1. Basic Information on Hearing Health
Students

2. 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)

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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

9. 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

10. 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.

11. 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

12. 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

13. 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

14. 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.

15. 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.

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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