Promoting Healthy Hearing in Musicians: Understanding the Risks and Protection

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PROMOTING  HEALTHY
HEARING IN MUSICIANS
Christine D. Njuki, Au.D., CCC-A
Clinical Professor
Audiologist
OVERVIEW
The Ear
Music Induced hearing loss-why we don't want it
Are you at risk?
Healthy hearing behaviors
Hearing protection for musicians
Additional resources
HOW THE EAR WORKS
HOW THE EAR WORKS
The inner ear (cochlea) is
tonotopically organized
http://bcove.me/gtvm0psh
 
HOW THE EAR WORKS
 
16000 hair cells sitting on the basilar
membrane
Shearing occurs with basilar
membrane movement
Hyperphysics.phy-astr.gsu.edu
 
HOW THE EAR WORKS
CHARACTERISTICS OF MUSIC -
INDUCED HEARING LOSS (MIHL)
Gradual decline in hearing
Early stages are rarely detected
It doesn’t have to hurt!
Loss of fidelity, specifically higher pitches, not volume
http://www.aafp.org/afp/2000/0501/p2749.html
HIGH FREQUENCY HEARING LOSS
SIMULATION
http://www.hearinglikeme.com/facts/what-hearing-loss/hearing-
loss-simulator-understanding-mild-and-moderate-hearing-loss
TREATMENT OPTIONS
ARE POOR
We cannot generate new hair cells……yet
Hearing aids are designed for communication, not music
appreciation
OTHER SYMPTOMS OF MIHL
https://www.youtube.com/watch?v=Dgq-ka1FkZk
Other symptoms may be worse than
the hearing loss
Permanent and constant tinnitus
Poor pitch perception
Hypersensitivity to loud sound
 
http://hearnet.com/features/feature_PSA.shtml
http://hearnet.com/audio_video/video/mermen.mov
http://www.hearnet.com/audio_video/video/Hearnet_
Protect.mov
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ARE YOU AT RISK?
 
 
National Institute of
Occupational Safety & Health
INTENSITY
 
How loud is too loud?
 
 85dBA SPL (dial tone)
INTENSITY
MAXIMUM LEVELS FOR INSTRUMENTS
(WAGNER RING CYCLE:  CAMP AND HORSTMAN, 1992)
DURATION
How long is too long?
 
40 hours per week
Classically trained musicians tend towards higher noise exposure
than rock musicians because of the amount of time exposed.
NOISE DOSAGE = 
DURATION AND INTENSITY
85dBA SPL over a 40-hour work week =
 safe
3dB Exchange Rate (+3dB = sound exposure doubles and safe
listening time is cut in half)
UT Dallas has explored positive effects of ensemble instructors
consciously setting practice agendas with overall noise dose in mind
> 100% noise dose is associated with hearing damage
CHASIN (2006)
Safe listening time
85  = 8 hours
88 = 4 hours
91 = 2 hours
94 = 1 hour
100 = ½ hour
TRACK YOUR OWN NOISE DOSE
NIOSH Sound level meter App
https://www.cdc.gov/niosh/topics/noise/app.html
TRACK YOUR OWN NOISE DOSE
NIOSH Sound level meter App
https://www.cdc.gov/niosh/topics/noise/app.html
UCONN MUSICONN STUDY - 
IN PRESS
Noise Dose of 56 UCONN students
(not including ear/headphone use!)
 
