A Rare Case of Combined Charles Bonnet Syndrome and Musical Ear Syndrome in an Elderly Patient with Severe Visual and Auditory Loss

Charles Bonnet Syndrome (CBS) manifests as complex visual hallucinations in individuals with significant visual impairment and preserved cognition. Musical Ear Syndrome (MES), an auditory analogue, occurs in patients with hearing loss. Co-occurrence of CBS and MES is exceedingly rare. We describe a 92-year-old woman with end-stage glaucoma and profound bilateral sensorineural hearing loss who developed concurrent complex visual and auditory hallucinations. She retained full insight, and neurological evaluation excluded psychiatric or neurodegenerative disease. Visual hallucinations were independent of her musical hallucinations, supporting the dual diagnosis of CBS and MES. This case reinforces the sensory deafferentation theory, whereby loss of visual or auditory input leads to cortical hyperexcitability. Distinguishing CBS/MES from primary psychiatric illness is critical, particularly in the elderly. The simultaneous presentation of CBS and MES is extremely rare and highlights the importance of clinician awareness to avoid misdiagnosis and unnecessary psychiatric intervention.