One of our most precious assets, as musicians, is our hearing, yet we are constantly endangering our hearing merely by going to work. Janet Horvath, Minnesota Orchestra cellist, describes some of the most common hearing injuries and offers some excellent advice as to what you can do to protect your hearing.
Let’s talk about something scary; something musicians are even more reticent to talk about than overuse injury. Hearing loss is on the rise and is a danger to all of us. Our world is becoming toxically noisy and we who are musicians must be particularly vigilant. Symphony orchestras are loud, and our own instruments are loud. Violins and violas can reach 100 decibels – comparable to the sound of a major sporting event. Brass instruments reach 114 decibels – the level of a chain saw and a loud band in a bar. Symphonic music at its peak can reach 130 decibels – the level of a jackhammer.
But life is loud too! Over the last several years, environmental noise has doubled each decade. It seems that wherever you go, volumes are cranked up: notice the volumes at movies, of your iPods, of power tools, lawn mowers and snow-blowers, and the background music in restaurants, grocery stores and clothing stores, let alone discos, rock concerts and high-decibel recreational events. Over 28 million Americans have hearing loss and that number is dramatically rising.
Like many overuse injuries, hearing loss is cumulative, but unlike overuse injuries, hearing loss is permanent. Noise-induced hearing loss is our biggest concern and is on the rise, even among very young people. Sometimes noise-induced hearing loss occurs so slowly over time that we don’t even realize that damage is occurring until it is too late. The ear is just like any other part of our body: use it too much and it can be damaged.
Have you ever experienced reduced hearing, ringing in your ears, and/or a hot heavy feeling in your ears after a loud rehearsal or performance? This is called a temporary threshold shift. Usually a period of 16 hours of rest will allow the ear to recover from a particularly loud performance. Those of us in professional symphony orchestras know that sometimes that amount of time off is difficult. But too many occurrences of threshold shift can result in a permanent hearing injury.
Are young people immune? NO! Children and young people are at risk too. In fact, in a recent survey on MTV’s website of nearly 10,000 people under the age of twenty-one, two-thirds had experienced ringing in the ears or hearing loss, although only 8% of respondents reported that they were concerned about hearing loss.
Sometimes a hearing injury can occur without hearing loss. I would like to discuss two very devastating and life changing hearing injuries: tinnitus and hyperacusis.
Nearly 50 million Americans suffer from tinnitus, or “ringing” in the ears or head that only you can hear, and of these sufferers, 13 million are under the age of 18. The sounds can be intermittent or continuous, in one or both ears. It can be one pitch, or it can be a roar described by some sufferers as a sound like a jet taking off or a train. It is more pronounced at night in bed when there are no other ambient sounds. Exposure to loud noise is the leading cause of tinnitus and can be, but is not always, accompanied by hearing loss. There are other causes of tinnitus as well, such as high blood pressure, a tumor, diabetes, thyroid problems, an injury to the head or neck, and taking certain medications. It is important, therefore, to see an otolaryngologist to determine the cause of your tinnitus.
In many cases tinnitus is incurable. Treatment options include cochlear implants to mask the sounds you hear internally with electrical stimulation or white noise (i.e., broadband sound that is a combination of all sound frequencies at very low levels). This is called tinnitus-retraining therapy. Sometimes the severity of the tinnitus symptoms can be reduced by decreasing the intake of salt and caffeine, keeping blood pressure levels controlled, exercising daily to improve circulation, using relaxation techniques, avoiding fatigue and stress, quitting smoking, and especially avoiding exposure to loud sounds.
Sufferers may become paranoid and depressed about their condition. They may be tempted to avoid any situations that may be loud, and may be tempted to isolate themselves from normal social interactions as well as noisy locations.
It is paramount that musicians protect themselves from this condition by careful preventative techniques. A few suggestions follow in this article.
Hyperacusis is the collapsed tolerance to normal sound. All sounds are too loud for sufferers of hyperacusis, but sensitivity to sound is NOT hyperacusis. Hyperacusis is a symptom where the person’s abnormal discomfort and intolerance to sound does not improve. Although this condition is more rare than tinnitus, many tinnitus sufferers also have some degree of hyperacusis.
Hyperacusis can occur in the absence of hearing loss. It can occur in one or both ears, and these patients yearn for an escape from sound – for total silence. Imagine being at a movie where the sound track seems to be at the highest volume, or the clattering of dishes, women’s voices, microwave beeps, jingling of keys, someone speaking on the telephone, or the sound of your own voice is intolerable. The volume of the whole world seems to be stuck on high! With hypercusis, the protective mechanisms a normal ear employs to minimize the harmful effects of loud noise are malfunctioning due to noise-induced damage, so noise may seem too loud even with hearing protection. Most hyperacusis patients also experience inner ear pain and a feeling of fullness or pressure.
