Case Studies
The Woman Who Heard Music
High Salicylate Levels and Tinnitus
By James R. Allen, M.D.
A delightful 70-year-old woman of Irish descent presented to my office for a neurologic consultation because of a 3-week history of continuously hearing music. She initially suspected that it was coming from another apartment in her building, but friends and neighbors could not hear it. The woman wore bilateral hearing aids and had some dental fillings. She thought she might be picking up a radio station or Muzak; but when she called the stations, none said they were playing what she was hearing. The woman had been seen by a dentist and even a psychiatrist, but no cause could be found. When an ENT physician placed her in a sound-proof room, she still heard the music. Her primary care physician referred her to me. She told me that I was her last hope as she could not bear to go on living with this constant irritation.
She heard mostly big band songs from the 1930s and ’40s that were popular during her youth. The song she heard that bothered her the most was “When Irish Eyes are Smiling,” which had been one of her favorites. When her parish priest requested that church members fill out funeral instructions so that their wishes could be honored when they passed, she had asked that it be sung at her funeral. Since she started hearing music, she had grown to hate the song she once so loved.
I performed a neurologic exam, which was normal. An EEG showed no seizure activity. The woman denied taking any medication whatsoever. But when I noticed that her hands were very arthritic, I asked if she was taking aspirin. She said she was but that she did not consider it a medication. It turned out that she was taking 12 aspirin tablets (300 mg) per day. Knowing that salicylates can cause tinnitus, I ordered a salicylate level. Hers was well above the therapeutic range. I asked her to reduce the dosage to 6 tablets per day. The woman called me a few days later to thank me for stopping the music.
I reported this as a letter to the editor in the New England Journal of Medicine.1 The story was picked up by a number of media outlets. As a result, I received calls and letters about 17 other cases from all over the world of persons who were hearing entire pieces of music, vocal and instrumental, with no etiology established. In some cases, the music persisted for months or years.
Most of these individuals were older, except for 2 who experienced this phenomenon during alcohol withdrawal. The vast majority had hearing impairments. Approximately 90% were female. The type of music they heard depended on the person’s age and background, with people who were musicians hearing original music or recognizing certain instruments, arrangements, and other nuances. In virtually all cases, the music was repetitive. However, some could change the tune. For others, exposure to differences in the frequency of background noise (eg, a ceiling fan vs. air conditioner) would change the tune.
The medications the patients were taking included everything from salicylates to chemotherapeutic agents. Most had been reported to cause tinnitus.
It may be that in elderly persons with hearing problems the addition of a medication capable of causing tinnitus will provide the adequate stimulus to produce an evoked response in the auditory cortex of the brain causing them to hear “phantom music.”
It is important that physicians be alert to this phenomenon and, if a patient reports suddenly hearing music, to check whether a medication has been added to their regimen or whether a dosage has been increased recently. If the medication can be discontinued or the dosage reduced, the symptom can often be relieved.
James Allen is a semiretired neurologist in Minneapolis.
Reference
1. Allen JR. Salicylate-induced musical perceptions. N Engl J Med. 1985;313(10):642-3.