A Neurologist Investigates His Own Musical Hallucinations

IRA FLATOW: Imagine you’re sitting at home, and then all of a sudden you hear a men’s choir belting out “The Star-Spangled Banner.” You check your phone, your computer, radio. Nothing’s playing. You look outside. No one’s there.

This scenario is not a hypothetical. It’s what happened to my next guest after he received a cochlear implant. But he’s not just a patient. He’s also a neurologist. So, of course, he had to learn everything he could about his condition called musical hallucinosis.

And he recently published an article in a medical journal about his experience to raise awareness about this surprisingly common condition. Dr. Bruce Dobkin is a neurologist at UCLA Health based in Los Angeles, California. Welcome to Science Friday.

BRUCE DOBKIN: Thank you. Nice to be here.

IRA FLATOW: Nice to have you. Dr. Dobkin, what a story. It almost sounds like a tale out of an Oliver Sacks book.

BRUCE DOBKIN: Actually, Oliver Sacks wrote about musical hallucinosis. He suffered with it as his hearing got worse over time.

IRA FLATOW: So were you surprised what had happened to you, then, if you had heard about it in Oliver Sacks’s book?

BRUCE DOBKIN: Well, I’m listening to “The Star-Spangled Banner” being sung by tenors and baritones every 62 seconds on a loop, non-stop for three and a half weeks. And like you said, I was looking all over the place where it might be. And then it suddenly struck me. Do I have musical hallucinosis?

And then, interestingly, within hours of the last sung stanza, new tunes, childhood songs came into play, “Yankee Doodle,” “Old MacDonald,” “Mary Had a Little Lamb,” “Go Down Moses,” and dozens of others, always sung with gusto and lyrical clarity every waking hour.

And whenever I woke up overnight, there was another medley. And then it changed about eight months later. So I no longer heard either “The Star-Spangled Banner” or nursery rhymes. I began to hear nonsense lyrics with the same four to six notes. And one went like this.

(SINGING) A rainbow teeth

A rainbow teeth

A rainbow teeth

A rainbow teeth

And just all kinds of lyrics pop in there. I can’t interrupt them. I can’t alter them. I can’t unplug this choir’s jukebox.

IRA FLATOW: And why do you think these unusual phrases were chosen? Do you have any idea?

BRUCE DOBKIN: Well, the brain is always trying to make sense of nonsense. It’s always trying to take what’s within your expectations or your experience and come to a kind of neural agreement that what you’re hearing is this or that.

And so in the face of noise coming up through the brainstem, it turns out that music has certain rules that allow for regularity of sounds and familiar words to sort of come together.

The drive from below, from this neural noise, forces some of these regions to begin to take this ambiguous input and place it, in a sense, within the powerful properties of music and reinforces it. And that becomes the sounds that we’re hearing, the musical hallucinosis.

IRA FLATOW: Now, this all started way back when you started progressively losing your hearing when you were 45 and then got a cochlear implant. What happened after that? Take us– what happened following the implant? Your hearing didn’t come back right away, did it?

BRUCE DOBKIN: No. Well, what you hear initially with a cochlear implant is, at least in my case, was truly bizarre. The people whose voices I knew, I couldn’t recognize their voices. All voices sounded like they were frying in bacon grease. Syllables just kind of sizzled in those first days and weeks of the cochlear implant.

And I’m doing rehabilitation, trying to convert these odd sounds due to direct stimulation of the nerve, as opposed to going through the cochlea and the hair cells. Suddenly, I’m dependent on electrical inputs, and they’re very inexact.

And so that probably contributed to perhaps the musical hallucinosis, this odd sense of sounds that weren’t anything like normal hearing. And yet our brains are so clever that we can eventually learn and appreciate what’s coming in.

Voices now sound to me like the voices I remember. I couldn’t hear my grandkids speaking. And now I can if they’re right in front of me.

IRA FLATOW: So all that distracting music and noise, it’s worth it.

BRUCE DOBKIN: It is.

IRA FLATOW: Mm-hmm. What’s it like being a neurologist, looking at your own brain and figuring this out?

BRUCE DOBKIN: There’s a mix, a real dissonance here between the repetitiveness of the song and the way it can especially interrupt in quiet places, like when you’re laying in bed, and how fascinating it is that this is happening.

And so, of course, I went and looked into a lot of the literature, contacted some fellow scientists, looked at brain imaging to try to get a handle on it. For example, in musical hallucinosis, the same parts of the brain are active as when you actually are hearing a song, all the auditory cortex, musical-related cortex, rhythmic-related cortex.

IRA FLATOW: And how do you keep from going crazy hearing that same song over and over again, for how long?

BRUCE DOBKIN: I tried to mask it. I tried to cope with it. So, for example, I’m talking to you. If there’s a moment of utter silence, the lyrics will and the melody will kind of leak through. And my wife said I suddenly shouted out, Mary, get your lamb out of my pasture! “Mary Had a Little Lamb” was driving me crazy.

Interestingly, the majority of people who have this, when they’re surveyed say that it doesn’t particularly bother them. There’s no paranoia associated with it.

And it turns out that when, let’s say, a survey is done by audiologists who were asking their patients with hearing impairment whether they’ve ever experienced musical hallucinosis, sometimes as many as 4% to 20% will say they have experienced this on occasion. And some have it rather persistently. And almost none of them have ever mentioned it to another person.

IRA FLATOW: That’s amazing.

BRUCE DOBKIN: Yeah. I don’t know if they’re embarrassed by it or think it’s– make them sound crazy or it just doesn’t annoy them enough. There are plenty of blame mechanisms that allow us to reduce our sense of angst about it and just come to accept it.

IRA FLATOW: Because there are no real treatments for it. You just have to accept it.

BRUCE DOBKIN: Yes. And I, of course, like many people, didn’t initially accept it. I looked through the literature. I found some various medications that might work. As a researcher myself, my area has been in motor neuroplasticity. How do we improve reaching and grasping or walking after a stroke or spinal cord injury or traumatic brain injury?

And so I had, more than most people, a rather good understanding of adaptations that the brain makes under various circumstances. My case is, and musical hallucinosis is one of the relatively rare ones.

IRA FLATOW: Has this experience changed your understanding of how the brain works?

BRUCE DOBKIN: Yes, it has complemented my understanding. I mean, we’re in a world where there’s so much ambient visual input and ambient talking and noises in the environment. All these sensations are just constantly coming into the nervous system.

It’s constantly trying to recognize what in all this information that’s coming in is likely to be important. And all of that probably developed a million or more years ago as our hearing apparatus became more and more attuned to danger.

What are the sounds around us? We want to be aware of them. So the brain is always taking in all this remarkable information. And yet we don’t have to process much of it. It’s just been a decision, in a sense, made by the brain under a lot of input.

IRA FLATOW: I want to thank you for sharing your experience with us. Fascinating discussion. And good luck with you and your cochlear implant.

BRUCE DOBKIN: Me and my choir. Thank you.

IRA FLATOW: [LAUGHS] You’re welcome. Dr. Bruce Dobkin, neurologist at UCLA Health, based in Los Angeles, California.

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