What is the difference between musical hallucinations and tinnitus?

Before I left for Switzerland at the start of this month I printed off a few articles that I had hoped to read for background research, and also to provide you, dear reader, with some of the latest findings in music psychology.

995998_10151888557415991_774341405_nWell, this hope has been slightly delayed. It has been a long few weeks here in Luzern as I have been balancing immigration admin, with the freedom that comes with being able to write up articles that have been sitting on my desk for months. I love being able to finally sit down to write up these interesting research projects. I have also been enjoying the planning and teaching of my new Music Psychology course, here at the Hochschule Luzern – Musik.

All this is why it has taken me a little while to get to my exciting pile of new papers. Here I am finally though, reading the first one.

This new paper tackles the question of whether musical hallucinations and tinnitus are similar phenomena. This is of interest to me as these two kinds of ‘auditory phantom’ may also be on a continuum with earworms, tunes that get stuck in our head (a keen research interest for me).

What is tinnitus? Tinnitus is when a person hears a simple tone or buzzing noise that is not coming from the environment. The term comes from the Latin word tinnire meaning “to ring”. Many of us will have experienced temporary tinnitus, perhaps after visiting a concert or nightclub, or exposure to other loud and prolonged sounds.

I Hear MusicWhat are musical hallucinations (MH)? MH are complex false sound perceptions meaning that a fully conscious person might report hearing whole songs or other musical arrangements, all of which have no external source. Musical hallucinations are more common in older adults, especially those who are suffering from a degree of hearing loss. MH can also arise from brain lesions at any point in the auditory pathway, from the lower centres (e.g. brainstem) right through to the auditory cortices.

What do these two things have in common? Both MH and tinnitus represent the perception of a sound stimulus in the absence of any physical stimulation from the environment – people are hearing things that are not ‘there’.

In both cases people can often not realize at first that these sounds are not ‘real’ – they may go searching for the source of the sound (a hidden radio or a buzzing piece of electrical hardware) eventually to realize that the sound is being generated internally rather than externally. Because people can eventually recognize the internal source of the sound MH and tinnitus are not, by themselves, a form of “psychosis”, which is defined as a loss of contact with reality.

The new paper I am reading hypothesised that MH and tinnitus might share a common source in the brain that differs only in its complexity, with tinnitus producing simple sound and MH producing complex music.

Neuron_in_tissue_cultureThe model: The model the authors chose was ‘Thalamocortical dysrhythmia’ (TCD), a suitably complex term (go on, say it three times fast, I dare you!). TCD is a theory that suggests the neurons in the thalamus can start to behave in an odd way, either diminishing their excitation or increasing their inhibition. This haywire activity at the neural level, known as ‘deafferentation’, can trigger both positive and negative symptoms in neurological conditions.

How might TCD cause tinnitus and MH? According to the new paper, tinnitus may be caused by abnormal, spontaneous and constant gamma band activity as a consequence of a particular pattern of deafferentation in the thalamic nuclei. This can be combined with an increase in theta activity, and perhaps also a decrease in alpha activity. This combination of abnormal firing patterns is known as the “edge effect”

The difference that turns tinnitus into MH might be found in brain areas like Broca’s , regions of the brain that handles both language and music stimuli. Perhaps a low level “edge effect” combined with higher brain centre abnormal activity turn simple tinnitus into MH?

UnbenanntThe test: The new study used EEG to compare resting state brain activity between healthy controls, and people with either tinnitus or MH. The hypothesis was that both simple (tinnitus) and complex (MH) auditory phantoms will share a common neural signature of increased gamma-theta activity in combination with decreased alpha activity, as in TCD. Furthermore, only MH should involve traces of abnormal activity in higher music and language areas

The authors compared 10 people in each group (control, tinnitus and MH). The two clinical groups had both had their symptoms for at least a year and had comparable hearing loss (not severe).

The results: People with MH or tinnitus both showed increased gamma-theta activity within their auditory cortex. This finding alone suggests that TCD might underlie both simple (tinnitus) and complex (MH) auditory phantoms.

Interestingly both groups also showed suppressed beta band activity in their visual cortices. The reason for this is not yet known, but it has been reported in previous studies.

There was also increased beta activity in areas such as the dorsal anterior cingulate cortex and anterior insula during both tinnitus and MH. This activity might be related to the brain ‘filling in’ missing auditory information and brining the phantom auditory percepts to awareness.

Gray726_inferior_frontal_gyrusWhat is unique in MH? People with MH showed more alpha activity, which we can explain as the increased memory load of dealing with complex percept as opposed to a simple buzz or ring of tinnitus. People with MH also showed increased resting state activity in right inferior frontal regions, areas associated with retrieval of familiar musical imagery from memory, and areas associated with language and music processing.

Conclusions: The TCD model may prove to be a suitable explanation for both musical hallucinations and tinnitus, since both were seen in the new study to feature the relevant abnormal patterns of neural activity. The future will tell us if similar patterns are seen in prolific earworm sufferers.

Complex phantoms (MH) in addition are associated with additional patterns of abnormal neural activity in various bands across areas of the brain that are associated with memory and musical imagery, but also language processing.

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Sven Vanneste, Jae-Jin Song, Dirk De Ridder (2013) Tinnitus and musical hallucinosis: The same but more. NeuroImage 05/2013; DOI:10.1016/j.neuroimage.2013.05.107. Find and request a copy of the paper here.

10 thoughts on “What is the difference between musical hallucinations and tinnitus?

