ENT FEATURE Tone deafness and perfect pitch BY CHRIS ALDREN If you think you are tone deaf, do not despair. Singing tuition should help but it is probably too late to hope to develop perfect pitch. Consultant otolaryngologist and keen musician, Chris Aldren, discusses the complex and fascinating subject of amusia and music perception. itting in my kitchen writing her to recruit a group of lifelong congenital Dysharmonia this article, listening to Mahler amusics [2]. All were graduates and had Sacks describes another gifted musical Symphony No.2 it is hard to had formal musical education in childhood. performer and composer who was in Simagine the world of a patient They were self-reported as having no a coma for some days following a road suffering from amusia. As a violinist and musical ability for as long as they could traffic accident and severe head injury. otologist with three professional musician remember. Screening removed those who When she came around she had lost the children, all with perfect pitch, I find the were just underestimating their own ability. ability to integrate harmonies. Whilst she world of musical disability, and all it tells us The test group showed significant and had fortunately retained her intellectual of our higher auditory functions, troubling specific defects in ability to differentiate abilities and her linguistic skills, she heard but fascinating. A recent introduction to pitch and rhythm when compared to a string quartet as four independent ‘laser the work of Diana Deutsch on auditory normal controls who were not actively beams of music’, unrelated to one another. illusions has been enlightening [1]. involved in music. The amusical group also She describes in detail this agonising lacked ability to remember tunes. They inability to integrate individual musical Amusia were unable to distinguish which of a series voices and recounts hearing an orchestra Tone deafness is the inability to distinguish of well-known tunes had an incorrect pitch as 20 separate tunes. musical pitch and is a form of amusia. It is placed within it. They lacked the ability Perfect or absolute pitch is the ability less common than generally thought, at to recognise dissonance. Interestingly to recognise the pitch of a note and around 4%. Many people who say they are however, they were able to recognise name it without reference to an external tone deaf have just never been taught to speech-including where pitch variation was known source. Whilst rare in the general read music or encouraged to sing. Indeed, essential to meaning-and environmental population at one in 10,000 it is much more many may have been told they were tone sounds as well as the controls, suggesting common in trained musicians, especially deaf at an early age and unfairly confined they had a specific musical disability. if they started their musical training early to the choral dustbin. With training, many in life. It is thought that most people of these people can sing in tune - so if that Amelodia or tune deafness have the ability to have absolute pitch if is you, don’t give up. The TV work of Gareth In his excellent book Musicophila, trained in the first few years of life. It is Malone has produced amazing vocal neurologist and amateur musician, Oliver found more frequently in countries with results from groups of initially unpromising Sacks, describes some fascinating cases of tonal languages, such as Mandarin. Diana singers. acquired amusia [3]. One was a professor Deutsch studied music students in New Amusia can be congenital or acquired, of music in his 90s who had played double York and Beijing, all of whom had had the latter as a result of brain injury. bass in the New York Philharmonic under formal music training from the age of five. Right hemisphere strokes tend to lead Toscanini. He suffered a stroke of his She found rates of perfect pitch of 60% in to problems of pitch perception whilst right hemisphere and found, although the Chinese speakers and 14% in the US left sided lesions can lead to inability to he still had excellent recognition of pitch non-tonal speakers. recognise rhythm without affecting pitch. and rhythm, he was unable to recognise Some studies have shown perfect pitch Whilst amusia includes abnormalities melody. Even simple melodies such as rates of up to 50% in children born blind or of pitch perception, patients can also have Happy Birthday were unrecognised. He blind from infancy. discrete deficiencies in other musical was however, able to read music and could abilities such as rhythm, melody and recognise melody from the musical score Do we all hear the same? harmony. and