Answer Man

Music never stops playing in her mind

Q: For more than three weeks, I have been hearing music in my mind ALL THE TIME. My doctor diagnosed me with Musical Ear Syndrome, and I was told it may never go away. It drives me nuts. The same song may play five or six times and then it might switch to another song and another ad nauseam. Either Christmas songs or patriotic songs or just odds and ends (“You Are My Sunshine,” etc). As I write this, it’s just a few measures of repeated notes that aren’t even from a recognizable piece of music.

I have to really strain to understand people talking to me. I hear them, but not clearly over the music. I have to turn the TV really loud to cover the music, and I have difficulty focusing when I try to read or work puzzles. At night I can’t fall asleep until I am thoroughly exhausted. I tried leaving my ceiling fan on when I went to bed thinking it would cover the sound and lull me to sleep, but the music is louder than the noise the fan makes.

How common is this? Has any cure been found? I can’t imagine living the rest of my life like this.

T.K, of Belleville

A: While I wish my answer could be sweeter music to your ears, I fear you may find it filled with more sour notes.

Although relatively common (as unusual medical problems go), Musical Ear Syndrome is not well understood nor, until relatively recently, well researched. Nobody is certain what causes it or why some experience it while most don’t. In fact, it wasn’t even given its name until 2004. As a result, cures apparently are rare, although drugs and cognitive behavior techniques may help lower the volume on that maddening, nonstop jukebox in your mind.

I’m glad you sought help quickly. According to case studies, it usually strikes older people, and many immediately think they’re becoming mentally ill, so they tell no one. They’ve read all those stories about people with schizophrenia hearing strange voices in their head, and now they may be hearing Alka-Seltzer commercials or baseball broadcasts playing over and over. It’s not surprising they fear they are crazy, but they’re not. Here’s what we know — and a little about what you might try:

You’ve probably heard of tinnitus, a condition in which people complain of hearing a constant buzzing, ringing, or other annoying sound even though no external source is producing it. Perhaps as many as one in 10 people complain of it. Many experts describe Musical Ear Syndrome (MES) as a specialized form of tinnitus. But instead of perhaps a hissing or buzzing sound, MES patients complain of hearing continual phantom music.

“It’s as if the choir is in the room with you,” one sufferer told the London Daily Mail in 2012. “Sometimes it was a rock concert, and sometimes classical music or opera. One night, I was kept awake by what sounded like a drunken choir singing ‘Away in a Manger.’”

It’s not a recent phenomenon. According to the late Dr. Oliver Sacks, who gained fame studying unusual neurological disorders, Romantic composer Robert Schumann drew his inspiration from entire symphonies he heard playing in his head — although later in life the phantom sound turned into a ceaseless A note. Russian composer Dmitri Shostakovich also reported music hallucinations after shrapnel was removed from his skull.

The syndrome seems most likely to strike people just like you. According to Tim Griffiths, a professor of cognitive neurology at Newcastle University in England, 90 percent of those with the condition develop it because of mild to severe hearing loss. It is more commonly reported by women. Sacks once estimated that it may affect 2 percent of the hard-of-hearing population, but Dr. Neil Bauman, who gave the syndrome its name a decade ago, estimates the number may be closer to 10 percent because of underreporting.

The exact cause is unknown, but the most popular theory goes something like this: As you lose your hearing, your brain no longer receives the auditory stimulation it needs from the outside world. Making matters worse, older people may have lost a spouse so they may spend even more time alone in a quiet environment. To provide the missing stimulation, the brain may start unleashing its own sounds — often quite suddenly and intensely. Often, it calls on its musical memory, perhaps because it is the most pleasant stimulus.

Research seems to bear this out. According to Bauman, more than half (52 percent) of the songs that MES patients report hearing consist of hymns, Christmas carols and patriotic songs. Often, he writes, they’ll follow a seasonal pattern. Sadly, it all turns into a kind of monster earworm that often can’t be shut off.

Why some people develop it while most do not is also not clear. Some speculate that other medical problems such as high blood pressure may contribute to the problem by causing mini-strokes that affect an area of the brain known as the auditory cortex. Some drugs also have been known to trigger MES. In other cases, sudden deafness due to head injury may produce it, and stress or anxiety may intensify it. Some epilepsy patients report experiencing MES before a seizure, and brain tumors may cause it as well.

With so little known of its cause, equally little seems to be available in the way of treatment, which must be done on a case-by-case basis. In fact, Dr. Richard McCollum, an English psychiatrist, found only 16 percent of patients sought treatment and only 3 percent of those said it was effective. These are some possibilities:

Seeing a neurologist (especialy one familiar with MES) and having an MRI, CT or EEG may find or rule out brain abnormalities that may be triggering the problem. If nothing else, it may make some patients less anxious.

Inquire about drugs. Although there is limited evidence, a few say antipsychotics, benzodiazepines or antiepileptics may help.

Rule out drugs. Have you had any changes in your medication regimen? Changes in drugs or dosages may fuel the problem.

Work to convince your brain that the music is not real. I know, that’s easier said than done, but Bauman says the more you can do to convince your brain, the more relief you may experience. At the same time, making yourself too anxious about the problem may increase the volume.

Here’s another contradiction: If you do lead a mostly quiet life, Bauman recommends enriching your environment with as many real sounds as possible. Become more socially active if you aren’t. Such activities provide more auditory stimulation and may help take you mind off the MES. Yet he recommends against such “white noise” as the ceiling fan you mention. The constant unchanging background sound may actually trigger your brain to produce something more enjoyable much as a random sound in the real world may spur memories of a familiar song.

The only immediately effective treatment I found was a radical one attempted by a 42-year-old London woman —a cochlear implant in her right ear.

“About four days after the implant was fitted, I woke up to complete silence,” said the woman, who suffered hearing loss at birth and MES for 30 years.

Bauman said your best be may be to simply note anything that seems to lessen the intensity and add it to your routine. One patient learned to order her brain to change songs. Another patient told Bauman he focused his mind on the sound of his breathing deeply in and out as he lay in bed.

“With a bit of practice, my brain seems to place less emphasis on the music, which becomes more in the background, and it becomes easier for me to fall asleep.”

I will be sending you a lengthy article Bauman wrote about the problem. For more information, you can find his book “Phantom Voices, Ethereal Music & Other Spooky Sounds,” and others on Amazon.

Today’s trivia

It’s often mistakenly called “Teenage Wasteland,” but the actual title of The Who’s opening song on its “Who’s Next” album is “Baba O’Riley.” Of what significance is the odd title?

Answer to Sunday’s trivia: The Missouri River may be nicknamed The Big Muddy, but when it comes to dirt and silt it apparently doesn’t hold a candle to the Yellow River in China. So named because of the color of its muddy water, the Yellow is regarded as the world’s most sediment-laden river in the world. At the worst in 1933, it is estimated nearly 4 billion tons of silt were discharged into the river over its 3,400-mile course.

Roger Schlueter: 618-239-2465, @RogerAnswer