hearing and hearing conservation for musicians hearing and hearing conservation for musicians paul c...
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HEARING AND HEARING CONSERVATION
FOR MUSICIANS
HEARING AND HEARING CONSERVATION
FOR MUSICIANS
Paul C Checkley MPaul C Checkley MSc MSHAASc MSHAAMusicians’ Hearing ServicesMusicians’ Hearing Services
Paul C Checkley MPaul C Checkley MSc MSHAASc MSHAAMusicians’ Hearing ServicesMusicians’ Hearing Services
International Federation of Musicians International Federation of Musicians ConferenceConference
44thth – 6 – 6thth May 2011 May 2011
International Federation of Musicians International Federation of Musicians ConferenceConference
44thth – 6 – 6thth May 2011 May 2011
Overview…
Hearing and hearing loss
Noise induced hearing loss
Hearing health surveillance - The Musicians Hearing Passport
How do we hear?
The Organ of Corti
Noise damage and hearing protection
“Noise-induced hearing loss is the most common, permanent and preventable occupational injury in the world”
World Health Organization
Noise Induced Hearing Loss
Causes no pain
Causes no visible trauma
Leaves no visible scars
Is unnoticeable in its earliest stages
Accumulates with each over-exposure
Takes years to diagnose
Is permanent and 100% preventable
What’s the Risk?
Evidence shows that continued exposure to high-intensity noise can Evidence shows that continued exposure to high-intensity noise can result in permanent hearing damage result in permanent hearing damage
TinnitusTinnitus Ringing in the earsRinging in the ears
HyperacusisHyperacusis Reduced tolerance to loud Reduced tolerance to loud soundssounds
Hearing lossHearing loss Reduction in hearing acuityReduction in hearing acuity(temporary & permanent)(temporary & permanent)
DiplacusisDiplacusis Distortion of pitchDistortion of pitch
The damage - audiometry
Temporary threshold shift – the warning signs…
Temporary hearing loss following exposure to loud sounds
Research shows that hair bundles are capable of rebuilding their structure from top to bottom over a 48-hour period (the common duration of temporary hearing loss).
Researchers suggest that permanent hearing loss may occur when damage is so severe that it overwhelms the self-repair mechanism.
Often accompanied by tinnitus
M.E., Belyantseva I.A., Azevedo R.B., Kachar B. Rapid renewal of auditory hair bundles. Nature. 22 Aug 2002. 418(6900): 837-838.
Hyperacusis
Intolerance to loud sounds
Can range from slight intolerance to extreme discomfort
86% of people with increased sensitivity to sound also report tinnitus (Jastreboff 2009)
No clear model for causality
Exacerbated by exposure to loud noise
Diplacusis
Differences of pitch between ears (binaural) or in the same ear (monaural)
Binaural is the perception of a tone of given pitch differently in right and left ears
Monaural described as the generation of an “internal sound” in response to an external sound (Tyler 2000)
Can result in significant distortion of the signal
TINNITUSTinnitus facts Prevalence
15-20% of the general population
70-85% of hearing impaired individuals
Majority (75%) report tinnitus is more of an “irritation”
WIDEX LET’S TALK ABOUT TINNITUS 13/XX
TINNITUS
Is a perception of sound
Is involuntary
Originates in the head
McFadden,1982
WIDEX LET’S TALK ABOUT TINNITUS 14/XX
TINNITUS
Most common difficulties attributed to tinnitus
Tinnitus is persistent – present “forever”
Sleeping problems Speech understanding Inability to relax (stress) Depression / despair
TINNITUS GENERATION
Large variety of suggested causes
Generally accepted: Tinnitus involves some
kind of neural activity, interpreted by the brain as sound
Where the spontaneous activity originates is much in dispute
WIDEX LET’S TALK ABOUT TINNITUS 16/XX
TREATMENT METHODS
Large variety of suggested causes generate large variety of suggested treatment methods
WIDEX LET’S TALK ABOUT TINNITUS 17/XX
Common elements of effective tinnitus management
TREATMENT METHODS
WIDEX LET’S TALK ABOUT TINNITUS 18/XX
Educationand
counselling
Sound stimulation
Stress reduction
Hearingaids
00How is noise induced hearing loss
treated?
“If minor hearing loss is neglected and the auditory system is not excercised, when the time comes that a HA is essential it may not be as effective as if treatment had been given earlier ”
Dr Thomas Stuttaford
The ONLY way to avoid permanent noise damage is to
protect your hearing?
