Musical hallucinations in a patient with presbycusis: a case report

Musical hallucinations are a rare subtype of auditory hallucination characterized by the perception of musical sounds, instrumental music, or songs. They are most commonly seen in older women with age-related hearing loss but are also associated with neurologic and psychiatric conditions. The underlying pathophysiology is poorly understood and likely multifactorial.

A 74-year-old woman presented with subjective hearing loss 2-3 years in duration with a recent development of hearing continuous patriotic and children's songs playing in her head. After extensive interviewing and the documentation of a normal otologic/comprehensive head and neck examination, audiologic evaluation revealed evidence of a symmetric high-frequency sensorineural hearing loss consistent with presbycusis. She was counseled on the use of ambient noise and offered a trial of binaural hearing amplification.

The diagnosis of musical hallucinations requires the consideration of numerous possible etiologies. Treatment varies widely, but many patients improve with the use of ambient noise and hearing amplification. Lack of response requires the consideration of pharmacologic treatments such as anticonvulsants, antipsychotics, and anticholinesterases. It is important to reassure patients with a nonpsychiatric etiology that use of these drugs does not imply psychiatric illness.