even hum the tunes. He therefore We are all aware that colour perception is Isabel Peretz in Montreal has done lots of appeared to have an acquired amelodia due not absolute. Remember the 2015 Twitter work on amusia: media advertising allowed to an auditory processing anomaly. storm over the gold / white black / blue “Many may have been told they were tone deaf at an early age and unfairly confined to the choral dustbin.” ent and audiology news | SEPTEMBER/OCTOBER 2016 | VOL 25 NO 4 | www.entandaudiologynews.com ENT FEATURE “What we perceive appears to be related to our native language and dialect and there are considerable differences between different groups.” notes. For example the note A may be Summary C a blend of 440Hz with 880Hz, 1760Hz, B C# • True amusia is rare at 4%. 220Hz and 110Hz. Whilst most individuals, • Most so called tone deaf people can A# D especially musicians, can clearly detect sing in tune with tuition. whether the notes they hear go up or down, • Perfect pitch is probably innate and there is considerable variation between is more common in adults who have # A D them, much to the consternation of the received musical tuition early in life. Garsington chorus. I asked them, “How can • Pitch perception is not uniform and G# E you hope to sing together if you can’t even is influenced by native language and agree which way the notes are going?” dialect. What we perceive appears to be related G # F F to our native language and dialect and References there are considerable differences between 1. Diana Deutsch. Tritone Paradox. http://deutsch.ucsd. Figure 1: The pitch class circle. This corresponds to the 12 edu/psychology/pages.php?i=206 Last accessed July semitones within the octave. In experiments on the Tritone different groups. Deutsch compared 2016. Paradox, pairs of tones are played that are opposite each English speakers who had grown up in 2. Ayotte J, Peretz I, Hyde K. Congenital amusia. A group other along the circle, such as A to D#, or F to B. California with those who had grown up in study of adults afflicted with a music-specific disorder. Brain 2002;125:238-51. the South of England. These two groups 3. Sacks O. Musicophilia: Tales of Music and the Brain. differed substantially in how they heard Picador; 2007. the Tritone Paradox: frequently when a 4. BBC News. Optical illusion: Dress colour debate goes wedding dress [4]? You may not therefore global. http://www.bbc.co.uk/news/uk-scotland- be surprised to learn that the same is true Californian subject heard a pattern as highlands-islands-31656935 Last accessed July 2016. for pitch perception. ascending, a subject from the South of When teaching the Garsington opera England heard the identical pattern as chorus, I was fascinated to see their descending, and vice versa (Figure 2). reaction to Diana Deutsch’s Tritone Paradox [1]. In this test, listeners are played Conclusion computer generated tones followed by Whilst, as ENT surgeons and audiologists, another, separated by half an octave or we tend to concentrate on the mechanics opposite on the pitch class circle (Figure of the ear, the interesting stuff is how 1). They are then asked to say whether the the brain processes the auditory signal. notes rise or fall. The notes themselves The perception of music is complex and are not pure tones but Shepard tones, fascinating and our understanding is which are a careful blend of octave related currently rudimentary. Christopher Aldren, MA, MB, BS, 30 FRCS, FRCS(ORL), English Consultant Otolaryngologist, 20 Wexham Park Hospital. Correspondence address: Princess Margaret Hospital, 10 Windsor, SL4 3SJ, UK. E: [email protected] www.windsor-ent.com 0 A # B C C # D D # E F F # G G # A Declaration of Competing Interests: None declared. 30 Californian ABOUT THE AUTHOR percentage peak percentage 20 Chris has a special interest in otology, especially stapedotomy and ossiculoplasty. He is currently 10 President of the British Society of Otology and past President of LION (Live International Otolaryngology Network). He is a keen musician 0 with three professional musician sons. Chris is A # B C C # D D # E F F # G G # A an amateur violinist and plays in the European pitch class Doctors Orchestra. He is ENT advisor to the London Philharmonic Orchestra and is on their Figure 2: Distributions of peak pitch classes in two groups of subjects. One group had grown up in Advisory Council. the South of England, and the other group had grown up in California. The two groups heard the Tritone Paradox in strikingly different ways. ent and audiology news | SEPTEMBER/OCTOBER 2016 | VOL 25 NO 4 | www.entandaudiologynews.com.