Musical Memories-Musical Hallucinations in a Lung Transplant Recipient: Case Report and Literature Review.

Abstract

Abstract Background Musical hallucinations (MH), also known as auditory Charles Bonnet Syndrome, are auditory phenomena in which individuals “hear” music without an external stimulus. The music may be verbal or nonverbal, and is usually culture-bound and familiar. MH differ from auditory verbal hallucinations (AVH) in etiologies, patient insight, accompanying symptoms, and neurobiology. The purpose of this case report is to present and discuss the complicated clinical case of a lung transplant recipient with multiple medical and psychiatric comorbidities who developed MH. Methods The case presentation discusses the numerous variables that could contribute to the patient’s MH; similarly, her complex workup and treatment are reviewed. Existing scientific MH literature is explored through the case. Topics reviewed include 1) neurobiology of hearing and music processing, 2) MH pathophysiology including neurotransmitters and central nervous system structures, 3) data on iatrogenic, otologic, neurologic, and psychiatric diseases correlated with MH, 4) MH work up, and 5) the evidence behind different interventions to treat MH. Results A multifaceted approach was utilized to assess and treat the patient. Cessation of iatrogenic contributors had transient benefit. After obtaining imaging, laboratory, and auditory studies, initiation of an acetylcholinesterase inhibitor, consistent use of hearing aids, and depression treatment led to sustained symptom improvement Conclusion MH are due to complex interplay between peripheral auditory structures, central neurocircuitry and neurotransmitters connecting auditory cortices, memory, and emotional processing. A multidisciplinary approach to these patients provides better understanding and symptom management