Content uploaded by Susan L Phillips
Author content
All content in this area was uploaded by Susan L Phillips on Dec 10, 2015
Content may be subject to copyright.
Content uploaded by Susan L Phillips
Author content
All content in this area was uploaded by Susan L Phillips on Apr 07, 2014
Content may be subject to copyright.
Article
Music Performance
R
esearch
Copyright © 2008
Royal Northern College of Music
Vol 2: 36-47
ISSN 7155-9219
Sound level measurements in music practice rooms
Susan L. Phillips and Sandra Mace
ABS T R A C T Average sound levels and percentage of daily dose of noise expo-
sure were measured in the practice rooms of a university school of music, with
the primary objective of determining whether sound levels in student practice
rooms were high enough to warrant concern for hearing conservation. A secon-
dary objective was to determine whether any instrument group was at higher
risk for music-induced hearing loss due to exposure levels. Students represent-
ing 4 instrument groups were tested: brass, wind, string and voice. Measure-
ments were taken using a dosimeter or DoseBadge clipped to the shoulder dur-
ing 40 students’ individual practice sessions. These readings provided average
exposure levels as well as the percentage of total allowed exposure (dose) ob-
tained during the practice session. The mean measurement time for this study
was 47 minutes (SD = 22). Mean sound levels measured averaged 87-95 dB(A)
(SD = 3.5-5.9). Mean average levels for the brass players were significantly
higher than other instrument groups. Using the mean duration of daily practice
reported by the participants to estimate dose, 48% would exceed the allowable
sound exposure. Implications for professional musicians are discussed, includ-
ing the need for 12-hour breaks and the use of musicians’ earplugs. The im-
plementation of a Hearing Protection Policy in the School of Music will also be
discussed.
KE Y W O R D S : Music-induced hearing loss, hearing loss risk in musicians,
sound exposure levels, hearing protection
Full-time college-level music students are immersed in an intensive programme of study
toward a professional career in music. Success as a student, and subsequently, a profes-
sional, requires many hours of practice. Most undergraduate music students spend a
greater number of hours practising their instrument (both individually and in ensembles)
than was possible prior to coming to a university. Assuming the 10,000-hour hypothesis
(10,000 hours of study toward expertise) of Ericsson, Krampe, and Tesch-Römer (1993) is
correct, a musician is likely, in the course of 10 years of study, to practise three hours per
day (at least) on average. Students spend many of these hours in relatively small practice
rooms, where exposure to high sound pressure levels may be a threat to the hearing sensi-
36
Article
tivity of the student musician. Because hearing requirements for the careers of profes-
sional musicians are high, requiring accurate pitch, loudness, and timbre perception, it is
crucial that students and instructors become aware of excessive sound levels in order to
protect their hearing.
The underlying pathology in noise-induced hearing loss is damage to the inner ear. Spe-
cifically, this damage affects the outer hair cells of the organ of Corti, which are respon-
sible for the enhancement of hearing sensitivity and tuning. The outer hair cells have a
motor function that amplifies soft sounds along all frequency points in the cochlea (Kiang,
Liberman, Sewall, & Guinan, 1986). When outer hair cells are damaged, low-level sounds
are perceived as softer or not heard at all while mid and high-level sounds can be per-
ceived as loud. Outer hair cell damage also can widen cochlear auditory filters thereby
leading to a loss of frequency specificity. These alterations in auditory perception can
have deleterious effects on the perception of music. Of particular concern is the percep-
tion of timbre, which is the relationship of harmonics and overtones for a given instru-
ment. These harmonics are high frequency sounds even for a bass instrument. Although for
speech, two formants, or overtones, differentiate vowel identity, for a vocalist there is a
third formant called the singer’s formant, which falls between 2800 and 3500 Hz, and
gives professional voices “brilliance” in their tone quality. A vocalist who possesses a hear-
ing loss in the frequency range of the singer’s formant would be lacking information when
making judgments about voice quality.
Although not typically applied to education and performing arts, in the United States
industrial facilities in which employees are exposed to high sound levels are regulated by
the Occupational Safety and Health Administration (OSHA, 1983). For the purposes of this
study, criteria set out by the National Institute for Occupational Safety and Health (NIOSH,
1998) were used. NIOSH criteria were chosen because OSHA criteria are based on an “ac-
ceptable risk” of hearing loss basis, and for musicians, there is no acceptable risk. NIOSH
criteria are the more stringent and protective of the individual’s hearing sensitivity, and
are therefore considered to be “best practice” (Suter, 2000). Many of the NIOSH criteria
are based on standards of the International Standards Organization.
