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Pleasurable emotional response to music: A case of neurodegenerative generalized auditory agnosia
Published in Howard J. Rosen, Robert W. Levenson, Neurocase, 2020
Brandy R. Matthews, Chiung-Chih Chang, Mary De May, John Engstrom, Bruce L. Miller
On the contrary, all of the subjects contributing to the development of this particular model experienced musical hallucinations as distressing. This is in concordance with a review of the literature on musical hallucinations where 41% of subjects experienced the hallucinations as frightening, compared to only 10% of cases that were described as pleasant. However, more consistent with the experience of JS, 78% of the patients reported in the literature described hallucination of familiar tunes (Evers & Ellger, 2004). This consistency in the familiarity of tunes has prompted other authors to suggest ‘neuronal irritation’ resulting in stimulation of the relevant neuronal circuit with resultant re-experience of stored perceptual (in this case musical) experiences (Keshavan et al., 1992). Analogously, deafferentation resulting in visual hallucinations is well-known in the medical community and can result from pathology at any point along the visual system pathway (Eustache et al., 1995). We speculate that JS experiences personally preferred music and his associated positive emotions by a similar mechanism. Using more precise terminology, such experience would represent a type of musical illusion rather than hallucination, as an auditory stimulus is actually presented and subsequently misperceived.
Tinnitus
Published in Stavros Hatzopoulos, Andrea Ciorba, Mark Krumm, Advances in Audiology and Hearing Science, 2020
Another type of auditory hallucination is musical hallucinations, where the patients perceive hearing instrumental music, sounds, or songs. Latest research using neuroimaging has determined significant differences between the brain activation patterns in the subjects with tinnitus (being an example of simple auditory percept) and in patients with musical hallucinations (being an example of complex auditory percept) (Vanneste et al., 2013), providing objective evidence for substantial differences between the two conditions. To date, it is not quite clear if the musical hallucinations are the psychiatric condition or not.
Tinnitus and Hyperacusis
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
As discussed earlier in this chapter, the sound perception of tinnitus can take virtually any form. A small number of patients report that they can hear music when none is present, usually describing short excerpts of music that they were familiar with in their youth. Although many feel that the music sensation is within their own head, some perceive it as an external sound. This may lead them to falsely accuse neighbours of playing the music, either unthinkingly or maliciously. The condition is more common in women, the elderly and those with significant hearing impairment.213 The association with hearing loss has led to the hypothesis that musical hallucination is caused by deafferentiation, in which reduced input to the central auditory system causes increased gain within the associative auditory cortex.214 This results in the brain misinterpreting background neuronal activity as music. The difference between this and the ‘earworm’ or tune stuck in the head that we all get from time to time is that people with musical hallucination are convinced that the sound is real. It is important to ensure that the patient is not describing the auditory hallucinations of mental illness; if there is any doubt, a psychiatric opinion should be sought. Musical hallucination can rarely be associated with epilepsy so a neurological opinion is prudent. There is no substantial evidence base for the management of musical hallucination but addressing any associated hearing loss is anecdotally helpful.
Conversations about mental illness and health in adult audiological rehabilitation
Published in International Journal of Audiology, 2023
Emma C. Laird, Christina A. Bryant, Caitlin M. Barr, Rebecca J. Bennett
Nearly half of the participants reported that they have had at least one previous conversation with a client about symptoms of psychosis (prompted in the survey with ‘e.g. Hearing voices, paranoid thoughts, unusual beliefs’). One participant provided some insight by stating that discussions about psychosis ‘would be more in relation to describing tinnitus-like symptoms rather than being specific to symptoms of psychosis’. Prevalence of psychosis is only approx. 0.39% in the general population (Moreno-Kustner, Martin, and Pastor 2018) and hearing loss has been estimated to increase the odds of experiencing psychosis by 2.23 times (95% CI = 1.83–2.72) (Linszen et al. 2016). However, when auditory hallucinations have been studied in isolation, Linszen et al. (2019) found that 16.2% of people with hearing loss had experienced auditory hallucinations over the past month. Most auditory hallucinations involved hearing voices and music, and these symptoms were found to increase with the severity of hearing loss (Linszen et al. 2019). This may help to explain why many audiologists have reported previous discussions of client psychotic experiences, where information about auditory hallucinations may arise from enquires about tinnitus experiences. Many auditory hallucinations experienced by people with hearing loss are, however, not a product of psychopathology, but rather an experience of tinnitus or musical hallucinations (Musiek et al. 2007). Nevertheless, audiologists should still endeavour to establish the psychological impact of these experiences on their clients.