Although the majority of cases are the result of noise exposure over time, sometimes a sudden burst of noise can do it. Other causes associated with this disorder include Meniere’s disease, migraine, head injury, or surgery to the face or jaw. It is important to be evaluated. Audiograms for hyperacusis sufferers are typically normal but sensitivity levels are well below normal. For example, most people do not experience discomfort until the sound level is above 100 decibels. For hyperacusis patients this level of discomfort is 40 or 50 decibels. Sometimes not all frequencies cause the same level of discomfort, and certain frequencies will be extremely disturbing even at very low volumes.
Many hyperacusis patients have trouble facing the noise of the day and resort to wearing headphones and earplugs. They feel like they must avoid telephone use, tiptoe around their house, and avoid normal activities, let alone play music for a living! Isolation is tempting but can result in a further breakdown of tolerance to sound.
The most successful treatment for hyperacusis is tinnitus-retraining therapy. This involves going to a qualified tinnitus-retraining center. There the patient is fitted with a headpiece that transmits “pink” noise or broadband sound (i.e., very soft sound without the higher frequencies that a typical hyperacusis patient is more sensitive to) just below intolerance levels for several hours a day, to rebuild tolerance to normal environmental noise. Sound desensitization therapy takes months but has been shown to be effective.
How loud can we safely turn up our headphones when we listen to music? Risk varies with the type of headphone you use. A study in 2001 found that the closer to the eardrum the sound is, the greater the risk, as the sound levels are higher closest to the eardrum. Are you ready for a surprise? The study by Fligor found “that you can safely listen to headphones with it set at level six (out of ten) for an hour a day.” (www.rollingstone.com Music Making Fans Deaf?) For ear buds or other in-the-ear headphones, it is half that amount of time – around thirty minutes – at which point you are already at your safe daily dose. How many of us know people who wear them all day? iPods and Sony Walkmans with ear buds can go as high as 130 decibels – the level of a jackhammer. Interestingly, a law has been passed in Europe. Their iPods are capped at 100 decibels.
1. Practice more softly. Consider wearing earplugs to practice loud passages.
2. Avoid practice in small rooms with hard surfaces. We all sound fabulous in a small tiled room, but such spaces are harmful to our hearing.
3. Distance yourself. Whenever possible, increase the space between you and the noise.
4. Use Plexiglas shields and hearing protection. The Etymotic Research ER-15 & ER-25 Musicians Earplugs are deep fitting, custom-fitted ear plugs that one can play with, and they are very effective in reducing the decibel level by 15 or 25 dBA. But store-bought earplugs work too! Carry them wherever you go and remember that cotton or tissue doesn’t work!
5. Minimize your exposure. Our ears are subject to constant abuse, both on and off the stage. Avoid exposure to environmental noise as well. Noise directly contributes to hearing loss and tinnitus. Be vigilant about your exposure, both on the job and off. Wear ear protection when you are exposed to loud music or when you operate power tools.
6. Alternate your repertoire. Whenever possible, alternate noisy pieces of music with quieter ones. This protects you from overusing one particular muscle group as well as your ears.
7. Avoid air travel when you are congested due to a cold or sinus or ear infection. Serious damage can occur with changes in air pressure. If travel is imperative, consider using a decongestant, and use a nose spray when you put your seatbelt on and again prior to landing if you’ve flown four hours or more.
8. Take breaks. Take a 10-minute break every hour for both your body and your ears. Go to a quiet room after a particularly bombastic rehearsal or performance, and if you go to or perform in a loud concert on Friday, don’t mow your lawn on Saturday. Give yourself a 16-18 hour auditory rest period whenever possible.
9. Violinists: protect your left ear. A violinist’s left ear is bombarded with sounds as high as 100 decibels coming out of the F-hole – about as much sound as a sporting event and almost as loud as a French horn! At least when you practice, use hearing protection in that ear.
10. Hum! When you might be caught without your earplugs, hum. Humming or grunting just prior to a loud noise like a cymbal crash and sustaining the hum through the sound gives significant protection. This is because we have a small muscle called the stapedial muscle, which, when contracted, partially blocks loud sounds from getting through to cause damage.
11. Turn down volumes on everything and avoid unnecessary exposure to loud noise.
12. Get better headphones. Avoid ear buds and limit your time listening in this fashion.
13. Quit smoking. Your risk for hearing loss is double that of your non-smoking counterparts.
Watch for Signs of Trouble:
We need to be serious about our hearing health. Make an appointment to get a base-line hearing test so that, in the years to come, you can monitor any changes that might be occurring.
Hearing loss is a combination of factors. You can sustain hearing loss at any age if you are exposed to noise that is too loud, too close to you, or if you are exposed for too long a time. Your ears are your most important asset if you are a musician. Protect them!
From Janet Horvath’s
Playing (less) Hurt - An Injury Prevention Guide for Musicians
Available for $23.95 at www.playinglesshurt.com.
© 2002 and 2006 by Janet Horvath