A Closer Look At The Relationship Between Auditory Hallucinations And Tinnitus

What Are Auditory Hallucinations?

Auditory hallucinations, or paracusias, are when a person hears noises or sounds that aren’t coming from external stimuli. Individuals will report hearing voices or other types of sounds, like music, and the sounds may seem as though they are coming from their ears, body, mind, or surroundings. Whether they appear frequently or sporadically, auditory hallucinations are typically a symptom associated with mental health issues. It is not uncommon for those afflicted by psychiatric disorders to experience them more regularly than others.

Are There Different Types Of Auditory Hallucinations?

There are two types of auditory hallucinations – auditory verbal hallucinations and hearing sounds/noises.

Auditory Verbal Hallucinations

Auditory verbal hallucinations (AVH) are a common symptom experienced by individuals with mental health conditions such as schizophrenia, bipolar disorder and depression. AVHs involve hearing voices that are not actually present in the physical environment. They can range from single words to entire conversations and can be perceived as coming from either inside or outside of one’s own head.

People experiencing auditory verbal hallucinations may feel as though the voices are criticizing, commenting on or commanding them to do certain things. Individuals may hear one or more voices, and the source and volume of the voices can vary. Treatment for AVHs can involve cognitive behavioral therapy (CBT) to help the individual manage their symptoms, along with medications such as antipsychotics and antidepressants. Additionally, supportive psychotherapy and lifestyle changes such as reducing stressors.  

Hearing Sounds

When someone says they’re hearing sounds, what comes to mind? Perhaps music. Musical hallucinations are a special type of auditory hallucination where people can hear entire melodies or songs. Though musical hallucination is not as common as other forms such as those that involve animal and nature noises, these types of experiences do occur. Musical hallucinations can be triggered by a variety of factors, including hearing loss, overexposure to loud noise, and brain damage or disease. They may also arise spontaneously in some individuals. People who experience musical hallucinations often describe the sensation as being like “a radio station playing inside their head.” The experience can be very distressing for some people and can cause feelings of confusion and fear.

Are Auditory Hallucinations Different From Tinnitus?

Auditory hallucinations are commonly confused with tinnitus, because tinnitus also refers to hearing a sound that does not come from the external auditory stimuli. Usually, tinnitus patients report hearing buzzing, humming, or whooshing type sounds in one or both of their ears. This is different from what individuals with auditory verbal hallucinations experience, as they report hearing things like voices.

Are Auditory Hallucinations Normal?

Auditory hallucinations, whether occurring when you’re drifting off to sleep (hypnogogic) or waking up (hypnopompic), are quite common and usually don’t require medical care. Research indicates that approximately 5-28% of all Americans may have experienced this phenomenon at one point in their lives – making it more widespread than visual hallucinations.

Auditory hallucinations often occur in those with mental illnesses, such as schizophrenia or bipolar disorder. By contrast, visual hallucinations are more common in old age. However, they can also occur in those with neurological, otologic, and other medical conditions. Seventy-five percent of individuals with schizophrenia, 20-50% of those with manic depression, 40% with post-traumatic stress disorder, and 10% with major depression experience auditory hallucinations. Both children and adults can experience auditory hallucinations.

As much as ten to fifteen percent of those who experience auditory hallucinations do not endure a mental illness or tinnitus. Hearing loss is linked to having auditory hallucinations, but those with normal hearing can also encounter them. This is especially true amongst individuals with sleeping deprivation, are taking certain medications, or have migraine-induced visual hallucinations. Even people without any existing mental disorder can be subject to hearing things that aren’t there.

What Causes Auditory Hallucinations?

Although the exact cause is yet to be identified, it appears that spontaneous activation in the auditory cortex – particularly within the left temporal lobe, left superior temporal gyrus and transverse temporal gyro – may be responsible. Another theory is that auditory hallucinations stem from a mismatch between bottom-up limbic hyper-excitation and hypo-active prefrontal inhibitory system. It may also be the result of an imbalance of neurotransmitters, like dopamine and serotonin, that are essential for underlying neural dynamics within our auditory system. FMRI studies have shown that there is activation within the auditory cortex during auditory hallucinations.

Psychiatric Disorders

People with psychiatric conditions such as schizophrenia, bipolar disorder, post traumatic stress disorder (PTSD), anxiety and depression are the most susceptible to auditory hallucinations. Scientists posit that dysfunction within the auditory system is a potential contributor to this phenomenon in those with schizophrenia. It is thought that altered processing of sound may produce false perceptions which manifest themselves as audio delusions.

Fascinatingly, post-mortem examinations have ascertained that the auditory cortex of those suffering from schizophrenia is smaller than in people without it. Different studies also demonstrate a correlation between hearing impairment and schizophrenia. A particular research team found out that early onset of hearing loss was associated with an augmented likelihood to develop schizophrenia over time. Recent studies suggest that individuals with schizophrenia have a higher hearing threshold than people without, and also present a greater number of minor hearing impairments. Various studies indicate that having some degree of auditory loss might increase the likelihood of developing mental health issues.