NIOSH exposure regulations are based on a time-intensity relationship. The amount of
time an individual can spend in a high-intensity environment depends on the sound level
of that environment. NIOSH criteria indicate that a Hearing Conservation Programme
should be established which includes annual audiometric testing, education and training
for employees in environments where they are exposed to 85 dB(A) or more over an eight
hour period. These more recent recommendations by NIOSH may be implemented by fed-
eral agencies in future regulations. The OSHA and NIOSH levels can be seen in Table 1.
Previous investigations of high sound level exposure in musicians have been restricted
to studies of professional musicians during full rehearsals or full orchestra performance.
All have recorded both average sound levels in excess of 85 dB(A), though not for eight
hour periods of time in every case (Westmore & Eversden, 1981; Royster, Royster, & Kil-
lion, 1991; Sabesky & Korczynski, 1995). Peak measurements reach sound levels much
higher 85 dB(A). For example, Chasin and Chong (1991) measured levels of 126 dB(A) at
the shoulder of a piccolo player during a relatively quiet etude. Although peak sound lev-
els are of interest to musicians, peaks are usually very limited in time, and in this study,
the effect was small enough that they will not be discussed in detail.
37
Article
Table 1
NIOSH Allowable Noise Exposure Levels
Max. Exposure level in dB(A) NIOSH Recommendations
80 Begin conservation programme
85 8 hrs.
88 4 hrs.
90 2 hrs., 31 min., 11.4 sec.
91 2 hrs.
94 1 hr.
95 47 min., 37.2 sec.
97 30 min.
100 15 min.
103 7 min., 15 sec.
105 4 min., 43.47 sec.
106 3 min., 37.5 sec.
109 1 min., 48.75 sec.
110 1 min., 29.292 sec.
112 54.38 sec.
115 27 seconds
Laitenin, Toppila, Olkinuora and Kuisma (2003), taking measurements for the Finnish
Opera, found average levels across instruments to be 88-98 dB(A), while averages for solo
vocalists were 97-105 dB(A). Laitenin et al. also found that sound levels of individual re-
hearsals were often 6-20 times higher than levels during group rehearsals and perform-
ance, and were the major source of exposure for vocalists, percussionists and woodwind
players, except for the flute/piccolo players. These higher levels may be due to the
smaller size of practice rooms and also to the lack of a need to blend or match tone qual-
ity with other musicians.
Another way to look at exposure is in terms of allowable time spent at elevated sound
levels. Jansson and Karlsson (1983) evaluated sound level exposures for symphony orches-
tra musicians based on allowed exposure levels for an industrial worker for a 40-hour
working week. Results indicated that, depending upon the location of the musicians within
the orchestra, musicians received a maximum allowable exposure in 10-25 hours of work-
ing time. In this case, the allowable exposure for a 40-hour work week was experienced
after 10 hours for musicians in locations with exposure to the highest intensities and 25
hours for musicians in other positions.
One previous study examined the sound exposure of students of classical music during
full ensemble rehearsal (Backus, Clark, & Williamon, 2007). Seven of ten students had
maximum exposure levels above 85 dB(A). No study has examined the sound exposure in-
curred by students during individual practice. Only one study has looked at levels of expo-
sure incurred by professionals during individual practice, and found that it was the major
source of exposure for many professional musicians. Therefore, the present study exam-
ined sound levels produced in practice rooms by student musicians.
The purpose of the current investigation was to determine whether sound level expo-
sures in the practice rooms warranted the inclusion of a hearing protection programme
into the programme of study in the School of Music at the University of North Carolina at
Greensboro (UNCG). The primary purpose was to determine whether sound levels in the
38
Article
practice rooms would exceed levels at which NIOSH would mandate such a hearing conser-
vation programme. A secondary purpose was to determine whether the type of instrument
played would identify additional risk factors for noise exposure which might be pertinent
in designing a hearing conservation programme in the School.
Method
Participants
Fifty undergraduate student-musicians (aged 18-22) from The University of North Caro-
lina at Greensboro School of Music participated in the study. There were 10 students in
each of four instrument groups: brass (2 female, 8 male), string (5 female, 5 male),
woodwind (6 female, 4 male), percussion (4 female, 6 male) and voice (4 female, 6 male).
Participating students reported that they had played their instruments for eight to four-
teen years, with no significant differences between groups. All participants signed an in-
formed consent form prior to data collection. Participants completed a brief survey in
which questions were answered regarding instrument played, number of hours a day of
practice, and number of practice sessions per week.
