The short version
- In 80 people who hear music that is not there, hearing loss explained only about one case in five on its own, and psychiatric illness alone explained about two in five.
- The music was mostly familiar and often from early life, with hymns, children’s songs and pop songs heading the list.
- Two in three found it a burden and had no control over it, and nothing they tried gave lasting relief.
People who hear music with no source are usually told the cause is in their ears: the hearing fades, and the brain fills the silence from memory. A study of 80 such patients in the Netherlands, published in July in the Journal of Neurology, finds that account fits only part of them.
The design
The team, led by Daphne Kerklaan and the psychiatrist Jan Dirk Blom of the Parnassia Psychiatric Institute in The Hague with the neurologist Jan Adriaan Coebergh of St. George’s Hospital in London, enrolled 81 people at two Hague hospitals between 2010 and 2023 and analysed 80. Nearly half were referred by psychiatrists, and the rest mostly by neurologists, family doctors and ear specialists.
Each person was interviewed with a questionnaire the team wrote for the purpose, alongside hearing tests, EEG and brain imaging. This paper reports what people said when they first came in. The cohort is still being followed every year.
The average participant was 65, with an age range of 15 to 95, and 59% were women. On average they had been hearing the music for eight years before they enrolled.
What they found
Half had no documented hearing loss. Hearing loss alone accounted for 21% of cases, and a psychiatric disorder alone, most often a psychotic or depressive illness, for 41%. Another 21% had hearing loss together with a structural change in the brain. Taken together, about half had a psychiatric diagnosis, half had hearing loss, and nearly three in ten had more than one cause.
The music was rarely just music. Four in ten participants also had tinnitus, a third had visual hallucinations, and a quarter heard voices. One person reported false perceptions in six different senses. The exception was the group whose only problem was hearing loss: three in four of them reported nothing beyond the music.
Most people heard tunes they knew, and more than half of those heard only music from early in life. Religious music was the most common, at 18% of mentions, followed by children’s songs and popular songs at 17% each. Most heard it inside the head, and about a quarter heard it as if it came from the room.
For most it was not a pleasant curiosity. In all, 65% called it a burden and 68% said they had no conscious control over it. People described being unable to stand the noise, trouble following conversations and sleeping, exhaustion and depression. Turning on the radio, TV or other music was the most common thing they tried. It helped some of them, and only for a while. The authors report that no one found a lasting fix.
The limits
The questionnaire was not validated, and the authors call it a semi-structured survey. People were recalling events from a median of eight years earlier. Most were recruited through a psychiatric clinic, which almost certainly inflates the share with psychiatric causes. The authors say so, and warn that the findings may not carry over to an ear clinic or the general population.
There is no comparison group, and the paper reports no treatment results.
Why it matters
The familiar picture of an older person whose hearing has faded is real, but this study suggests it is one profile among several. Women outnumbered men only slightly here. In the authors’ words, musical hallucinations “may be more common than previously appreciated within broader multimodal perceptual syndromes and mixed etiologies, suggesting a more distributed pathophysiology than traditionally assumed.” In plain terms, many brain systems can produce phantom music, not just a deprived auditory cortex.
That has a practical edge. Someone who hears music and also sees things, or hears voices, may need a different workup from someone whose hearing has simply faded. The overlap with tinnitus is notable too, since sound enrichment is now a recommended part of tinnitus care, as we reported in our piece on the updated US guideline.
What to watch next: the same cohort’s follow-up data, which should show whether the music fades, shifts or spreads over the years, and studies that recruit people early, before memory blurs the onset.
