Musicians & HearingPlaying and Enjoying MusicBetter and For Longer

Vincent HowardHearology Co-Founder and Director of AudiologyABRSM 9th November 2019

• Welcome• Your most wonderful and valuable musical instrument: The Ear• Music and auditory disorders• Figures and statistics• Existing prevention strategies and solutions consideration• The Musicians’ Hearing Conservation Programme!• Tips on ear health longevity

Agenda

You care for your eyes.You care for your teeth.You check your blood pressure.You measure your heart rate.You track your steps.You monitor your calories.What about your ears?

There is more to ears than

meets the eye

Music/Noise-inducedAuditory Disorders

Music or NoiseDe-mystifying the concepts…

Although music (generally considered a desirable sound), is clearly not ‘noise’

(usually an undesirable sound), the risk of damage to the auditory system from exposure to music is considered the same as the risk due to exposure to

noise.

TinnitusFactors affectingMIAD Misophonia

HyperacusisLegislation Somatosounds

DiplacusisHearing loss: Noise-induced temporary &

permanent threshold shiftsPhonophobia

Intensity, duration and frequency of high sound

exposure (music and exposure to other sounds)

Individual factors that may put you at higher risk of auditory disorders, e.g. genetic predisposition,

environmental (chemicals, solvents), medical (ototoxic

drugs), health status (cardiovascular issues,

diabetes)

At the upper daily exposure level of 85dBA,

the employer is required to put more effort into

reducing the risk of hearing loss faced by a musician

working in such an environment

Applies to all musicians, including self-employed

freelancers (Noise at Work Regulations, 2005), came into force for the musical

world from 2008

According to this law, the lower exposure level where action is required is 80dBA

of daily noise exposure. The employer is required to

assess the risks, control the risks, to make Hearing

Protection Devices (HPDs) available for voluntary use

and provide employees with information, instruction and

training

If there are marked variations in daily

exposures, weekly personal noise exposure

values can be used to ensure compliance with the

regulation

If exposures are still above the upper level (85dBA),

the employer is required to ensure that employees use personal hearing protection

devices effectively

The noise reaching the ear must not exceed a daily

personal noise exposure of 87dBA

Important information for freelancers and

music studentsWhilst musical institutions have a duty of care

to all their staff and students, the law states that employers are not obliged to ensure that

freelance staff and students are taking the necessary precautions to protect their hearing.

Temporary & Permanent

Threshold Shifts

Noise-inducedHearing Loss

Causes no painNo visible traumaLeaves no visible scarsIs unnoticeable in its earliest stagesAccumulates with each over-exposureKnock-on effects are enormous

100% Permanent but100% Preventable

Sounds above 85dB have the potential to damage hearing. With every 3dB increase, your safe exposure time halves.

Noise-induced hearing loss is the most common

permanent and preventable occupational

injury in the world.

World Health Organisation

Temporary change in auditory sensitivity with return of the auditory

threshold to pre-noise exposure level.

(Rawool, 2012)

Temporary Threshold Shifts

Auditory thresholds remain worse after the noise exposure or do not show any

recovery over time.

(Rawool, 2012)

Permanent Threshold Shifts

Music-induced Hearing Loss

Inner hair cells

Outer hair cells

Inner hair cells

Outer hair cells

Inner Ear Hair Cells

Normal Damaged

Hearing Conditions and Disorders

Bothersome tinnitus is a negative emotional and auditory experience, associated with or described in terms of actual or potential physical or psychological harm.

(Baguley & Fagelson, 2016)

Tinnitus

HyperacusisThe term hyperacusis is used to describe discomfort or annoyance associated with sound levels that are not considered uncomfortable by most other individuals with normal hearing. Its most common cause appears to be exposure to loud sounds and more specifically exposure to loud music.

(P.J. Jastreboff 2009)

When a tone of a specific frequency is presented to the two ears, the pitch perception of that tone can be very different in the two ears for some individuals and can interfere with music perception.

(P.J. Jastreboff 2009)

Diplacusis

This is a strong dislike of sounds which are around you, squealing bike breaks, chalkboard scratching or even someone chewing very loud. Surround sounds are an extreme irritation and can cause anxiety.

(P.J. Jastreboff 2009)

Misophonia

This is the sensitivity to internal body sounds, jaw bones clicking, stomach rumble, heart beat or other quiet body sounds. This causes stress and anxiety and can be difficult to overcome.

(P.J. Jastreboff 2009)

Somato-sounds

This is an extreme anxiety and fear of environmental sound that are experienced around you on a daily basis, could damage the hearing further or make the symptoms worse and force the individual to excessively use ear plugs to drown our all sounds all of the time.

(P.J. Jastreboff 2009)

Phonophobia

Stress &Fatigue

of adult musicians aged 27-66 have

hearing loss

In youth musicians aged

18-22, that rate isof child musicians aged 8-12 have

hearing loss

61%22%

16%

Zhao et al. (2010) reviewed five studies reporting that between 37% and 58% of classical musicians experienced MIHL.

The largest study into noise-induced hearing loss was published in 2014. Three million Germans were examined, including 2227 professional musicians. They found that the musicians were four times as likely to report a new NIHL compared to the general population (Schinket al. 2014).

Study of 100 musicians. Amongst the auditory symptoms, 72% reported tinnitus (63% occasional and 9% permanent). Intolerance to loud sounds was next, reported by 67%. (Luders et al. 2016).

A summary of key, recent academic findings

Decibels (dB) measure sound pressure.

We can listen to a sound at 85dB for about 8 hours over the course of a day before it becomes dangerous.

With each increase of 3dB you halve the safe exposure time, so 88dB = 4hrs, 91dB = 2hrs etc.

Therefore, for each 3dB reduction, you double your safe exposure time

If you double the distance from a single sound source, you effectively reduce its sound pressure by 3dB.

