These comments do not constitute a clinical opinion. They have been written in response to a large number of enquiries about musical hallucinations. Because I receive so many of these I regret I cannot enter into individual correspondence: I hope they are of some help. The comments represent some observations based on my own experience and knowledge of the literature. A description of the typical features of the common form of the condition in association with deafness is available in Stewart et al (2006) [click here for link]. There are articles from lay press in media section as well.

COMMON FORM

(in association with hearing loss, aka ‘auditory Charles Bonnet syndrome’)

1. The phenomenon is fairly common and most people with the condition in association with deafness do not have a psychiatric disorder or dementia. So do not be scared or embarrassed about asking for help!

2. If you read the medical literature or secondary sources (occasional articles in the lay press) you might get the impression that the condition is treated as a bit of a joke. It is clearly is not and can drive people to distraction, and medical professionals do treat it seriously.

3. The commonest feature associated with musical hallucinations is new deafness in middle to later life. I have seen approximately 30 patients with this type. It is not clear whether this is a sufficient ‘cause’ as most people with moderate or severe deafness do not have musical hallucinations.

4. Patients with musical hallucinations should see their family doctor and many will need a hearing test.

5. If you have the form of the condition associated with deafness, a hearing aid (or improved hearing aid) is the only thing that helps the symptoms, in my experience. A large variety of drugs have been tried, which do not in general help. A form of ‘noise masking’ has also been tried (playing noise to try mask the hallucinations, a treatment that has also been used for tinnitus [ringing in the ears]).

6. Although the condition is fairly common there are no systematic treatment trials of which I am aware. This means that most treatments are not based on clear evidence.

OTHER FORMS

1. The phenomenon very rarely occurs i) in association with brain lesions (tumours or strokes) ii) due to an unusual form of seizure where patients do not lose consciousness and iii) in association with psychiatric disorders.

2. These other conditions are all unlikely if the only symptom present is the musical hallucinations (with no other neurological symptoms or psychiatric symptoms) and there are no abnormal neurological findings when you are examined by your doctor.

3. I would stress that these forms of musical hallucinations are so unusual that they often appear in case reports in the medical press (where they are overrepresented compared to the commoner form).

4. Unusual underlying causes of musical hallucinations should also be picked up if patients consult their family doctor, who is in a position to advise on whether they need to see a neurologist or psychiatrist.

THE BOTTOM LINE

1. If you have musical hallucinations that are troubling you, see your family doctor for further advice.

2. Your family doctor may arrange for you to have a further opinion from audiology, otolaryngology, neurology or psychiatry services.

3. The most effective treatment for the common form is a hearing aid.

Tim Griffiths DM FRCP

Professor of Cognitive Neurology, Newcastle University, UK

July 2006