Talk given by Prof Jan Hemming at ICMPC 12 in Thessaloniki (Greece) as part of the earworm symposium convened by Dr Vicky Williamson

1. When an everyday-phenomenon
becomes clinical: The case of long-
term ‘earworms’
Jan Hemming, Music Institute, University of Kassel, Germany
Eckart Altenmüller, University for Music, Drama and Media Hannover, Germany
ICMPC-ESCOM Thessaloniki, Greece, 2012
July 26, 2012

2. The case of long-term 'earworms'
• Research on 'eaworms' as
everyday phenomenon
• Broad media coverage
(peer to public communication)
• Subjects with long-term 'earworms'
contacting the authors for help

3. The case of long-term 'earworms'
Hemming, J. (2009). Zur Phänomenologie des 'Ohrwurms'. In W. Auhagen,
C. Bullerjahn & H. Höge (Eds.), Musikpsychologie - Musikalisches
Gedächtnis und musikalisches Lernen (pp. 184-207). Göttingen: Hogrefe.

4. The case of long-term 'earworms'
Some results (1):
• INMI occurs with preferred titles/genres in about two thirds (68.2%) of the
cases, and in about one third (31.8%) with disliked titles/genres.
• Once they are there, INMI is considered to be pleasant in two thirds (62.6%)
of the cases, and unpleasant in one third (27.4%) of the cases

5. The case of long-term 'earworms'
Some results (2):
Time between listening to music and its occurence as
"tune in the head"
9,8% 9,8%
while music is still playing
7,3%
directly after listening
several minutes
29,3% 17,1%
several hours
several days
several weeks
26,8%

6. The case of long-term 'earworms'
Some results (3):
"Tunes" keep persisting for ...
8,6%
17,1%
several minutes
several hours
several days
37,1% several weeks
37,1%

7. The case of long-term 'earworms'
Some results (4):
• INMI frequently starts in periods of mental relaxation, sometimes paired with
physical activity.
• There was no difference in the number of INMIs between people inactive or
active in music.
The preliminary assumption that INMI might be an effect of our cognitive
system to provide music when it is otherwise absent cannot be held up
(e.g. Liikkanen 2012)

8. The case of long-term 'earworms'
Definitions
Musical imagery – voluntaryly imagining music e.g. by 'singing inside'
Involuntary musical imagery – double involuntary everyday-phenomenon
a. music involuntarily gets stored in long-term memory
b. music is involutarily retrieved from memory
The sound-source is always perceived within the subjective space
Musical hallucinations – clinical symptom following brain lesions, psychotic
disorders or drug abuse. Typically, there is a strong belief in a sound-source
outside the subject.
Pseudo-hallucinations or hallucinosis (Griffiths 2000) – perception of sound
or music outside the subjective space with an awareness that it is not actually
present. Not necessarily a clinical condition.

9. The case of long-term 'earworms'
Method
After a period of informal exchange of experiences, systematic case studies
were set up to investigate the phenomena in detail. Interviews guided by a list
of 19 questions were carried out in person, by telephone or video conference.
Nothing was recorded, only notes were taken down. If provided by the subjects,
medical information and other sources are included in the data.

10. The case of long-term 'earworms'
Subject A
• male, 33 years
• professional cook working as a DJ
• suffered from lingering sounds after nights in the clubs
• switched back to his original profession as no medical advice could be
obtained
• under psychiatric treatment with permanent medication
• suffers from depression and has given up hope to find a cure for his
condition.
• contact to the researchers has broken up.

11. The case of long-term 'earworms'
Subject B
• female, 87 years
• retired after pedagogic / creative profession
• very high affinity to music, learned to play various instruments
• has suffered from weak tinnitus for a long time
• are-related hearing impairment makes own musical activity almost
impossible
• Starting with the age of 84, a specific canon kept pertaining. This can
nowadays be replaced by any other melody, but cannot be stopped
• she speaks of 'hearworms' located inside the head, while the tinnitus directly
stems from the ears
• refuses antidepressants since she considers herself a 'happy person'
• Personal coping strategies include breathing and relaxation techniques
borrowed from tinnitus-retraining therapies. She also considers it a great
relief to now know "Nothing is wrong with me!"

12. The case of long-term 'earworms'
Subject C
• male, 41 years
• works in creatively demanding technology development
• has a high affinity to music, but never learned to play any instrument
• if only a slight clue is given (e.g. keyword 'Whitney Houston') or when he is
confronted with unavoidable music, it keeps haunting him afterwards.
• first occurrence of the long-term 'earworm' was paralleled by a personal
crisis
• general depressive tendency
• has long suffered from severe tinnitus originally caused by mal-fitting dental
prostheses
• reports a continuum between the tinnitus and the 'earworm' is, both located
inside the head.
• Again, personal coping strategies include breathing and relaxation
techniques borrowed from tinnitus-retraining in addition to a general
avoidance of 'catchy' music.

13. The case of long-term 'earworms'
Subject D
• male, 48 years
• switched from an electronic technician to social pedagogy after a personal
crisis
• almost completely deaf since childhood
• attended an efficient school for the deaf, learned to play xylophone and to
dance
• high affinity to music, regrets not to have extended his instrumental skills
• has long suffered from a severe tinnitus, a continuum between the tinnitus
and the 'earworm' is again reported, both located inside the cochlea which
he imagines to be thickened
• 'Earworms' are a severe obstacle when going to sleep, long-term
'earworms' frequently occur in between sleep and awakening
• Personal coping strategies include supporting well-being and avoidance of
music which can often be realized by turning off the hearing-aid.

14. The case of long-term 'earworms'
Subject E
• male, 79 years
• retired production engineer
• high affinity to music, but never learned to play any instrument
• exactly remembers the day when his tinnitus started, caused by a deficient
dental treatment
• for six years, four different, very specific musical hallucinations have taken
turns with each other. They overlap with the tinnitus and dominate it.
• While the tinnitus is located inside the ear, the hallucinations are felt to stem
from the back of the head, accordingly there is no continuum.
• All of the pieces are loaded with strong positive or negative personal
affection.
• eventually agreed on the treatment with initially high-dosed antidepressants
to be gradually reduced in the course of one year. In combination with self-
chosen relaxation techniques (yoga), this brought significant relief.

15. The case of long-term 'earworms'
Conclusions
• the frequency and intensity of 'earworms' might be an indication of a general
affinity to music – possible link to conceptions of musicality
• physical causes of tinnitus or musical hallucinations (dental and cervical
spine disorders, whiplash injuries) need more attention
• A treatment with anti-depressants seems promising (even with non-
depressive subjects) since these have the potential of eliminating memory
traces. Their combination with psychotherapeutic treatment borrowed from
tinnitus therapy can result in significant relief of the affected subject.
• An adoption of the conception of hallucinosis as a third entity between
everyday (involuntary) imagery and clinical hallucinations might help
subjects to understand that "nothing is wrong with me"
• These findings yet need to be communicated into otolaryngology,
neurology, orthopedics and possibly even chiropractics.

16. The case of long-term 'earworms'
Future directions of INMI research
• link INMI to conceptions of musicality
• communicate findings into the clinical world
• include not only preferences but also emotional valence in research designs
• do brain imaging on the presentation of stimulus material