Historically, hearing conservation strategies have rarely been implemented, or even considered in the
entertainment industry
“The ringing usually goes
away the next day so its not a
problem”
“I can always get a hearing
aid”
“I like it
loud”
“Wearing earplugs is uncool”
“I feel blocked up and cut-off from the music”
“I’ve got used to the loudness
– it doesn’t bother me anymore” “I don’t
care if I can’t hear when I’m
50”
“Earplugs dont fit in my ears so I cant wear them”
WHY?“I don’t play my kit very loudly, so I don’t think there is a problem”
Most hearing protection destroys the fidelity of the sound
Can be cumbersome to wear
Lack of appropriate protection products
Lack of education and awareness to the dangers of high SPL’s
What are the real reasons?
EN Standard 89/656/EG noise levelsNew changes in European legislation
state that in the workplace when personal dose levels reach…
80 dB(A) -Risk assessment-Hearing protection available-Maintenance programme for equipment-Provide training
85 dB(A) -Programme of control measures, if not sufficient then:-Suitable hearing protection MUST be worn-Health surveillance programme implemented
How loud is loud?
Sound examples dB
Rocket Launching 180
Jet Engine 140
Thunderclap, Air Raid Siren 1 Meter 130
Jet takeoff (200 ft) 120
Rock Concert, Discotheque 110
Firecrackers, Subway Train 100
Heavy Truck (15 Meter), City Traffic 90
Alarm Clock (1 Meter), Hair Dryer 80
Noisy Restaurant, Business Office 70
Air Conditioning Unit, Conversational Speech 60
Light Traffic (50 Meter), Average Home 50
Living Room, Quiet Office 40
Library, Soft Whisper (5 Meter) 30
Broadcasting Studio, Rustling Leaves 20
Hearing Threshold 0
97 dB(A)0,5 hr +
94 dB(A)1 hr +
91 dB(A)2 hr +
88 dB(A)4 hr +
85 dB(A)8 hrMax. exposure time (hrs.) a day
Ris
k level in
dB
(A)
8 4 2 1 0.5
3 dB doubling effect
Much live music is typicallymeasured at above 100dB(A)
That means (according to noise regulations) that the safe exposure time is 15 mins
At 103dB it’s 7 minutes and 30 seconds
At 106dB it’s 3 minutes and 45 seconds
At 109dB – Play the intro, take a bow and leave the stage!
The trouble with hearing protection
loss of clarity !Typical conventional hearing protection attenuation values
15dBreduction
25dBreduction
9dBreduction
Flat response earplugs(musicians’ earplugs)
Developed to provide musicians with a flat reduction in on stage levels
Tuned to replace lost ear canal resonance
3 levels of filters – 9dB, 15dB, 25dB
Tested and certificated to conform to EN352-2
Custom moulded silicone earpieces
ER9, 15 and 25 filterattenuation curves
0
5
10
15
20
25
30
125 250 500 1000 2000 4000 8000Atte
nuat
ion
in d
B(A)
ER-9ER-15ER-25
Frequency in Herz
The good news with 15 dB The good news with 15 dB reduction…reduction…
15dB of protection allows playing in 15dB of protection allows playing in 100dB100dB safely for up to safely for up to 8 hours8 hours
15dB of protection allows playing in 15dB of protection allows playing in 103dB103dB safely for up to safely for up to 4 hours4 hours
15dB of protection allows playing in 15dB of protection allows playing in 106dB106dB safely for up to safely for up to 2 hours2 hours
15dB of protection allows playing in 15dB of protection allows playing in 109dB109dB safely for up to safely for up to 1 hour1 hour
In the same way that the safe listening time dramatically decreases as In the same way that the safe listening time dramatically decreases as the sound level gets higher, if you’re able to put some viable protection the sound level gets higher, if you’re able to put some viable protection in place, the safe listening time can be increased just as dramatically.in place, the safe listening time can be increased just as dramatically.
Why do we need a hearing passport?
Helps to increases awareness of the risk of hearing damage
Promotes the provision of health surveillance amongst freelancers
Reduces the risk of hearing damage
Promotes the use of hearing protection when necessary and ensures that hearing protection is used correctly
What happens when a musician enrols on the scheme?
Audiological / medical history Full aural examination
Overview of the CNAWR and the risk of hearing loss
Advice and training on hearing protection
Full audiogram, audiological assessment
Details on the MHS scheme and to enrol…
musicianshearingservices.co.uk
Conclusions
Understand the importance of limiting the intensity and exposure time
Avoid exposure to levels above 90dB where possible
Use custom made hearing protection whenever you are in noise
Encourage musicians to have regular hearing health surveillance (e.g. The Musicians Hearing Passport)
If you protect your instrument in a If you protect your instrument in a case?case?
Why not protect your ears with Why not protect your ears with hearing protection?hearing protection?
A final thought………
THANK YOU