  1. I’m an amateur radio operator – a ham. One of the things I do for fun is participate in radio contests. We try to talk to as many people as possible; some of those signals are very weak, only just barely above the noise level. It takes a lot of concentration to dig those signals out. For a very weak signals, we use Morse code, which being a simple tone is easier to understand than speech is at that level.

    After a weekend of digging weak Morse signals out of the noise, when I finally take off the headphones I can hear phantom Morse code in things like computer fans, building ventilators and even in the wind noise on the windows. This goes away after a day or two, but I didn’t realise that one could have a full blown, permanent musical hallucination.

    The brain is an amazing organ.

  2. Hi,
    About three years ago I was hearing music from an external source that didnt exist, (not like hearing music in your mind like when a song gets stuck in your head). It happened out of the blue while I was fully functioning speaking even, when doing a university presentation, on the subway etc. It started once a day and then eventually happened 10-20 times a day. It was very frightening I had no other physical symptoms and I couldnt find any info on the internet relating to my hearing music that wasnt there. Doctors said it was brought on by stress, that I should do yoga but I knew it was something different, something wasnt right. Finally I found a doctor who sent me to a psychiatrist who sent me to do a CT scan. It turns out that those ephisodes of hearing music were actually musical seisures which are extremely extremely rare and the scan showed that I had a brain tumor. I dont mean to scare you, I am fine now completely heathy but my advice is to listen to your body if you think you know something is wrong find a good doctor that will do everything to help you including psychological tests and a CT scan just to be safe.

  3. Hello. Thank you very much for this very valuable addition to the blog. Musical seizures are indeed very rare and can be completely benign, but in some cases they can indicate an underlying neurological problem. I am very happy that you found good help and once again, thank you for bringing your story to this forum.
    All the best,Vicky

  4. My tinnitus is like a million little tsetse flies in my head and I sometimes cry myself to sleep wishing to be free of them. Buzzing is too nice a word for it. I have not seen a doctor yet because everything I’ve read indicates there is little that can be done. Do you know of anyone who has been helped?

  5. I have reviewed the medical literature and convinced myself at least that musical hallucinations like tinnitus originate in the inner ear. I could not find any example of MH due to a tumour in any part of the cerebral cortex. Perhaps Meldi could give a bit more information about her tumour. If it was in the cerebellopontine angle or brainstem, it is quite likely it was irritating the auditory nerve or even the cochlea. I cannot remember if I found any example of MH due to an acoustic neuroma, but would not be surprised if this happened occasionally. Anyone with tinnitus needs to get this investigated and diagnosed.

  6. About a year ago I startet having trouble getting off to sleep because my neighbour was playing music. It was very, veryquiet though, no bass. Sometimes it was orchestral, violins, brass or just soothing type music. Eventually, I mentioned to my neighbour who looked confused, but said it couldnt be her as she doesnt play any music at all. So, I asked my daughter to listen with me and each time she heard nothing at all. I thought I was going mad. However, now Ive learned to enjoy it and even call it angel music to convince myself its a good thing!! Im not religeous at all by the way. Any info would be gratefully welcomed.

  7. Hi Victoria. This sounds like a typical experience for someone who has encountered musical hallucinations for the first time. My grandmother’s neighbour had exactly the same story – she thought my grandma was playing music from her childhood at night but when she asked of course my grandma had done no such thing. And this lady has since asked people if they can hear the music when she does and they say no. This lady has been very happy to learn that this is a recognised phenomenon (i.e. she was not crazy!), most common in women who are experiencing a degree of hearing loss. If you have any concerns at all then you should of course seek out medical advice but in the majority of cases this symptom has no underlying pathology – it is just a consequence of the way music is processed in the brain in connection with our hearing, which we don’t yet understand fully. You can find more info here: http://www.tinnitus.org.uk/musical-hallucination All the best, Victoria

  8. Hello,

    I thank you for this great article on my problem. (Well mine and a few others I understand.) I first heard what is referred to as birds in the ear or rattling back around 14 years ago and have lived with it since. The new music in the brain started this past January 2014. We were on a five month trip in my motor home looking for warm weather. We were at a RV campground in Apache Junction, AZ.

    I was working on the computer and committed to my traveling partner how much I was enjoying the radio station she was playing. The answer was there is no radio on and she couldn’t hear any music. She hears better than me even when I am wearing my hearing aids. I told her I would turn on the radio and find the station. It had to be a special station as there were no commercials. Just beautiful music and a new one would start as soon as the last note was played on the previous song. I never did find that station. I went out and walked around the neighbors RV’s and found nothing but the music kept playing. I tried listening with without my hearing aids with no change in the volume.

    Upon returning home to Arkansas I made contact with my VA health care provider. They have taken on my story and are trying to find out what is going on. I went through a CT scan to see if they could find dementia. The report said there none present.

    In the last month or so it has changed. At first it was complete songs with choir like voices and big band music with all the movements. Now it has settled on five or so songs but is now only playing the ending or a chorus not the full song. Also now it may play that same small selection over and over up to 12 hours.

    This past Saturday night was a first. I laid down to relax before going to sleep. There is my head was the bird noise and a song was playing our Amazing Grace with a choir singing . Then also there was another musical selection of two accordions playing in harmony the selection was notes that were not exact but closely resembling our national anthem. The volume of all three was so I could concentrate on either but still hear all three. This week along with hearing my song I seem to be hearing people talking. I have not been able to hear well enough to hear what they are saying but can hear more than one person talking.

    Thanks for reading this and if you wish to reply I thank you.
    Larry

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