Non-Musicians
                                 
Musicians
Mean =        41%                                                   293%
Range =       1-294%                                              7 – 902%
WHAT ABOUT THE MUSICAL BRAIN?
The Musician Advantage?
Years of playing               = speech in noise ability
WHAT ABOUT NOISE EXPOSURE ON
THE MUSICAL BRAIN?
Routine noise exposure         =  speech in noise ability
Standard hearing test  = normal results
WARNING SIGNS OF OUTER HAIR CELL
DAMAGE
Tinnitus (noises in your ears)
Ringing
Buzzing
Hissing, etc.
“Temporary” decrease
Muffled,
muted,
ears may “feel” plugged
Temporary can become
permanent
HEALTHY HEARING BEHAVIORS
REDUCING INTENSITY AND DURATION
Use noise cancelling headphones in noisy areas (bus, mowing,
gym, plane) 
when it is safe 
to do so
Reduce the volume and/or duration of personal music devices
80-90 rule for MP3 players (80% volume for 90 minutes) = 50%
dose 
, Fligor 2006 (50% volume is safe for any length of time)
Turn up your favorite song, then turn it back down.
Give your ears at least 14 hours of “recovery time”, but realize
that it is a warning sign and may become permanent
Humming can be used as a temporary protective mechanism
Take quiet breaks whenever possible
HEARING PROTECTION
Sound quality???
High fidelity
Designed for musicians
Can you use too much?
Custom and non-custom
ADDITIONAL RESOURCES
UCONN Speech & Hearing Clinic (860)486-2629
https://music.uconn.edu/health-and-wellness/
Musicians’ Clinics of Canada: 
http://www.musiciansclinics.com/
Which earplug is right for you?
https://www.etymotic.com/consumer/hearing-protection/which-
earplug
Hearing Education and Awareness for Rockers:
www.hearnet.com
National Association of Schools of Music
http://nasm.arts-accredit.org/
Performing Arts Medicine Association
http://www.artsmed.org/
REFERENCES
"Noise Exposure May Diminish the Musician Advantage for
Perceiving Speech in Noise", Skoe, Camera, Tufts  - in press
"Examining the noise life of the Musician: a weelong noise
dosimetry of music and non-music activities, Tufts and Skoe IJA
2017; early online: 1-8
“Output levels of MP3 players” Portnuff and Fligor, NIHL in
Children at Work and Play Conference, October 2006
Marshall Chasin powerpoint lecture slides (#15,17):
www.musiciansclinics.com
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Preventing Music-Induced Hearing Loss (MIHL) is crucial for musicians. This informative content by Christine D. Njuki, Au.D., CCC-A, sheds light on the workings of the ear, characteristics of MIHL, treatment options, and associated symptoms like tinnitus and poor pitch perception. The emphasis is on adopting healthy hearing behaviors and using hearing protection to preserve musicians' hearing health.


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  1. PROMOTING HEALTHY HEARING IN MUSICIANS Christine D. Njuki, Au.D., CCC-A Clinical Professor Audiologist

  2. The Ear Music Induced hearing loss-why we don't want it Are you at risk? Healthy hearing behaviors Hearing protection for musicians Additional resources OVERVIEW

  3. HOW THE EAR WORKS

  4. The inner ear (cochlea) is tonotopically organized http://bcove.me/gtvm0psh HOW THE EAR WORKS

  5. Hyperphysics.phy-astr.gsu.edu 16000 hair cells sitting on the basilar membrane Shearing occurs with basilar membrane movement HOW THE EAR WORKS

  6. HOW THE EAR WORKS

  7. Gradual decline in hearing Early stages are rarely detected It doesn t have to hurt! Loss of fidelity, specifically higher pitches, not volume CHARACTERISTICS OF MUSIC - INDUCED HEARING LOSS (MIHL) http://www.aafp.org/afp/2000/0501/p2749.html

  8. http://www.hearinglikeme.com/facts/what-hearing-loss/hearing- loss-simulator-understanding-mild-and-moderate-hearing-loss HIGH FREQUENCY HEARING LOSS SIMULATION

  9. We cannot generate new hair cellsyet Hearing aids are designed for communication, not music appreciation TREATMENT OPTIONS ARE POOR

  10. https://www.youtube.com/watch?v=Dgq-ka1FkZk http://hearnet.com/features/feature_PSA.shtml http://hearnet.com/audio_video/video/mermen.mov Other symptoms may be worse than the hearing loss Permanent and constant tinnitus Poor pitch perception Hypersensitivity to loud sound http://www.hearnet.com/audio_video/video/Hearnet_ Protect.mov OTHER SYMPTOMS OF MIHL

