For two years, a 19-year-old woman heard music that was not playing. Not a ring, not a hum, but vivid and complex music with melody and structure. Her hearing tested normal. Her imaging was unremarkable. Her psychiatric evaluation turned up nothing.
Audiologists reported her case in the American Journal of Audiology, published online March 17, 2026. Selva Samaei of the University of Social Welfare and Rehabilitation Sciences in Tehran worked with Prashanth Prabhu and colleagues at the All India Institute of Speech and Hearing in Mysore. Their diagnosis was idiopathic musical ear syndrome, and the word carrying the weight there is idiopathic.
Everything Came Back Normal
The team ran the full battery: pure-tone audiometry, tympanometry, otoacoustic emissions, imaging, neuropsychological assessment, and the Tinnitus Handicap Inventory, a standardized questionnaire used to measure how much an internally generated sound disrupts a person's life.
Nothing explained the music. No psychiatric disorder, no neurological lesion, no hearing deficit. The perception was real to her and absent from the room.
That matters clinically because musical hallucinations are frequently mistaken for a psychotic symptom. People experiencing them usually retain full insight. They know the music has no source. Being told otherwise, or being routed straight to psychiatry, can delay a proper audiological and neurological workup.
The Profile This Patient Does Not Fit
Musical ear syndrome is classically described in older adults with significant hearing loss. The leading explanation is deafferentation: when the auditory system stops sending the brain its usual stream of input, the auditory cortex becomes more excitable and starts generating patterns of its own. The brain, in effect, fills the silence with something it already knows. That is why most people who experience it report hearing familiar tunes, and why the phenomenon is often grouped with tinnitus, a far more common condition in which the invented sound is a ring, buzz, or hiss instead of a melody.
Imaging has offered some support for a cortical explanation. In a 2022 case published in the American Journal of Case Reports, a 62-year-old man with two decades of one-sided hearing loss and continuous musical hallucinations underwent structural and functional MRI. The analysis found increased activity and reduced cortical thickness across several regions, including the prefrontal cortex and temporal and limbic areas, consistent with a widely distributed process rather than a single misbehaving spot.
Even in that population, it is uncommon. A 2024 case report from the Joan C. Edwards School of Medicine at Marshall University cites research in which only 3.6 percent of 193 patients with mild to severe hearing loss experienced musical hallucinations. The same report summarizes a review of published cases from 2005 to 2022 in which the most common categories were not otherwise classifiable at 25 percent, psychiatric disorders at 23 percent, and hearing impairment at 22 percent.
Hearing loss is not the only recognized route. A 2019 review in the Journal of Neurology examined the relationship between musical hallucinations and epilepsy, screening 191 articles describing 983 unique patients and identifying 24 detailed descriptions of epilepsy-related musical hallucinations, including phenomena tied to brain stimulation.
The authors of the 2026 report argue their patient challenges the assumption that the syndrome is tied to hearing loss, and that diagnostic frameworks should widen to include younger people with normal audiograms.
Twelve Sessions, No Medication
The intervention was structured and drug-free: 12 sessions combining psychoeducation, sound enrichment, and auditory retraining built around stimuli the patient selected herself. Over three months, her Tinnitus Handicap Inventory score fell from 54, in the moderate range, to 12, in the slight range. She also reported that the hallucinations felt less intense, that she was coping better emotionally, and that she had become more socially active.
The framing matters. The outcome measured was distress and handicap, not whether the music stopped.
The three components do different jobs. Psychoeducation replaces a frightening unknown with a name and a mechanism, which by itself tends to reduce how threatening an intrusive perception feels. Sound enrichment adds low-level background audio so the auditory system is not left in the quiet that appears to invite the hallucinations in the first place. Auditory retraining works on the brain's response to the sound rather than the sound itself, an approach borrowed from tinnitus management, where deliberate habituation is a mainstay.
The contrast with drug treatment is notable. The Marshall University case involved an 82-year-old woman whose musical hallucinations persisted despite trials of gabapentin, quetiapine and donepezil. A broader review of published treatment attempts found no single reliable protocol, and noted that some cases resolve without any intervention at all.
What a Single Case Can and Cannot Show
This is a case report, the least powerful form of clinical evidence. There was no control group, no blinding, and no comparison treatment. Symptoms can fluctuate or improve on their own, and a patient who has finally been told what is happening to her may report less distress for that reason alone. The report cannot establish that auditory retraining caused the improvement, and it does not change any treatment guideline.
What it does do is document a phenotype that the textbook description would not predict, and offer a nonpharmacological approach worth testing properly.
The practical takeaway for readers is about routing. Hearing music with no external source is a recognized medical phenomenon with several possible causes, including hearing loss, medication effects, neurological conditions, and epilepsy. Anyone experiencing it should ask for an audiological evaluation and a neurological assessment rather than assuming the explanation is psychiatric, and should bring a list of current medications to that appointment.
Key Questions Answered
What is musical ear syndrome?
It is the perception of music, from fragments of tunes to full arrangements, without any external source. It is also called musical hallucinations or auditory Charles Bonnet syndrome and is considered a rare phenomenon.
Is it a sign of mental illness?
Not by itself. People with musical hallucinations typically know the music is not real. Psychiatric disorders are one recognized category among several, alongside hearing impairment and cases with no identified cause.
Why is this case unusual?
The syndrome is most often described in older adults with hearing loss. This patient was 19 and had normal hearing, normal imaging, and no psychiatric or neurological findings.
What treatment was used?
A 12-session program of psychoeducation, sound enrichment, and auditory retraining using stimuli the patient chose. No medication was involved, and her distress score dropped from 54 to 12 over three months.
Does this prove the therapy works?
No. A single case report cannot demonstrate that a treatment caused an improvement, and this one does not change clinical guidelines. It supports further study.
What should someone do if they hear music that is not there?
Seek an audiological evaluation and a neurological assessment, and bring a full medication list. Several treatable causes exist, and a proper workup is the way to identify them.
