A recent revival of interest in musical hallucinations has led to a revaluation of the clinical significance of these possibly underreported phenomena, which are associated with a significant emotional burden. We present three cases of musical hallucinations. The first two involved a loss of hearing, namely a 93-year-old woman, who also suffered from tinnitus, and a 72-year-old woman. The third case was a 37-year-old man with a history of substance abuse and a psychotic disorder. Based on these case reports and the available literature the authors of this article conclude that musical hallucinations always warrant further investigation in clinical practice. Musical hallucinations are often idiopathic in nature, especially in elderly patients with a hearing loss. In such cases behavioural measures and reassurance may suffice. Musical hallucinations may also be symptomatic. This type of hallucination is more likely in younger individuals, in cases of unilateral musical hallucinations, after a sudden onset of the symptoms, and after changes in the medication prescribed.