![]() 6 Antipsychotics are not recommended as first-line treatment.ĭr. 5 Frequently, symptoms spontaneously remit.Ĭonsider electroconvulsive therapy (ECT) for patients with musical hallucinations that are refractory to medical treatment and cause distress 3 patients with concurrent major depressive disorder showed improvement after ECT. 4 Two cases have reported successful carbamazepine therapy 2 other cases demonstrated success with clomipramine. Nonpharmacotherapeutic treatments include hearing amplification, and masking tinnitus with a hearing aid emitting low-volume music or sounds of nature (ie, rainfall). Treating concurrent insomnia, depression, or anxiety might resolve the hallucinations. If she (he) is experiencing unilateral symptoms, pulsatile tinnitus, unilateral hearing loss, and a constant feeling of unsteadiness, further evaluation is necessary to exclude underlying pathology. ![]() Rule out unilateral symptoms, tinnitus, and hearing loss. Perform a complete history, physical, and neurologic examination. Reassure your patient that the experience is not necessarily associated with a psychotic disorder. 2,3 Cerebral atrophy and microangiopathic changes are common co-occurring findings on MRI. Pure tone audiograms show a bilateral loss of >30 decibels, affecting the higher and lower ranges. Both sensorineural and conductive involvement indicates a mixed type of deafness. Patients with auditory musical hallucinations associated with deafness may not have dementia or psychosis. Some patients hear singing voices, predominantly deep in tone, although the words usually are not clear. ![]() The musical tones are reported to have a vibrating quality, similar to the sound produced by blowing air through a paper-covered comb. Some patients identify 1 musical instrument that dominates others. 1 Auditory musical hallucinations occur in psychiatric diseases, ictal states of complex partial seizures, abnormalities of the auditory cortex, thalamic infarcts, subarachnoid hemorrhage, tumors of the brain stem, intoxication, and progressive deafness. Auditory musical hallucinations mainly affect older (mean age, 61.5 years) females who have tinnitus and severe, high-frequency, sensorineural hearing loss. 1 OCD comorbidity with other psychiatric disorders increases the frequency of auditory musical hallucinations. Nonpsychotic auditory musical hallucinations-hearing singing voices, musical tones, song lyrics, or instrumental music-occur in >20% of outpatients who have a diagnosis of an anxiety, affective, or schizophrenic disorder, with the highest prevalence (41%) in patients with obsessive-compulsive disorder (OCD). ![]()
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