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The Science Of Hearing Wellness: The Doctor Is In

Addressing the causes of hearing injury -- even if you're experiencing issues, it's likely not too late

By Michael Santucci, Au.D. August 2, 2016

This article is provided by Sensaphonics.

 
Editor’s note: I’ve known Michael Santucci for a couple of decades now. I’ve been to his clinic and have talked with him numerous times about hearing health.

His company, Sensaphonics, a manufacturer of in-ear monitors, is unique. The products are designed to promote safe listening through maximum isolation, and it’s the only IEM company with a Musicians Hearing Clinic on site. They would literally rather sell you a hearing test than a pair of IEMs.

Sensaphonics has also been awarded the coveted Safe-In-Sound Award for innovation in hearing conservation from NIOSH and NHCA. Michael is arguably the pro audio and music industry’s leading voice for hearing health, and PSW is very pleased to bring his expertise to our community with this article, the first in a series devoted to hearing wellness. – Keith Clark

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I founded Sensaphonics in 1985 because, as an audiologist. I saw an unmet need for hearing wellness in the music industry. Back then, a hearing disorder was worn like a badge of honor, as if it was the inevitable price to pay for years of touring.

Awareness of hearing issues has dramatically increased since then but musicians and crew remain at risk from loud sound on stage, from practice, rehearsal, and recording. The industry and lifestyle add up to a near-constant assault on the ears. 

For music industry personnel, there is no question whether your hearing is at risk. It is. According to a landmark 2003 study by researcher Kim Kähäri at Göteborg University in Sweden, 74 percent of rock/jazz musicians reported hearing disorders. The most common ones were hearing loss, tinnitus, and hypersensitivity (extreme sensitivity to loud sounds). (Research abstract: http://www.ncbi.nlm.nih.gov/pubmed/12916701

The pro audio and music industry was – and remains – completely unregulated. Occupational Safety & Health Administration (OSHA) workplace rules do not apply. With no limits on sound levels, shows can easily exceed daily exposure limits and injure your moneymakers. And without your hearing, it’s pretty difficult to be a musician or audio professional.

As an audiologist, I’ve always found it puzzling that so many musicians and sound engineers don’t take care of their hearing. Instrumentalists take great care of their hands; singers take care of their voices. But even after a show that produces scary symptoms like ringing or pain in the ears, once the symptoms go away, most musicians figure they’ve dodged a bullet and go right back to the same behavior.

So why do they do so little to protect their ears?

1. Fear. Some perceive that turning it down or wearing protection will compromise their music. Some just fear getting bad news about the state of their hearing.

2. Ignorance. Not sure which tools will be effective. Some feel it’s too late for them, others feel they’re not at risk. Some just don’t care about their hearing.

3. Inconvenience. Finding an audiologist, seeing them during business hours, not to mention the time and expense.

4. Habit. Musicians have auditory plasticity beyond the non-musical population. Once your brain gets used to listening at the same (and sometimes unsafe) loudness, it’s difficult to get used to a lower listening level. Don’t worry, thousands have. So can you.

The only way to truly “dodge” hearing injury is to change behavior. There’s no shortcut, no magic wand, no piece of equipment that will protect you from overexposure to loud sound.

At Sensaphonics, we have a Musicians Hearing Clinic. We’ve seen about 2,000 music industry professionals annually for more than 20 years, and all visits are completely confidential. Many of our clients are touring professionals, but most are working musicians and techs from our hometown of Chicago. This has given us tremendous insight into the listening habits and hearing health needs of musicians and engineers, and I would like to share this expertise with you in this series of articles. I hope you find the information applicable to your career.

Audiology – Your Ticket To Hearing Wellness
Audiologists are trained health care professionals, and we have the tools and knowledge to help individuals deal with hearing loss and hearing aids. However, not many are experts in hearing loss prevention for the music industry.

In 1992, Sensaphonics started conducting two-day training seminars for audiologists about hearing disorder prevention for musicians. Found on our website, these audiologists with a Gold Circle designation have attended and are aware of the special circumstances and needs of musicians.

Hearing Conservation – Having The Conversation
Whether or not the audiologist is Gold Circle, don’t settle for just getting ear impressions. The appointment is your opportunity for knowledge. Here’s what happens at our Musicians Hearing Clinic. Our protocol has the components of any successful hearing conservation program:

• Case history – Our chance to learn about your exposure to loud sound, plus lifestyle and medical markers that may indicate increased risk.

• Hearing screening – Get a hearing test to create a baseline audiogram. The goal is to create a personal history to track changes in your hearing over time. At our clinic, we routinely include high frequency testing, which is not standard practice in most offices.

• Molding and fitting – Yes, we do take ear impressions for IEMs and/or earplugs or other protective device.  We also advise that you return to the audiologist to ensure of proper fit.

• Sound level assessment – We also try to nail down how loud you’re listening. Not the peaks, but the average over time. Do you play a 90-minute show? How often do you rehearse? What’s the average level? These are important keys to hearing wellness.

• Education and motivation – We spend more than 60 percent of our time on education and motivation and 40 percent on testing and molding. Research has demonstrated that this aspect is the most important for success.

Causes Of Hearing Loss
Let’s start with some education on hearing loss. Case histories help us determine the cause of your hearing disorder(s). There are five main causes of permanent hearing loss:

• Genetics
• Disease
• Injury from ototoxic substances, head or eardrum trauma
• Compromised vascular function, and
• Loud sound exposure.

Notice that old age is not listed as a cause of hearing loss. If that were true, then all old people would have hearing loss. The aging correlation is more about one or more of the five causes degrading your hearing over time.

I’ve heard all too often, “I’m going to lose my hearing anyway, so what’s the difference?” If you don’t fall into any of the five categories, you will likely have normal hearing throughout your life. It’s worth protecting.

