Complex auditory hallucinations associated with hearing impairment in elderly adults

Auditory hallucinations are a common yet underexplored phenomenon in individuals with hearing impairment, particularly in the elderly. Oliver Sacks syndrome, often seen in patients with sensory deprivation, is typically characterized by musical hallucinations but can also present with nonmusical auditory experiences. This case series presents three elderly patients with hearing impairment who experienced a range of auditory hallucinations, including voices, instrumental music, and environmental sounds, all localized to the ear with greater hearing loss. Despite these auditory experiences, patients demonstrated good insight and no signs of psychosis or cognitive decline. Comprehensive clinical evaluations ruled out other conditions, and diagnoses of Oliver Sacks syndrome were confirmed. The neurobiology underlying these hallucinations involves sensory deprivation leading to maladaptive cortical reorganization, with overactivity in dopaminergic pathways and dysfunction in the auditory cortex contributing to the hallucinations. All patients were treated with risperidone, melatonin, and hearing aids, leading to significant improvements in the frequency and intensity of hallucinations. This case series highlights the diverse nature of auditory hallucinations in elderly individuals with hearing impairment, stressing the importance of recognizing sensory deprivation as a contributing factor and utilizing a comprehensive approach to treatment.