 1975; Scott, 1975, 1979; Schiffter and Straschill, 1977; Miller and Crosby, 1979; Raghuram et al, 1980; Wieser, 1980; Gilchrist and Kalucy, 1983; Hammeke et al, 1983; Mackworth-Young, 1983; Aizenberg et al, 1986, 1987, 1991; Jonas, 1986; Cambier et al, 1987; Lanska et al, 1987; Patel et al, 1987; Keshavan et al, 1988, 1992; Duncan et al, 1989; Fenton and McRae, 1989; Wengel et al, 1989; Berrios, 1990; McLoughlin, 1990; Donnet and Régis, 1991; Fisman, 1991; Nevins, 1991; Podoll et al, 1991; Shapiro et al, 1991; Vallada and Gentil, 1991; Wagner and Gertz, 1991; Freeland and O'Reilly, 1992; Klostermann et al, 1992; Paquier et al, 1992; Erkwoh et al, 1993; Feehan and Birchwood, 1993; Fénelon et al, 1993; Gilbert, 1993; Inzelberg et al, 1993; Isaacson et al, 1993; Couper, 1994; Hosty, 1994; Murata et al, 1994; Terao, 1995; Wodarz et al, 1995; Baurier and Tuca, 1996; Gertz et al, 1996; Stephane and Hsu, 1996; Douen and Bourque, 1997; Marneros et al, 1997; Thorpe, 1997; Clark, 1998; Fernandez and Crowther, 1998; Fukunishi et al, 1998b, 1999; Terao and Tani, 1998; Baba and Hamada, 1999; Terao and M...…”

“…Improvement was deemed meaningful whenever a report implied that the patient had experienced an improvement in quality of life; irrespective of whether the MH were experienced as quieter, less frequent, or not interfering as much with sleep or daily activities, or whether there was increased acceptance/insight or improved mood/anxiety. Two articles (Bergman et al, 2014 ; Islam et al, 2014 ) used the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). At times it was difficult to rate the exact treatment effects; e.g., Warner and Aziz (Warner and Aziz, 2005 ) briefly described 30 patients, mostly elderly people suffering from hearing loss, and stated that 90% were treated (among which 23 with antipsychotics).…”

“Radio Inside My Head”: A Curious Case of Early Onset “Stuck Song Syndrome” or Obsessive-Compulsive Disorder with Predominant Musical Obsession

“…[ 5 ] Musical obsessions are best explained as miscellaneous obsessions which consist of repetitive, intrusive thoughts of musical words/sound/tunes which the patient is not able to suppress, and this causes marked anxiety and distress. [ 6 ] Musical obsessions are also referred as earworms,[ 7 ] stuck song syndrome,[ 8 ] or involuntary musical imagery. [ 9 ] At present, the OCD symptom checklist Yale-Brown Obsessive Compulsive Scale (Y-BOCS)[ 10 ] includes an item of intrusive nonsense sounds, words, and music.…”