Of those listed above, genetics, disease and ototoxic injury are less likely to cause hearing loss than loud sound exposure and poor vascular function. And the latter are the only two causes that you have control over. If you avoid injury from loud sound and maintain good vascular function, your risk of hearing disorders drops dramatically.

Hearing Disorders: Associated Injury From Loud Sound
We classify music-induced hearing loss as hearing injury – not hearing damage. I find the term “damage” to be so impersonal. In an auto accident, the people involved sustain injuries. Damage is what happens to the car.

Why make this distinction? To drive home an important point: that you are injuring yourself from overexposure to loud music and your behavior has hearing health consequences. What are some of the negative effects of overexposure to loud music?

Tinnitus – A persistent ringing, roaring, clicking, buzzing, etc. heard in the ear. Tinnitus typically begins as a temporary symptom, but can become chronic and debilitating. It can be caused by prolonged and repeated exposure to loud sounds, or even by short exposure to very loud sound.

Hyperacusis – Increased sensitivity to sound, sometimes across a specific frequency range. In hyperacusis, soft or moderate sounds may be perceived as unpleasantly loud, while loud sounds will literally cause pain. Obviously a huge problem for performing musicians.

Threshold Shift (TS) – This is a result of extreme ear fatigue, typically experienced as an inability to hear normal conversation after a gig, such that only sounds louder than a certain level will be heard. The most common form is temporary threshold shift, with recovery to normal hearing after the ear has had sufficient rest. Repeated exposure without sufficient recovery time can result in chronic or permanent threshold shift.

Diplacusis – In diplacusis, a single tone is perceived as two different pitches. The cause is a loss of hair cells across a certain frequency range, causing you to perceive pitches differently.

Our clinical experience indicates that severe tinnitus and/or hypersensitivity end more music careers than hearing loss itself.

Hearing Evaluations
The cornerstone to any hearing loss prevention program is getting a baseline hearing evaluation and periodic re-tests. Think of a baseline audiogram as a snapshot of your hearing at the time you decided to take action to preserve your hearing. Whether there is evidence of pre-existing hearing injury or not, the idea of hearing loss prevention is to keep your hearing – whatever its condition – from getting worse.

Check your hearing annually and compare against the baseline. Hearing change from loud sound is gradual and not readily noticeable. If you wait years before re-checking, the change could be dramatic.

Sound Level Measurements
Most musicians don’t know how loud they’re playing, so using a sound level measuring device is important. Both sound levels and daily exposure time are needed to determine risk of injury. When using a sound level meter (yes, several apps are available), set it for “A-weighting” (dBA), and get the average level over a period of time. (Note: Apps are usually approximations and not completely accurate. But they are still decent tools for tracking your exposure to loud sound.)

Once you know how loud your stage is, compare your results to the chart below.

image

As you can see, any prolonged level above 85 dBA carries with it a risk of long-term damage. Note: 78 dBA or less is safe for any length of exposure. The National Institute for Occupational Safety and Health (NIOSH) scale is more conservative, and thus more protective.

On the NIOSH scale, allowable exposure times are halved every 3 dB (the point at which sound energy doubles). Following this scale protects 92 percent of people from loud sound induced hearing loss.

The OSHA scale is more liberal. It uses an “exchange rate” of 5 dB for its exposure time guidelines, allowing two hours of exposure at 100 dBA, while the NIOSH scale suggests only 15 minutes at that level. That’s why the OSHA scale protects only 78 percent of the population. (Source: NIOSH publication No. 980126)

It’s important to realize that these exposure scales were developed to reduce the excess risk of developing hearing loss from noise, typically in an industrial setting. Since there are no criteria for music exposures, we use the only standard available. Hopefully a study to explore the effects of music vs. noise at the same levels will cast some light in the future. 

The onset of Music Induced Hearing Loss (MIHL) is gradual, and the tones initially affected are in the 3,000 Hz to 6,000 Hz (3 kHz – 6 kHz) frequency range. When it begins, MIHL is easily overcome with a little EQ and by turning up the volume. Obviously, this treats the symptom but does not address the cause, so it only serves to make matters worse.

It’s never too late to get help. Even if you already have some hearing issues, audiologists can help prevent them from getting worse. It’s not that difficult to have a career in music and keep your hearing health. But it’s up to you to take the necessary steps.

One Last Thing: How Hearing Works
Rather than spend a lot of time explaining how your ears work, I strongly recommend the video “Auditory Transduction” by Brandon Pletsch, embedded directly below. It provides a clear, easily understood explanation of the human ear and how it perceives sound. Highly recommended.

 

 

Summary
I have a lot to share with you about hearing protection, using IEMs safely, etc., in future articles. But for now, just remember these few key points:

• See your audiologist once a year for a hearing test. Don’t put if off!
• Hearing wellness is behavior driven. Change your behavior, save your hearing.
• To minimize long-term risk, know your exposure times relative to your sound level (OSHA/NIOSH).
• It’s never too late! We can’t bring back lost hearing, but we can help you preserve what’s left.

Remember: There’s no reason a career in music or pro audio should cost you your hearing. We have the technology and techniques to help you keep your hearing while still enjoying the music you love!

Q&A
Knowledge is power, and I’m happy to answer questions, since that’s what the ProSoundWeb forums are all about. So fire away!

 

Dr. Michael Santucci is founder and president of Sensaphonics, Inc., manufacturers of custom in-ear monitoring and hearing protection solutions for the music industry, NASA, motorsports, and consumers. Last year he addressed the World Health Organization (WHO) global conference on hearing health in Geneva, Switzerland, and is currently a member of the Standards Committee for the WHO Make Listening Safe initiative.

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