Neurological Conditions

Auditory hallucinations are more common in those with hearing loss and may increase as the impairment worsens. Furthermore, they may also happen to people living with neurological conditions including Alzheimer’s disease, sleep disorders, migraines, brain tumors or Parkinson’s disease. There are many temporary causes that can trigger this phenomenon such as alcohol consumption and recreational drug use; but it is also associated with sleep deprivation, hunger periods of time without eating; medications side-effects; infections-related issues and anesthesia during medical procedures.

How Can I Be Evaluated For Auditory Hallucinations?

Usually, a psychiatric evaluation is performed for those experiencing auditory hallucinations. The evaluation will review the development of the hallucinations, as well as a medical work-up, an intake of family history, past trauma, triggering factors, and past mental illnesses. A review of medications is also important to rule out drug-induced hallucinations or the presence of other hallucinations, like visual hallucinations. A mental evaluation can also provide insight regarding the types of voices or sounds that are heard and how they may connect to their mental status.

Some tests that are likely to be completed as part of the medical work up include: urinalysis, complete blood count with differential, renal function test, blood alcohol level, serum electrolytes, hepatic function test, imaging studies (CT or MRI), and EEG.

Can Auditory Hallucinations Be Treated?

Yes, depending on the underlying cause auditory hallucinations can be treated, and different treatment options are available. If temporary causes related to sleep or hunger are found, then those will be addressed. If hearing impairment is believed to be a contributing factor, then appropriate audiologic treatments will be provided to improve hearing loss and enhance auditory function. Amplification can help improve auditory processing and the way the auditory cortex handles and interprets auditory stimuli. If mental illness is suspected, then psychiatric treatments, including medication and psychotherapy, will be considered.

How Are Auditory Hallucinations Treated?

If medical testing revealed any form of disease, pathology, or disorder, then the condition should be treated to determine if it has any effect on the auditory hallucinations. If a temporary cause is found to be the reason for the auditory hallucinations, then that will need to be addressed. Some of the potential causes of auditory hallucinations are listed below, along with various treatment options.

Lifestyle Changes

For example, if the musical hallucinations began shortly after the individual started an extreme diet, then they will be advised to reintroduce foods to see if it impacts the hallucinations. If an individual has been extremely sleep deprived for the same period of time that they began experiencing verbal hallucinations, then they will be treated for a sleep disorder to see if that improves both their sleep and hallucinations.

Addressing Hearing Loss

Individuals found to have hearing loss, may be fit with an appropriate hearing device to see if access to more auditory stimuli improves their perception of auditory hallucinations. This is often helpful for tinnitus patients who are not experiencing complex hallucinations. Increased auditory inputs can help adjust to damage that has occurred from sensory deprivation due to hearing loss to help higher auditory processing pathways. If a physician determines that the auditory hallucinations are of psychiatric origin, then the treatment will depend on which mental illness diagnosis they receive.

Medications

Two of the most common medications are neuroleptics also known as antipsychotics or psychotropics. Clozapine is one of the most effective neuroleptics that is used for treating schizophrenia. Antidepressants and mood stabilizers are common psychotropic medications prescribed to those suffering from depression or mania. Psychotherapy or talk therapy can also be used for auditory hallucinations. It is usually completed along with medication therapy.

Psychotherapy

The goal of psychotherapy is to determine what thoughts, emotions, and behaviors may be connected to auditory hallucinations. The three most popular forms of psychotherapy are cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and hallucination-focused integrative treatment (HIT).

Is There Something I Can Do To Improve Auditory Hallucinations?

If you’re suffering from auditory hallucinations while slipping into or out of slumber, make sure you are receiving enough high-quality sleep. Abstain from alcohol and illegal drugs to help mitigate the issue further and talk to your doctor about any prescription medications that might need adjusting.

For auditory verbal hallucinations from psychiatric or neurological conditions, ensure that you are working with a healthcare provider to develop a treatment plan. However, you can also work on using methods of distraction, group therapy, and cognitive restructuring.

Who Should I Go See For Auditory Hallucinations?

Treatment is most effective when using an interprofessional healthcare team. This involves different specialists, including physicians, audiologists, psychologists, social workers, pharmacists, etc. The first step is to discuss this with your primary care doctor, who can help to guide you to the necessary specialist. It is not uncommon to also be referred to an otolaryngologist (ENT) and an audiologist to determine whether what you are hearing is tinnitus or complex hallucinations.

Are There Differential Diagnoses?

Complex hallucinations, including auditory verbal hallucinations, visual hallucinations, musical hallucinations, etc. are more common for those with a mental illness. Hallucinations are part of the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for several disorders including: bipolar disorder, post traumatic stress disorder, schizophrenia, major depressive disorder, etc. Therefore, it is important to have a psychiatric evaluation to determine if this is the cause of your auditory hallucinations.