What is the treatment for Musical Ear Syndrome?

Treatment of Musical Ear Syndrome

The most effective treatment for Musical Ear Syndrome (MES) includes ambient noise therapy, hearing amplification, and management of underlying hearing loss, with pharmacological options reserved for refractory cases.

What is Musical Ear Syndrome?

Musical Ear Syndrome is a form of auditory hallucination characterized by the perception of musical sounds, instrumental music, or songs without an external source. It is:

• Most commonly seen in older adults with hearing impairment
• Different from psychotic hallucinations as patients typically recognize the sounds aren't real
• Often associated with hearing loss, particularly high-frequency sensorineural hearing loss

Diagnosis and Assessment

When evaluating a patient with suspected MES:

• Confirm the presence of musical hallucinations (perception of formed music without external source)
• Assess hearing status through audiometric evaluation
• Rule out neurological and psychiatric causes
• Document characteristics of hallucinations:
  • Type of music (instrumental, songs, familiar vs. unfamiliar)
  • Frequency and duration
  • Triggers (fatigue is common in 33.9% of cases) 1
  • Impact on quality of life

Treatment Approach

First-Line Treatments

1. Hearing Amplification

   • Binaural hearing aids for those with hearing loss 2
   • Cochlear implants may be considered for profound hearing loss (though they can sometimes trigger MES in some patients) 3

2. Environmental Sound Therapy

   • Use of ambient noise to mask hallucinations
   • Background music or white noise generators

3. Patient Education and Reassurance

   • Explain the non-psychiatric nature of the condition
   • Reassure patients that this is not a sign of mental illness 2

Second-Line Treatments

For patients with persistent, distressing symptoms despite first-line interventions:

1. Pharmacological Options
   • Anticonvulsants
   • Anticholinesterase inhibitors
   • Antipsychotics (at low doses) 2

Monitoring and Follow-up

• Regular audiological assessment
• Adjustment of hearing aids as needed
• Assessment of treatment efficacy and quality of life impact

Special Considerations

• Age Factor: MES appears to be more common in younger cochlear implant patients (mean age 56 years vs. 61.9 years in those without MES) 1

• Musician Background: Patients with musical training or background may be more susceptible, as seen in a case of a 67-year-old semi-professional musician 3

• Tolerance: Most patients (89%) find their musical hallucinations tolerable, though 11% report them as intolerable 1

Pathophysiology and Risk Factors

MES likely represents abnormal activity in the auditory associative cortices 4. Neuroimaging studies have shown:

• Increased activity and reduced cortical thickness in prefrontal cortex, temporal and limbic regions
• These changes may represent neural reorganization due to auditory deprivation 5

Prognosis

The prognosis for MES varies:

• Many patients experience improvement with hearing amplification and ambient noise
• Some may require ongoing management with pharmacological interventions
• The condition may persist but become more tolerable with appropriate interventions

Common Pitfalls to Avoid

1. Misdiagnosis as psychiatric illness: MES patients should not be assumed to have delusions or psychosis 5

2. Failure to address underlying hearing loss: Treating the hearing impairment is fundamental to managing MES

3. Overmedication: Pharmacological treatments should be reserved for cases that don't respond to non-pharmacological approaches

4. Inadequate follow-up: Regular monitoring is essential as MES characteristics may change over time

By addressing the underlying hearing loss and providing appropriate supportive measures, most patients with Musical Ear Syndrome can achieve significant improvement in their symptoms and quality of life.