Musicians and the Prevention Musicians and the Prevention of Hearing Lossof Hearing Loss

Catherine V. Palmer, PhD

Director of Audiology, UPMC

Associate Professor, Communication Science and Disorders

WarningWarning

By attending this presentation, you will have to think differently about the way you do things.

I would go as far as to say that it would be extremely uncomfortable to have this information and not take action…

Understanding the ear and Understanding the ear and hearinghearing

3 Primary Divisions3 Primary Divisions

Tour through the Ear.wmv

Auditory SystemAuditory System

With musicians, hearing loss With musicians, hearing loss is not the only problem …is not the only problem …

Tinnitus

Pitch perception problems

Two Critical Factors Affecting Two Critical Factors Affecting Hearing LossHearing Loss

Intensity

Duration

Who is in danger?Who is in danger?

Remember, the danger of damage to the hair cells and subsequent hearing loss has to do with the individual’s total dose.

You have to think about all the loud sounds that the individual will be exposed to during the day.

Functional ImpactFunctional Impact

Decreased sensitivity (you need sounds louder to hear them)

Diminished clarity (frequency resolution is poor). This impacts playing music, enjoying music, and hearing speech.

Tinnitus (ringing sounds, often high pitched)

After exposure there may be no symptoms, or the individual may experience ringing in the ears, a sensation of fullness, or sounds my seem “dull”

The damage and functional change is gradual. The individual may not notice a problem for a decade or more.

The damage continuesThe damage continues

We know that hair cells continue to die well after the exposure.

Musical LevelsMusical LevelsNormal Piano Practice 60-70 dB

Chamber Music in Small Auditorium 75-85 dB

Regular, Sustained Exposure May Cause Permanent Damage

>90 dB

Piano Fortissimo (2.5 to 5 hours) 92-95 dB

Violin (1.25 hours) 84-102 dB

Cello (5 hours) 82-92 dB

Oboe (2.5 to 5 hours) 90-94 dB

Flute (1.25 hours) 85-111 dB

Piccolo (5 minutes to 1.25 hrs) 95-112 dB

Musical Levels (cont)Musical Levels (cont)Music Levels dB

Clarinet (1.25 hours) 92-103

French Horn (5 min to 1.25 hrs) 90-106 dB

Trombone (5 min to 1.25 hrs) 85-114 dB

Ensemble (average) (1.25 to 2.5 hours)

97 dB

Timpani and Bass Drum Rolls (5 min)

106 dB

Orchestra Peaks (2.5 minutes) 120-137 dB

Band at a Sporting Event (2.5 min)

Marching Band (4 seconds)

100-120 dB

125 dB

Take a look at the graph in your Take a look at the graph in your handouthandout

Maximum Weekly Noise Exposure (NIOSH, 1998)

80

85

90

95

100

105

110

115

120

125

130

135

40 20 10 5 3 1 38 19 9 5 2 1 35 18 9 4 2 1

Hours Minutes Seconds

dB

(A) Major Major

SportingSportingeventevent

DrumlineDrumlinerehearsalrehearsal

Marching BandMarching Band

HoursHours Minutes Minutes Seconds Seconds

Take home messageTake home message Once instrumentalists play in a group, they are in

danger of permanent noise induced hearing loss within minutes

Drummers are always in danger of hearing loss (practicing alone or in a group)

You have to consider the total daily dose The impact of hearing loss may not be noticed for

years These times are based on adult data and there are

some animal studies that suggest that children are more susceptible

What can instrumental instructors What can instrumental instructors (and parents) do?(and parents) do?

Protect yourselfProtect your students (children)Educate your students (children)

– Hearing health care should be part of every music program and part of health class

– Let’s talk about hearing protection…

Hearing ProtectionHearing Protection

“Who wants earplugs that won’t let you hear?”

Mead Killion

Description of School ProgramsDescription of School Programs

A recent national study estimated that approximately 12% of all children ages 6 to 19 years have noise-induced hearing loss.

Children are the fastest growing population of individuals with noise-induced hearing loss.

Goals of the ProgramGoals of the Program

Provide instrumental music instructors with education related to hearing loss and hearing protection and music

Provide instrumental music instructors with non-custom Musicians’ Earplugs or custom Musicians’ Earplugs at a reasonable cost

Provide non-custom Musicians’ Earplugs to instrumental music students through the instructors

Provide education to instrumental music students through the instrumental music teachers

Putting Hearing Protection in Putting Hearing Protection in ContextContext

We would not consider sending students to chemistry class or shop class without protective goggles.

We would not consider allowing students to play football without a helmet.

We may know that a football player rides his bike with no helmet, but that would not make us decide not to bother with a helmet during football just because he has increased his chance of having a head injury anyway.

Parents have the right to assume that schools make school activities as safe as possible using current information and technology.

It actually would be much simpler if noise induced hearing loss caused pain or bleeding – then you can be sure hearing protection would be required.

The damage is invisible…finally there is functional impact but it can be years after the damage

Are we saying that music is Are we saying that music is dangerous?dangerous?

No, but we are saying like many things we engage in, you need to use the appropriate equipment to make it safe and to be able to enjoy it over a long period of time.

Successful Programs So FarSuccessful Programs So Far

What message is the teacher sending if he/she wears hearing protection in front of students? Good health habits

Mandatory – when you come into the band room, the first thing you do is get your hearing protection.

No hearing protection – you don’t participate in class. (keep lots of extras)

Help the students adjust. It takes about 2 weeks to get used to using the hearing protection (horns are the toughest)

Easy to useEasy to use

The plugs come with cords so the students can have them in and out if needed and drape them over their necks

The plugs come in a case that can be hooked to a back pack or instrument case

Students are welcome to use these earplugs throughout their days, weekends, etc. or the teacher may want to keep them in the band room

Who should absolutely be using Who should absolutely be using hearing protection?hearing protection?

InstructorsBand studentsOrchestra studentsSteel Band studentsAll drumming groupsMost other group-type musical studentsProfessional MusiciansAll ages

What about IPods?What about IPods?

They are not inherently dangerous. It’s the level and amount of time. Custom earplugs can reduce the volume used, but

then you can’t hear the sounds around you. I’m only talking about hearing safety, there are

other concerns with being “plugged” in for hours and not interacting with your environment.

Remember, it’s all about total dose.

Arms-Length RuleArms-Length Rule

If you have to shout to be heard from 3 feet away, then the noise (music) is too loud.

Turn down the volume or wear hearing protection.

E Earplugs/earmuffsA Avoid loud soundsR Reduce the volumeS Shorten the time in noise

FactsFacts Any type of music can cause

permanent hearing loss and ringing in the ears.

It is intensity level and length of exposure that matters.

The type of hearing loss people get from sound exposure is permanent.

The loss starts in the high frequencies and progresses. It causes difficulty communicating in noisy situations and impacts how music is perceived.

Sound exposure also may cause ringing in the ears (tinnitus).

Some musicians need to wear hearing protection when they are practicing alone.

All musicians need to wear hearing protection when they are playing in a group (band, orchestra) if they want to avoid hearing loss.