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Wednesday, May 11, 2011

These Go to Eleven: Music-induced hearing loss

In the mockumentary This Is Spinal Tap, Chris Guest's rocker "Nigel Tufnel" proudly points out that the volume controls for his amplifiers are "one louder" than standard amps. "These go to 11." In real life, This Isn't Spinal Tap, and one can have too much of a good thing. The "good thing" we are talking about is playing or listening to your favorite music too loudly and possibly damaging your hearing. Once you have hearing loss, music will never sound the same; ringing in the ears will rob you of the sound of silence.

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Whether it's rock, classical, hip hop, or something in between, at certain sound levels, repeated exposure to music can cause permanent hearing loss and/or ringing in the ears known as tinnitus. Recent studies by NIOSH researchers and others at nightclubs and other music venues show that all employees studied, regardless of occupation (waiters, bartenders, DJs, etc), were exposed to noise levels above the internationally recommended limits of 82-85 dB(A)/8 hours and were at a higher risk of developing hearing loss and/or tinnitus. A new term, music-induced hearing loss, has been coined to reflect this growing condition.

Musicians and others working in entertainment and sports (see related blogs) are often overlooked in terms of occupational safety and health. Few countries (Australia, Switzerland, Italy, Austria, Finland, and Sweden) have specific recommendations for occupational exposure limits when it comes to musical activities or noise in the entertainment industry. While great strides are being made in terms of research on music-induced hearing loss, hearing conservation efforts have been minimal.

Hearing loss prevention approaches need to be customized, since "classic" conservation initiatives—those geared toward industrial settings—may not be appropriate. For example, removing the hazardous noise source or removing the worker (i.e., the musician) are not really applicable. Assessing hearing risk can be complicated when it comes to music. Correct and consistent use of hearing protection can prevent hearing loss among musicians, but convincing DJs, musicians, and others at risk of hearing loss to use appropriate hearing protection is challenging. Finally, since we are not dealing with "noise," hearing conservationists have to think about hearing loss prevention from an artistic view—not just medically or scientifically.

So what can be done? Targeted communication campaigns are needed to highlight the value of hearing, the risks associated with continuous exposure to loud music and more importantly, the availability of services and products that preserve sound quality and are suited to musicians' needs. Examples of efforts to reach musicians and other professionals exposed to music come from three recipients of an award created by NIOSH in partnership with the National Hearing Conservation Association (NHCA), the Safe-in-Sound Excellence in Hearing Loss Prevention Award™:

2009 Innovation Winner (Services Sector). In terms of getting the message out to those who need it, possibly no one has had a bigger impact than Sensaphonics Hearing Conservation, Inc*. Their client list illustrates how effective they have been at teaching hearing conservation awareness and expanding services available to musicians. Sensaphonics developed training on the basics of live performance audio, technique and product solutions for safe music playing, backstage etiquette, and how to work effectively with music industry clients. They develop products that allow artists and engineers to translate that knowledge into great live performances in a way that preserves the hearing of those exposed. One of their major contributions to hearing conservation is the focus on In-Ear Monitors (IEMs). Bringing the mix directly to the musician places less reliance on stage and monitor volumes. Most recently, Sensaphonics has integrated sound level meters into the IEM so the musician can know the actual levels they are dialing in. Sensaphonics has placed a great deal of emphasis on personal choice and responsibility. Their aim is to empower musicians with the knowledge and resources to manage their hearing health.

2010 Innovation Winner (Manufacturing Sector). Etymotic Research, Inc*, was arguably the first company to offer solutions to the problem of music related hearing damage. They approached the problem of managing risk by thinking like musicians and working with them. Conventional earplugs can offer too much attenuation or distort sounds, but today we have better hearing protection alternatives for music performance and enjoyment. In terms of music and conservation, one of Etymotic's greatest contributions is the flat attenuating "Musician's Earplug". While many industries regard hearing protection devices as a last resort in terms of conservation, for many musicians this may be the only realistic and readily available option for protecting their ears. Etymotic's most recent contribution (Electronic BlastPLG earplugs) received a 2011 Innovation Award from the Consumer Electronics Association. The EB15 model automatically becomes a 15-dB high-fidelity hearing protector when ambient noise exceeds safe levels.

2010 Innovation Winner (Services Sector). Professor Kris Chesky (a musician himself, who has hearing loss since college) and the College of Music at the University of North Texas (UNT) are taking a broad approach to raise awareness of the importance of hearing loss prevention by changing the pedagogy of music education. They have developed educational goals, policies, support materials for music educators and an occupational health course for music students. They are also conducting research on measuring sound pressure levels in music classes and establishing exposure databases for different music school scenarios.

Professor Chesky's work has been inspired by his belief that: "...every person learning about music in the United States, from early grade school through college, must be taught to understand that music is a sound source capable of harming hearing and that music can be studied, practiced, performed, and consumed in ways that are not risky to hearing."

UNT's innovative research and methodology, education, and advocacy have reached music educators and students, university administrators and board members of accreditation agencies. It is also bringing additional attention to the risk of music-induced hearing loss to other professionals in entertainment venues and to the general public.

So, we are making strides and can go beyond "don't go one louder!" by offering some do's, which can work for musicians, workers exposed to music, and music lovers:

Know the risks. Overexposure to excessively loud sounds can cause irreversible damage to your hearing.Exposure time is just as important as exposure levels when it comes to creating risk. Be sure to take breaks in quieter areas. Limit your time in noise (from sports, transportation, firearms, etc). It all adds up!Wear earplugs. Consider custom- or universal-fit Musicians Earplugs to keep fidelity but decrease intensity.Move around venues to find a "quieter spot." Sound reverberates and you might decrease your exposure level if you stand in a spot where you are not getting sound directly from the source.If you are a professional performer in a constant venue (house player), examine or ask about engineering controls that could be implemented to improve the acoustics of the room or hall and reduce exposure levels. If you experience ringing or "muffling" for more than 24 hours, you may want to consider a hearing check-up. Tinnitus and temporary changes in hearing might be a sign of early onset of permanent damage.

Are there reasons for optimism? Plenty! In Sweden, a country that has invested in educational campaigns early on, higher percentages of young people wear hearing protection when exposed to loud music or noise, in comparison to other countries (61% study participants in Sweden, 9% in the US and 2% in Brazil; Zocoli et al., 2009). Hearing protection use for music exposure is increasing in Australia following reports issuing recommendations (Binge Listening, 2010).

Spreading the information from campaigns such as those referenced above and included below can help those exposed to loud music preserve their hearing and extend the enjoyment they get from music.

—Thais C. Morata, Ph.D., and Ryan Johnson, B.A.

Dr. Morata is a research audiologist in the NIOSH Division of Applied Research and Technology.

Ryan Johnson, a musician-audiology student, worked at NIOSH as a student member of the Safe-in-Sound Expert Committee in 2010.

*Inclusion of a company name or product does not constitute an endorsement from NIOSH or the Federal Government.

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