Musical ear syndrome
Encyclopedia
Musical ear syndrome 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) and some have suggested this phenomenon could be included under this diagnosis.
The occurrence of MES has been suggested to be very high among the hearing impaired.
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. 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
. The condition may be associated with early stages of dementia
.
It is postulated that MES is caused by hypersensitivity in the auditory cortex caused by sensory deprivation, secondary to their hearing loss.
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.
Charles Bonnet syndrome
Charles Bonnet syndrome is a condition that causes patients with visual loss to have complex visual hallucinations, first described by Charles Bonnet in 1760 and first introduced into English-speaking psychiatry in 1982.-Characteristics:...
(visual hallucinations in visually impaired people) and some have suggested this phenomenon could be included under this diagnosis.
The occurrence of MES has been suggested to be very high among the hearing impaired.
Sufferers typically hear music or singing and the condition is more common in women. The hallucinatory experiences differ in phenomenology
Phenomenology (science)
The term phenomenology in science is used to describe a body of knowledge that relates empirical observations of phenomena to each other, in a way that is consistent with fundamental theory, but is not directly derived from theory. For example, we find the following definition in the Concise...
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
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
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. 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
Tinnitus
Tinnitus |ringing]]") is the perception of sound within the human ear in the absence of corresponding external sound.Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period , ear...
. The condition may be associated with early stages of dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
.
It is postulated that MES is caused by hypersensitivity in the auditory cortex caused by sensory deprivation, secondary to their hearing loss.
Investigations such as magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
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
Robert Schumann
Robert Schumann, sometimes known as Robert Alexander Schumann, was a German composer, aesthete and influential music critic. He is regarded as one of the greatest and most representative composers of the Romantic era....
said he heard angelic music and music from other composers, which formed the basis for his violin concerto
Violin Concerto (Schumann)
Robert Schumann’s Violin Concerto in D minor, WoO 23 was his only violin concerto and one of his last significant compositions, and one that remained unknown to all but a very small circle for more than 80 years after it was written.- Composition :...
. An alternative explanation is that his symptoms were caused by syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
or mercury poisoning
Mercury poisoning
Mercury poisoning is a disease caused by exposure to mercury or its compounds. Mercury is a heavy metal occurring in several forms, all of which can produce toxic effects in high enough doses...
used for its treatment.