  11. ARE YOU AT RISK?

  12. National Institute of Occupational Safety & Health

  13. How loud is too loud? 85dBA SPL (dial tone) INTENSITY

  14. MAXIMUM LEVELS FOR INSTRUMENTS (WAGNER RING CYCLE: CAMP AND HORSTMAN, 1992) Instrument French Horn Bassoon Trombone Tuba Trumpet Violin Clarinet Percussion (Amplified Guitar Peak Level (dB SPL) 107 102 108 110 111 109 108 >120 >115) INTENSITY

  15. How long is too long? 40 hours per week Classically trained musicians tend towards higher noise exposure than rock musicians because of the amount of time exposed. DURATION

  16. 85dBA SPL over a 40-hour work week = safe 3dB Exchange Rate (+3dB = sound exposure doubles and safe listening time is cut in half) UT Dallas has explored positive effects of ensemble instructors consciously setting practice agendas with overall noise dose in mind > 100% noise dose is associated with hearing damage NOISE DOSAGE = DURATION AND INTENSITY

  17. CHASIN (2006) Safe listening time 85 = 8 hours 88 = 4 hours 91 = 2 hours 94 = 1 hour 100 = hour

  18. NIOSH Sound level meter App https://www.cdc.gov/niosh/topics/noise/app.html TRACK YOUR OWN NOISE DOSE

  19. NIOSH Sound level meter App https://www.cdc.gov/niosh/topics/noise/app.html TRACK YOUR OWN NOISE DOSE

  20. Noise Dose of 56 UCONN students (not including ear/headphone use!) Non-Musicians Musicians Mean = 41% 293% Range = 1-294% 7 902% UCONN MUSICONN STUDY - IN PRESS

  21. The Musician Advantage? Years of playing = speech in noise ability WHAT ABOUT THE MUSICAL BRAIN?

  22. Routine noise exposure = speech in noise ability Standard hearing test = normal results WHAT ABOUT NOISE EXPOSURE ON THE MUSICAL BRAIN?

  23. Tinnitus (noises in your ears) Ringing Buzzing Hissing, etc. Temporary decrease Muffled, muted, ears may feel plugged Temporary can become permanent WARNING SIGNS OF OUTER HAIR CELL DAMAGE

  24. Use noise cancelling headphones in noisy areas (bus, mowing, gym, plane) when it is safe to do so Reduce the volume and/or duration of personal music devices 80-90 rule for MP3 players (80% volume for 90 minutes) = 50% dose , Fligor 2006 (50% volume is safe for any length of time) Turn up your favorite song, then turn it back down. Give your ears at least 14 hours of recovery time , but realize that it is a warning sign and may become permanent Humming can be used as a temporary protective mechanism Take quiet breaks whenever possible HEALTHY HEARING BEHAVIORS REDUCING INTENSITY AND DURATION

  25. Sound quality??? Custom and non-custom High fidelity Designed for musicians Can you use too much? HEARING PROTECTION

  26. UCONN Speech & Hearing Clinic (860)486-2629 https://music.uconn.edu/health-and-wellness/ Musicians Clinics of Canada: http://www.musiciansclinics.com/ Which earplug is right for you? https://www.etymotic.com/consumer/hearing-protection/which- earplug Hearing Education and Awareness for Rockers: www.hearnet.com National Association of Schools of Music http://nasm.arts-accredit.org/ Performing Arts Medicine Association http://www.artsmed.org/ ADDITIONAL RESOURCES

  27. "Noise Exposure May Diminish the Musician Advantage for Perceiving Speech in Noise", Skoe, Camera, Tufts - in press "Examining the noise life of the Musician: a weelong noise dosimetry of music and non-music activities, Tufts and Skoe IJA 2017; early online: 1-8 Output levels of MP3 players Portnuff and Fligor, NIHL in Children at Work and Play Conference, October 2006 Marshall Chasin powerpoint lecture slides (#15,17): www.musiciansclinics.com REFERENCES

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