Instrumentation
Average sound levels were measured over the duration of a practice session using a
personal sound level dosimeter (Metrosonics dB-3080 or Cirrus Research ® DoseBadge CR-
100B). Both types of dosimeters used were set to calculate dose percentages based on
ISO/NIOSH recommendations. Care was taken to position the measurement instruments
such that normal posture and musical instrument position were not compromised. For
some of the practice sessions, travel between buildings on campus was required. Added
travel time may have shortened the practice sessions due to time constraints. While a few
sessions occurred at the end of the fall semester, the majority of sessions occurred during
the middle of the spring semester.
The dosimeter or DoseBadge calculated the runtime of the measurement, range (dB
SPL), the average sound level over the 80 dB(A) criterion (Lavg), the time-weighted aver-
age (TWA) levels in dB(A), and the dose for the measured time. The TWA averages the
sound over an eight-hour period. The TWA will be less than the Lavg if the measured time
period is less than eight hours. Dosimeters and DoseBadges were calibrated before each
use with the provided compatible acoustical calibrator. Comparative dosimeter and Dose-
Badge measurements found the resulting sound levels to be within two dB.
Procedure
Measurements were taken using ISO/NIOSH standards which include a 3 dB exchange
rate (reducing the allowable duration of exposure for every 3 dB increase in intensity) and
slow response. Use of the slow response setting reduces the likelihood of an overestima-
tion of sound levels. Measurements of one practice session (mean length = 46.54 minutes)
were made in School of Music practice rooms, most of which measured 3.05 x 3.66 x 2.29
metres. Each practice room has seven acoustic panels on the walls, made of fabric-
covered dense foam, that measure 124 x 63.5 x 5 cm. Percussion practice rooms measured
3.35 x 3.96 x 2.28 metres with 10 acoustic panels on the walls.
The average sound level (Lavg) was computed for the total measurement time. These
average levels determine whether the ISO/NIOSH maximum safe exposure level of 85
39
Article
dB(A) is reached. Dose is defined as the percentage of noise exposure measured over time,
typically eight hours, with 100% as the maximum exposure allowed for one day. For exam-
ple, 85 dB(A) for eight hours would be a 100% dose, and 88 dB(A) for eight hours would be
a 200% dose. If the measured levels vary between 85 and 88 dB(A), the dose would be be-
tween 100% and 200%. When determining the necessity of a hearing conservation pro-
gramme, individual exposure must be measured. To verify sound levels measured with
personal dosimeter systems, a Quest Model 1700 Sound Level Meter was used to measure
levels during random practice sessions in the practice rooms, using the NIOSH standard of
a slow response time and an A-weighted scale.
Results
Survey results indicated that the mean number of years student participants had been
playing their instruments was 9.7 years, (SD 3.34 years). The number of hours of practice
per day was similar between groups with a mean of 2.3 hours. Voice majors tended to
practise less at 1.4 hours while the other groups ranged from 2.5-2.7 hours. Differences
between instrument groups on these two questions were not significant. There were sig-
nificant differences between groups on the number of individual, F(3, 29) = 4.296, p < .05,
and ensemble practice sessions F(3, 29) = 3.691, p < .05 per week. Voice students re-
ported significantly fewer individual practice sessions (4.6) than woodwind players (6.7),
and brass players reported significantly more ensemble practice sessions (4.67) than
woodwind or string players (both at 3.1).
Average measurement periods and average sound levels (Lavg) during exposure are pre-
sented in Table 2 for each instrument group. Average measured levels were 87-95.2 dB(A)
(SD = 3.5-5.9) across the instrument groups. Some students’ sound level exposure, in one
practice session, was above the allowed daily exposure. Average measured doses for these
short individual practice sessions ranged from 27.9-118.7% of the daily allowed dose. The
last column indicates the estimated dose for the mean reported hours of practice per day
for each instrument group.
Table 2
Average Sound Exposure Dosimetry Results
Instrument
group Mean(SD) number of minutes
in measured period Mean Lavg
(SD) in dB(A) Mean
Measured dose Est. dose for
3 hours
Brass 38.4(10.8) 95.2(3.9) 118.7% 180%
String 47.8(24.5) 87.0(3.8) 27.9% 59.5%
Vocalist 39.3(13.1) 88.4(5.9) 30.7% 82.3%
Woodwind 62.3(29.2) 90.4(3.5) 68.1% 130.6%
Percussion 66.7(42.2) 90.1(4.7) 66.5% 121.8%
Note. Lavg: Average sound level during run. At eight hours TWA and Lavg will be equal. Dose: Per-
centage of maximum allowable exposure to noise.
