A preadolescent girl in Thailand heard instrumental music in both ears for about a week, even though nothing was playing and her hearing was tested as normal. The music had no lyrics, arrived during specific hours of the day, and upset her. Her case, published in the Journal of Developmental & Behavioral Pediatrics, stands out less for the music itself than for what was missing: the hearing loss often found in people who experience it.
That gap matters because one of the best-studied explanations for how brains produce music no one else can hear was developed in a patient who was losing her hearing. The girl's case suggests the picture may be broader, and it shows how much is still unknown.
A Symptom Usually Seen in Older Adults
Musical hallucinations are experiences of hearing melodies, songs, or instruments without any outside source. They are mostly reported in older adults. A 2024 review in the World Journal of Psychiatry gathered 294 cases from 357 publications. Among cases with ages reported, the average was 67.9 years, and about two-thirds were women.
The phenomenon is not new. The review traces the first recorded case to 1846, yet reliable estimates of how often it occurs in the general population still do not exist.
The reviewers sorted the cases into eight groups by likely cause. Psychiatric conditions formed the largest group at 85 cases, followed by hearing impairment at 77. ADHD appeared in only two cases, both adult men. The reviewers also found that most people in their pool had no underlying mental illness, and they warned that people with musical hallucinations are sometimes wrongly diagnosed as psychotic.
Children are rarer still. The Thai girl's clinicians wrote that fewer than 50 pediatric cases have been reported, and that the experience is particularly uncommon in children without hearing impairment or psychosis.
A Brain That Predicts Its Own Soundtrack
One of the most detailed looks inside a musical hallucination came from Newcastle University and University College London. In a 2014 study in the journal Cortex, a team led by Sukhbinder Kumar recorded brain activity in Sylvia, a 69-year-old musician with perfect pitch whose hallucinations began after a sudden hearing loss on top of years of gradual deafness. The phantom notes slowly multiplied until they formed parts of tunes, including pieces by Bach and Gilbert and Sullivan's HMS Pinafore.
The researchers proposed that the brain constantly predicts what it is about to hear and checks those guesses against the signal from the ears. When hearing fades and that signal turns weak and noisy, the predictions can take over. Their data fit a model in which the hallucinations arise from persistent back-and-forth communication within this prediction system.
In the university's announcement of the findings, co-author William Sedley said, "What we have found is that these processes sometimes end up running away with themselves to cause hallucinations." Kumar added that the model explains why real music quieted Sylvia's phantom tunes: a stronger, more reliable outside signal reins in the runaway activity.
A neurologist has since described the experience from the inside. Bruce H. Dobkin of UCLA published a 2025 account of his own musical hallucinations after receiving a cochlear implant for progressive hearing loss, noting that no first-person description tied to possible brain mechanisms had been published before. His began abruptly with a men's choir singing the Star-Spangled Banner, looping roughly every 62 seconds, day and night, for three and a half weeks. Familiar songs and nursery rhymes followed. Months later, the singers moved on to nonsense lyrics set to a simpler, repetitive tune. He associated the onset with deafness that resulted as a complication of electrode placement in his cochlea, among other factors.
Where the Girl's Case Breaks the Pattern
The Thai girl did not fit that picture. Her hearing tests were normal in both ears, and an EEG, a recording of brain waves, made during episodes showed no seizure activity. She had no psychotic illness. She had been diagnosed with ADHD at age 5 and was taking methylphenidate, a stimulant sold in the U.S. under brand names including Ritalin and Concerta.
Clinicians also noticed frequent eye blinking consistent with simple motor tics. Limiting her media exposure and trying behavioral techniques did not stop the music. After the team prescribed a low dose of the antipsychotic risperidone, the hallucinations, the tics and her distress resolved completely within three weeks, and she remained symptom-free at three months.
The report did not attribute the music to her stimulant, and it did not test the prediction model developed in hearing loss. Whether the same brain machinery can misfire in a child with intact hearing is an open question. The authors' central point was diagnostic: recognizing that these experiences can be structured and nonpsychotic may help clinicians avoid misdiagnosing a child.
What One Case Can and Cannot Show
A single report cannot say how often children with ADHD hear phantom music, what caused this girl's episodes, or whether risperidone would help other children. Her tics cleared at the same time as the music, and it is unknown whether the two were connected. Follow-up lasted three months.
The broader research carries its own limits. The Newcastle findings rest on detailed recordings from one patient, and the neurologist's account is one person's experience. Together, though, they point to the same idea: the brain does not simply receive sound but actively builds it.
Parents whose child reports hearing music, voices or other sounds without a source should raise it with the child's pediatrician or prescriber, who can arrange hearing and neurological testing. Families should not stop or change ADHD medication without medical guidance.
Related MedicalDaily Coverage
A Girl with ADHD Heard Instrumental Music at Predictable Hours, and No One Else Could Hear It
He Was Certain His Nose Smelled Like a Dead Mouse and Three Years of Testing Found Nothing
Key Questions Answered
What are musical hallucinations?
They are experiences of hearing music, songs or instrumental sounds when none is playing. Most reported cases involve older adults.
Why can hearing loss lead to phantom music?
One leading model holds that the brain constantly predicts incoming sound. When the signal from the ears weakens, those predictions can run unchecked and be experienced as music.
Why is the Thai girl's case unusual?
She was a child with normal hearing, no seizure activity and no psychosis. Fewer than 50 pediatric cases have been reported.
Did her ADHD medication cause the music?
That was not established. The case report did not attribute her symptoms to methylphenidate.
What should parents do if a child hears sounds that are not there?
Tell the child's pediatrician or prescriber, who can arrange hearing and neurological evaluation. Do not change medication without medical advice.
Published by Medicaldaily.com
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