Using Hearing Protection effectively

Insert your hearing protection in good

time before playing to allow time for

acclimatisation – this is the equivalent for

your ears of your eyes adjusting to the dark. This way you

won’t notice the volume difference.

Use the right level of attenuation for the

situation. Don’t over-protect or under-

protect.

With flat-attenuating filters, you will still

hear everything you need to hear to keep time and play to the best of your ability.

Build a long-term relationship with your Audiologist. Hearing

protection may not be a quick fix for all, although

it is for many. Bear in mind it can be adjusted. We want to find the best

solution for each individual.

Carry your hearing protection with you at all times and use it in other noisy situations as well as when playing music.

Hearing protection is an excellent solution –

as long as it is worn and fitted properly.

Custom hearing protection devices (HPDs). Verification of efficacy and education to end users.

MIHL awareness and education for music professionals and students.Acoustic assessments & evaluations.

Regular Audiological assessments and consultations with Audiologists.

Working alongside musicians to advance technology in this field.

How to Achieve Ear Health Longevity

Laurel orYanni?

What do you hear?

Invest in your hearing instrument and don’t

ruin your musical career

• Baguley, D. and Fagelson, M. (2016). Tinnitus. San Diego, CA 92123: Plural Publishing Inc.• Clayton, K., Swaminathan, J., Yazdanbakhsh, A., Zuk, J., Patel, A. and Kidd, G. (2016). Executive Function, Visual Attention and the Cocktail Party

Problem in Musicians and Non-Musicians. PLOS ONE, 11(7), p.e0157638.• Drennan, W. (2010). Hearing Loss in Musicians: Prevention and Management. International Journal of Audiology, 49(11), pp.855-855.• Dudarewicz, A., Pawlaczyk-Łuszczyńska, M., Zamojska-Daniszewska, M. and Zaborowski, K. (2015). Exposure to excessive sounds during

orchestra rehearsals and temporary hearing changes in hearing among musicians. Med Pr.• Elmer, S., Rogenmoser, L., Kuhnis, J. and Jancke, L. (2015). Bridging the Gap between Perceptual and Cognitive Perspectives on Absolute

Pitch. Journal of Neuroscience, 35(1), pp.366-371.• Kähäri, K., Zachau, G., Eklöf, M., Sandsjö, L. and Möller, C. (2003). Assessment of hearing and hearing disorders in rock/jazz musicians:

Evaluación de la audición y de los problemas auditivos en músicos de rock y jazz. International Journal of Audiology, 42(5), pp.279-288.• Laitinen, H. (2005). Factors affecting the use of hearing protectors among classical music players. Noise Health, 7(26), p.21.• Lüders, D., Gonçalves, C., Lacerda, A., Silva, L., Marques, J. and Sperotto, V. (2016). Occurrence of tinnitus and other auditory symptoms among

musicians playing different instruments. The International Tinnitus Journal, 20(1).• O′Brien, I., Ackermann, B. and Driscoll, T. (2014). Hearing and hearing conservation practices among Australia′s professional orchestral

musicians. Noise Health, 16(70), p.189.• O'Brien, I., Driscoll, T. and Ackermann, B. (2014). Description and Evaluation of a Hearing Conservation Program in Use in a Professional

Symphony Orchestra. Annals of Occupational Hygiene, 59(3), pp.265-276.

• Olson, A., Gooding, L., Shikoh, F. and Graf, J. (2016). Hearing Health in College Instrumental Musicians and Prevention of Hearing Loss. Medical Problems of Performing Artists, 31(1), pp.29-36.

• Otsuka, S., Tsuzaki, M., Sonoda, J., Tanaka, S. and Furukawa, S. (2016). A Role of Medial Olivocochlear Reflex as a Protection Mechanism from Noise-Induced Hearing Loss Revealed in Short-Practicing Violinists. PLOS ONE, 11(1), p.e0146751.

• Patynen, J., Tervo, S., Robinson, P. and Lokki, T. (2014). Concert halls with strong lateral reflections enhance musical dynamics. Proceedings of the National Academy of Sciences, 111(12), pp.4409-4414.

• Poissant, S., Freyman, R., MacDonald, A. and Nunes, H. (2012). Characteristics of Noise Exposure During Solitary Trumpet Playing. Ear and Hearing, 33(4), pp.543-553.

• Putter-Katz, H., Halevi-Katz, D. and Yaakobi, E. (2015). Exposure to music and noise-induced hearing loss (NIHL) among professional pop/rock/jazz musicians. Noise Health, 17(76), p.158.

• Rawool, V. (2012). Hearing conservation. New York: Thieme.• Raymond, D., Romeo, J. and Kumke, K. (2012). A Pilot Study of Occupational Injury and Illness Experienced by Classical Musicians. Workplace

Health Saf, 60(1), pp.19-24.• Rodrigues, M., Freitas, M., Neves, M. and Silva, M. (2014). Evaluation of the noise exposure of symphonic orchestra musicians. Noise Health,

16(68), p.40.• Schink, T., Kreutz, G., Busch, V., Pigeot, I. and Ahrens, W. (2014). Incidence and relative risk of hearing disorders in professional musicians.

Occup Environ Med, 71(7), pp.472-476.• Toppila, E., Koskinen, H. and Pyykkö, I. (2011). Hearing loss among classical-orchestra musicians.Noise Health, 13(50), p.45.• Zander, M., Spahn, C. and Richter, B. (2008). Employment and acceptance of hearing protectors in classical symphony and opera

orchestras. Noise Health, 10(38), p.14.• Zhao, F., Manchaiah, V., French, D. and Price, S. (2010). Music exposure and hearing disorders: An overview. International Journal of Audiology,

49(1), pp.54-64.

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