Basic Information on Hearing Health Students

Sources of Information on Hearing Health National Association of Schools of Music (NASM) Performing Arts Medicine Association (PAMA) American Academy of Audiology (AAA) Occupational Safety and Health Administration (OSHA) National Institute for Occupational Safety and Health (NIOSH) American National Standards Institute (ANSI)

Disclaimers: Information in This Presentation Information provided is generic and advisory. Information is oriented toward musicians and lay persons. Information does not substitute for professional judgments of medical or other experts. Information is not to be considered medical advice. Information does not supersede present and future empirical research. Information does not serve as basis for NASM accreditation functions. Information does not endorse accompanying reference materials.

Responsibility for Hearing Health Health and safety depend in large part on personal decisions of informed individuals. This information does not relieve individuals of personal responsibility for avoiding risk and preventing injuries to self before, during, and after study or employment at any institution. This information does not relieve the individual of personal responsibility for appropriate, prudent, and safe behaviors or actions. This information does not shift responsibility or liability for consequences of inappropriate, imprudent, and/or unsafe behaviors in any instance or over time to any institution, to NASM, or to PAMA.

Hearing Health: Important for Everyone, but Especially for Musicians Hearing loss can be the result of noise exposure. When hearing loss is caused by overexposure to noise, it is called Noise Induced Hearing Loss (NIHL). Music is a type of noise for purposes of sound exposure. Music of any type or source at high volume that exceeds daily exposure limits is dangerous. Preventive measures include information, applications of information, and acoustically appropriate performance and rehearsal spaces. 50% of musicians may have problems with hearing loss to some degree. Danger is calculated using scientific methods and instruments; individual perceptions are not a substitute for these.

Basic Facts about NIHL Any sound that is too loud or too loud for too long is dangerous to hearing health. Issues are: Loudness (also affected by proximity to source of sound) Duration Sounds below threshold risk are not dangerous no matter how long the exposure time. Hearing health can be affected by sounds other than music. Loud sounds from ALL SOURCES contribute 24/7 to daily exposure level. Protecting hearing health depends on balanced applications of knowledge and skills and by decisions made by individual students, professionals, and amateur musicians every day.

Middle Ear (little bones) The Path of Hearing Sound Vibrations Outer Ear Middle Ear (little bones) Inner Ear (cochlea) Brain Sound waves travel through the outer ear and eardrum to the bones of the middle ear. When they arrive at the inner ear, they are converted into electrical signals that travel through neural passages to the brain. It is these signals that the brain “hears” as sound or music.

Noise Induced Hearing Loss (NIHL) Middle Ear Damage Sudden very loud noise (like explosion) can perforate eardrum or dislodge miniature bones Can be corrected by surgery Inner Ear Damage Tiny hair cells help transmit sound to brain Loud noises damage hair cells Damage is permanent Severity of Loss Depends on severity of damage to inner ear hair cells NIHL is painless and progressive Initially NIHL reduces hearing sensitivity for high frequencies With continued noise exposure, damage progresses to greater loss for sounds involved in speech and music perception

Noise Induced Temporary Hearing Loss Known as “Temporary Threshold Shift” or TTS Reduces hearing ability temporarily Normally lasts no more than 16 – 18 hours May involve tinnitus (ringing, buzzing, or roaring in ears) Series of temporary hearing losses may be precursor to permanent damage Can be reversed with adequate rest and recovery time

Noise Levels and Risk Prolonged exposure to any noise or sound over 85 decibels (abbreviated dB) can cause hearing loss. Decibel is defined as “a unit for expressing the relative intensity of sounds on a scale from 0 for the average least perceptible sound to about 130 for the average pain level” (Merriam-Webster’s Dictionary). The longer one’s exposure to sounds over 85 dB, the greater the risk for hearing loss. The closer one is to the source of the sound, the greater the risk for hearing loss. Thus, duration and proximity, along with sound level from the source of sound, are key factors in risk assessment.

