Auditory Hallucinations: Musical Ear Syndrome Explained

Senior woman listening to music while cooking to drown out her auditory hallucinations

Our senses are an essential part of our daily lives, providing us with access to the world we live in and allowing us to share and engage in moments with the ones closest to us. It involves hearing the voices of loved ones whilst engaging in conversation or enjoying the musical notes of an orchestra to unwind. These experiences are often calming and comforting. Sometimes, these voices and musical notes are also experienced when they are not occurring in the listening environment, bringing stress and anxiety to the listener. This is referred to as an auditory hallucination. 

What are auditory hallucinations?

As its name suggests, an auditory hallucination implies that the sounds perceived by the listener are not present in the listener’s current environment. Auditory hallucinations present themselves in two forms, as either a psychiatric manifestation or a non-psychiatric manifestation. The psychiatric form of an auditory hallucination involves hearing voices, as though someone is talking to you and wants to engage in conversation and continue conversing with you. The voices often interact with the listener in a personal way, directing the listener to complete certain tasks or an activity, or providing advice and counsel. This manifestation may relate to an individual’s subconscious psyche. If you are experiencing the symptoms of a psychiatric auditory hallucination, you should contact a medical provider or psychiatrist for further evaluation.

The non-psychiatric form of an auditory hallucination is referred to as musical ear syndrome (MES). Experiences of musical ear syndrome are diverse, with individuals perceiving music, which is either instrumental or singing when none is present. Common melodies include hymns or songs that are patriotic or representative of a holiday, e.g. Christmas carols. Musical ear syndrome differs greatly from an individual who experiences a song or melody being “stuck in their head” (which is often called an ‘earworm’) in that, an individual with MES reports the melody coming from a certain direction, despite its absence. They often take time to understand that the sound is not occurring in their environment. 

What causes auditory hallucinations?

Our ability to perceive sound in our environment is due to complex processes that involve transporting the sound from our external environment, then along the chambers of our hearing system to be processed and understood by our brain. As we continue to expose ourselves to the diverse sounds in our environment, our brain is actively involved in making sense of the wide range of sounds. However, access to sound is decreased in individuals with hearing loss, and the extent to which sounds are no longer accessible is dependent on how the degree of hearing loss an individual has, and on how long an individual has been living with the loss. The most common assumption for the presence of MES is that the brain becomes bored due to a lack of auditory stimulation and generates sound on its own from auditory memories. The poor accessibility to sound results in the parts of the brain responsible for processing sound being deprived of sound and therefore becoming overly sensitive to slight hearing inputs. This deprivation may cause the brain to work harder to predict any hearing input you may be receiving and may overcompensate to fill in the gaps, which may present as hearing melodious tunes. 

Medication may also be a contributing factor to musical ear syndrome and in rare cases, damage to the brain; however, the precise causes of musical ear syndrome are still being researched.

How common is musical ear syndrome?

Musical ear syndrome is experienced most frequently in individuals with severe hearing loss and living a quieter lifestyle. Research suggests that MES has been experienced by almost 10% of individuals with hearing loss but is severely underreported due to fear of it being related to a psychiatric condition. MES may also be linked to a condition referred to as tinnitus, which is a ringing sound that is heard in the ears. Individuals experiencing MES may report it as tinnitus, which may seem like a more acceptable form of hearing “phantom sounds.”  The American Tinnitus Association (ATA) reports that over 50 million Americans experience some form of tinnitus. 

What is the treatment for musical ear syndrome?

Experiences of MES are greatly diverse and vary between each person. Despite MES not presenting as a life-threatening condition, its effects on one’s mental well-being can cause distress and infringe on one’s quality-of-life (QoL). As a cure for MES does not exist, treatment strategies aim to reduce the negative effects of MES and improve quality-of-life. Two broad strategies are used to assist in the management of MES; amplification and awareness.

1. Amplification

Amplification involves providing an individual with an assistive hearing device to improve their access to sounds in their listening environment. Considering MES is more frequently experienced by individuals with severe hearing losses living in quiet and calm environments, the use of hearing aids will provide access to sounds in the environment, giving the brain the auditory stimulation it requires. This may reduce the occurrence and severity of MES episodes, as the brain is being fed with auditory information and will no longer need to generate its sound. 

If you have been fitted with a hearing aid, and are experiencing MES episodes, it is important to use your hearing aid for as long as you can throughout the day. If you have not been wearing your hearing aid frequently, try using your hearing aid for short bursts throughout the day and slowly increasing how long you use your hearing aid, with each passing day. Try exposing yourself to a wide range of sounds to feed your brain with the diverse stimulation it requires. You can begin by listening to sounds in the environment, and progress to conversations with family or friends or a documentary on the radio.

2. Awareness

Awareness involves being alert to every MES episode and acting when an episode begins. Two strategies may be used, either to distract themselves from the MES episode by listening to other auditory signals or to train the mind to ignore the melodious sounds. 

Distracting oneself can involve putting on the television or radio, or any sound source sufficiently loud enough to drown out the MES signals or focusing on another environmental sound. This is a useful technique if one is in an environment that allows them to be in control but may prove inconvenient in more social situations outside of the home environment. Another technique involves using hearing aids. Many hearing aids come with additional connectivity and application functions that allow one to feed music or sounds directly into the hearing aid. Sounds can then be fed via the hearing aid for a period, to distract the listener from the MES episode. 

Ignoring the sounds requires training of the mind to re-route its focus at the onset of MES. Meditation can be an effective way to clear the mind and focus on thoughts that are important to you and de-stress as stress may worsen the effects of MES. Try breathing in and out deeply and focus on how your lungs are taking in air and expelling air, as a start to the meditation process.

Living with MES is an individual experience and no two experiences are the same. One can rest assured that it is not the manifestation of any psychiatric condition, but instead, the manifestation of our minds requiring auditory stimulation and is harmless and not the consequence of any serious underlying condition. Despite no cure being available, it is important to try the treatment strategies available to ensure that your quality of life is not affected in any way. 

If require advice on MES or would like to check if you have hearing loss that may be an underlying condition to MES, visit the Lexie Hearing website and speak to a hearing health expert who will provide you with insight, or take Lexie’s free online hearing test and get your hearing results in less than 2 minutes. 

Hearing library article writer and hearing expert

Written byMichaela Sewpersad

B. Audiology

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