Diagnostic dilemma: A woman heard voices for years but not because of psychosis
The patient: A woman in her early 50s in CanadaThe symptoms: The woman started occasionally hearing her name being called when she was alone, usually in quiet surroundings. Later, the sounds evolved into indistinct murmurs. These voices seemed to come from outside her head rather than from her own thoughts. They never spoke directly to her, commented on her actions or gave commands.What happened next: In the next two years after she began hearing voices, the woman made several trips to emergency departments and had brief psychiatric admissions. Because hearing voices is commonly associated with psychosis symptoms that occur when people experience a disconnect from reality doctors diagnosed her with "unspecified psychosis" and attempted various treatments.They first tried the antipsychotic risperidone, gradually increasing the dose, but the voices did not go away. Doctors then switched the patient to aripiprazole, but the hallucinations remained unchanged. Next, they tried haloperidol, and although the woman said the medication made her feel calmer and less distressed, the voices persisted.As they conducted further psychiatric evaluations, the doctors noticed that the woman frequently leaned forward during conversations, cupped an ear and asked people to repeat themselves. About four to six months after her first contact with a psychiatric team, she was referred for hearing tests. These tests revealed hearing loss in both ears, ranging from moderate to severe in one ear and mild to profound in the other.About two months later, the woman was fitted with hearing aids in both ears, which improved her hearing. The voices did not go away, however.Brain scans showed no abnormalities, and blood tests came back normal. Neurological evaluations turned up no evidence of other explanations. Meanwhile, the woman continued working full time, managing her household and maintaining an active social life. She showed no signs of paranoia, delusions, disorganized thinking or the decline in daily functioning that doctors would typically expect to be associated with a psychotic disorder.The diagnosis: Based on the woman's stable functioning, hearing impairment and lack of other clinical abnormalities, the doctors concluded that her auditory hallucinations stemmed from sensory deprivation caused by hearing loss.Reduced sound input from the ears can make auditory regions of the brain unusually active, causing them to "fill in" missing sounds, the doctors explained in a report of the case. A related phenomenon is known as musical hallucinosis, in which people with hearing impairments hear songs, melodies or other forms of music that are not actually playing.The treatment: Because neither antipsychotic medications nor hearing aids eliminated the patient's hallucinations, doctors shifted their focus toward helping the woman cope with them.They taught her about the connection between hearing loss and hallucinations and advised her to pursue psychotherapy aimed at reducing the distress associated with the voices and improving her coping strategies for dealing with their persistence. At the time the report was published, in May 2026, she was waiting to begin this therapy.Other DilemmasImproper use of a massage gun tore holes in a man's retinasAfter taking a medicine for years, a man suddenly had weird changes in his taste that made food disgustingViral infection caused woman not to recognize her own fatherWhat makes the case unique: In their report, the doctors noted that most published accounts of this phenomenon have described patients' hallucinations improving or resolving after their hearing impairment was treated. Persistent hallucinations after treatment are rare. In the woman's case, however, the voices persisted despite the use of hearing aids. The doctors suggest that prolonged hearing loss may cause lasting changes in the brain that do not immediately reverse once hearing improves. (The case report does not note how long the woman's hearing had likely been impaired.)The case also serves as a reminder that hearing voices does not always indicate psychosis, the doctors concluded. Because the woman's hearing loss was recognized only after years of symptoms and several unsuccessful medication trials, the report authors argued that doctors should consider running hearing assessments early in patients with isolated auditory hallucinations, especially when their insight and daily functioning remain intact.For more intriguing medical cases, check out our Diagnostic Dilemma archives.This article is for informational purposes only and is not meant to offer medical advice.Can you guess the diagnosis in these strange medical cases? Find out with our diagnostic dilemma quiz!
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