Common Sounds and their Corresponding dB Levels Decibel Level Approx. Max Rec. Daily Exposure 30 dB = A Whisper 50 dB = Moderate Rain 60 dB = The Average Conversation 70 dB = Passing Freeway Traffic 80 dB = Alarm Clock 85 dB = Potential Damage Threshold 90 dB = Blender, Food Processor, Blow-Dryer; The Subway Safe, No maximum Safe, No Maximum Safe, No Maximum Damage Threshold 2 hours

Common Sounds and their Corresponding dB Levels Decibel Level Approx. Max Rec. Daily Exposure 100 dB = MP3 Players at Full Volume; Lawnmower, Snow blower 110 dB = Rock Concerts and Sporting Events; Power Tools 120 dB = Jet Planes at Take Off 130 dB = Sirens; Race Cars; Jackhammers 140 dB = Gun Shots; Fireworks 15 minutes 2 minutes Unsafe, immediate risk

General Rules of Exposure The levels listed in the previous slides refer to: Continuous exposure at constant dB levels Specific durations of time Turn down the volume on your MP3 player or Smartphone 85 dB = 1/3 max. volume of MP3 94 dB = ½ max. volume 100 dB = full volume

Musicians and Risk of NIHL Facts Acute hearing and aural perception are essential for musicians. NIHL is preventable. Conclusions Musicians have basic hearing health responsibilities. Sound-level management is a critically important addition to the musician’s portfolio of essential disciplines.

Musicians and Risk of NIHL: Considerations Constant attention is required; hearing loss is usually a gradual, painless process. Initial stage hearing loss may involve pitch perception problems and tinnitus (e.g., ringing, buzzing, or roaring in the ears). These can progress to the point they become career-ending. Although musicians can be exposed to elevated sound levels while rehearsing and performing, exposure alone does not equal automatic risk.

Noise Can Impact Your Hearing When You: Attend concerts Play your instrument, especially with others Adjust the volume of your car stereo Listen to your radio, CD player, MP3 player, or Smartphone

Risky Sound Environments: Clues to Help You Know An environment is risky when You have to raise your voice to be heard You can’t hear someone who is 3 feet away from you The speech around you sounds muffled or dull after you leave a noisy area You experience pain or tinnitus (ringing, buzzing, or roaring in your ears) after you leave a noisy area

Major Variables in Risk of NIHL Sound Level Variation—sound levels rise and fall in various environments—e.g., the practice room, the ensemble rehearsal hall, the concert hall Settings—spaces for rehearsals and concerts need to have adequate cubic volume and acoustical treatment In-ear monitors and electronic amplification are particularly risky factors Distance—the closer the proximity to the source of the sound, the greater the sound level exposure Length of Exposure—the duration of exposure is a critical factor in determining risk

Basic Protective Devices for Musicians Earplugs Often made of foam or silicone Are inserted into the ear canal to protect against loud noise Some are designed for music applications Earmuffs Two protective foam pads connected by a headband or strap Cover the wearer’s ears to protect against loud noises

Basic Protective Behaviors for Musicians Avoid situations likely to pose danger to your hearing health. Refrain from activities that can endanger your hearing health. Maintain a safe distance from sources of loud sound, including speakers and the stage at loud concerts. Keep MP3 players and other personal listening devices at “safe” levels. 85 dB is normally about 1/3 of maximum volume for these devices. See an audiologist or other qualified professional to learn safe practices for in-ear monitors before using them. Develop a sense of your daily exposure levels of safe and unsafe volume and duration. Take breaks from exposure during rehearsals. Use earplugs or other protective devices in noisy environments and when using noisy equipment.

What to Do if You Have Concerns About Damage to Your Hearing Health If you are having difficulty hearing or experience symptoms of hearing damage (ringing, buzzing in ears, altered pitch perception, etc.), see a medical professional for assessment and any needed treatment. If you have concerns about the overall volume level in your ensembles or other situations, speak with your instructor. Take Personal Responsibility