From the Guidelines
Hearing music without an external source is most commonly caused by hearing loss, neurological conditions, psychiatric disorders, or certain medications, and a comprehensive evaluation by a healthcare provider is necessary to determine the underlying cause and appropriate treatment. The perception of sound in the absence of an external source, known as tinnitus, can range from innocuous to devastating and affects more than 50 million Americans, equally among men and women, and is most commonly noted in patients between 40 and 70 years of age 1.
Causes of Hearing Music Without an External Source
- Hearing loss: affects how the brain processes sound and may lead the brain to "fill in" missing auditory information with familiar music
- Neurological conditions: such as epilepsy, stroke, brain tumors, or dementia can trigger these experiences by disrupting normal brain function
- Psychiatric disorders: like schizophrenia, bipolar disorder, or major depression may include musical hallucinations as a symptom
- Certain medications: particularly those affecting the central nervous system, can induce this phenomenon as a side effect
- Sleep deprivation, high stress, or sensory deprivation: may temporarily cause someone to hear phantom music
- Tinnitus: can evolve into more complex musical sounds According to the American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines, a targeted history and clinical examination are the initial evaluation and determination as to whether the tinnitus is bothersome or not, before any imaging 1.
Evaluation and Treatment
- A comprehensive audiological examination is recommended in patients with hearing problems or with unilateral persistent tinnitus
- Imaging studies are not usually appropriate in the evaluation of subjective, nonpulsatile tinnitus that does not localize to one ear
- Treatment depends on identifying the underlying cause and may include addressing hearing loss, adjusting medications, or treating psychiatric or neurological conditions The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel, and in those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment 1. It is essential to consult a healthcare provider for proper evaluation and treatment, as musical hallucinations can have a significant negative impact on psychosocial well-being and quality of life 1.
From the Research
Causes of Hearing Music Without an External Source
- Hearing music without an external source can be caused by various factors, including auditory hallucinations, which can be a symptom of certain mental health conditions or a side effect of certain medications 2, 3.
- Research suggests that antipsychotic medications, such as clozapine, olanzapine, and risperidone, can cause EEG abnormalities and increase the risk of epileptic seizures, which may be associated with hearing music or other sounds without an external source 2, 3.
- However, there is limited research specifically on the topic of hearing music without an external source, and more studies are needed to fully understand the causes and mechanisms underlying this phenomenon.
Relationship to Music Exposure and Hearing Loss
- Exposure to loud music has been shown to cause hearing loss and tinnitus, which can lead to the perception of hearing music or other sounds without an external source 4, 5.
- Music-induced hearing loss can have similar effects to noise-induced hearing loss, but there are also important differences that make music a unique insult to the auditory system 5.
- Further research is needed to understand the relationship between music exposure, hearing loss, and the perception of hearing music without an external source.
Potential Risk Factors and Associations
- Certain medications, such as antipsychotics, may increase the risk of hearing music or other sounds without an external source 2, 3.
- Age, duration of disease progression, and diagnosis may not be associated with the risk of EEG modifications or hearing music without an external source 3.
- The presence of sharp or epileptiform activities on EEG recordings may be significantly greater for certain antipsychotics, such as clozapine, compared to other medications 3.