It seems that the ability to hear is maybe a theme of the story. Since in the beginning the narrator mentions his keen ability to hear, and then the old man hears the narrator entering his room on the night he's killed, and finally in the last part the narrator seems to hear a noise in his head. The noise seems to be a sign of guilt, once the initial thrill from the kill and believing he will get away with it pass, his ears realize what he has done and essentially forces him to admit it. The guilt he felt subconsciously was so overpowering that his brain seemed to use his good hearing as a way of forcing him to admit what he did.

It seem that the narrator has a very specific idea of what it means to be "mad" and that he is very focused on proving the audience that he is not mad. Even though the description and the act of murdering someone show that he is maybe not in the healthiest state of mind. It also shows some of the misconceptions on the mental health during the 1800s. The fact that the narrator seems to believe a "mad" person is unorganized or doesn't think a violent act through. When in reality their are many different types of mental illness that would cause a person to feel the need to kill another person, even in an organized way.