An analysis of variance (ANOVA) was run on mean sound levels to determine whether
there were differences in the exposure of music students based on the type of instrument
played. The ANOVA on average sound levels, in dB(A) during exposure, demonstrated sig-
nificant differences between instrument groups, F(4, 49) = 4.87, p < .05, observed power
40
Article
.937. Post hoc tests (Tukey HSD) indicated that average levels during practice were sig-
nificantly higher for the brass players when compared with levels for the string players
and vocalists (p < .01). There were also significant group differences on measured dose,
F(4, 49) = 3.5, p < .05, observed power .824. No other group differences were significant.
Post hoc Tukey HSD tests revealed significant differences in measured dose between the
brass players and string players and vocalists (all p < .05).
Dosimetry results for all instrument groups are presented in Tables 3-7. Lavg levels are
above 85 dB(A) for all brass and woodwind players. This is not true for all vocalists or
string players. The Lavg’s indicate that most of these students are exposing themselves to
levels which would mandate a hearing conservation programme if they were working in
industry. The Dose column indicates the percentage of total allowable exposure has been
met in the practice session. It is clear from Table 3 that Musician 4 reached one third of
her allowed exposure in a little less than two hours. The column furthest to the right indi-
cates what the dose level would be for a typical 2.5-hours of individual practice per day.
It must be remembered that this represents only the accumulated dose for the one meas-
ured practice session, which is not likely to be the only time the student played his or her
instrument during the day.
Musicians who would have exceeded the allowable dose played at sound pressure levels
over 90 dB(A). Of the 10 string players, data for whom are shown in Table 3, two viola
players would have exceeded the allowable dose in the mean reported hours of practice
for this group. With only one exception, all the brass players, data for whom are shown in
Table 4, would have exceeded the allowable dose in the 2.7 mean reported hours of prac-
tice for this group; five of the ten did exceed maximum exposure levels in just one indi-
vidual practice session. The specific instrument played did not necessarily predict the
level of exposure. Although the trumpet players played at uniformly high sound pressure
levels, levels for the horn and trombone players were more variable.
Table 3
Noise Dosimetry Results for String Instruments with Estimated Dose Measurements Based on Mean
Reported Practice Time for this Group
Subject # Instrument Run Time Hr.Min. Lavg dB (A) Dose % 2.5 Hr Dose %
1 Violin 0.35 87.8 13.92 59.7
2 Violin 0.35 85.5 8.21 35.1
3 Viola 0.46 84.1 7.84 25.4
4 Viola 1.51 92.9 143.35 193.9
5 Viola 0.34 90.7 26.54 116.6
6 Viola 0.51 82.5 6.00 17.5
7 Viola 0.46 88.8 23.20 75.2
8 Bass 0.22 80.5 1.69 11.1
9 Cello 0.37 88.6 30.27 71.8
10 Viola 0.59 88.9 17.66 77.0
41
Article
Table 4
Noise Dosimetry Results for the Brass Group with Estimated Dose Measurements Based on Mean
Reported Practice Time for this Group
Subject # Instrument Run Time Hr.Min. Lavg dB(A) Dose % 2.7 Hr Dose %
1 Trombone 51.30 98.0 215.5 680.4
2 Trumpet 42.50 98.0 178.5 680.4
3 Trumpet 16.00 97.6 61.2 620.3
4 Horn 41.00 98.6 197.8 781.5
5 Trumpet 51.50 98.5 242.8 763.7
6 Trombone 31.82 92.3 22.5 182.3
7 Horn 33.68 90.2 23.5 112.2
8 Horn 43.00 97.5 168.4 606.1
9 Tuba 30.00 87.9 12.6 66.0
10 Trombone 43.00 93.5 63.9 240.5
Table 5
Noise Dosimetry Results for the Woodwind Group with Estimated Dose Measurements Based on Re-
ported Mean Practice Time for this Group
Subject # Instrument Run Time Hr.Min. Lavg dB(A) Dose % 2.45 Hr Dose %
1 Flute 72.15 88.6 34.60 70.4
2 Flute 102.92 95.5 240.40 346.5
3 Flute 49.00 90.6 37.20 111.7
4 Sax 43.87 88.2 19.20 64.2
5 Sax 23.43 92.0 24.60 154.3
6 Oboe 40.53 95.2 89.07 323.3
7 Clarinet 54.37 85.3 12.15 32.8
8 Flute 61.47 87.1 20.81 49.8
9 Oboe 120.00 88.3 53.59 65.7
10 Oboe 51.00 93.5 81.67 218.3
Five of the ten woodwind players, data for whom are shown in Table 5, would have ex-
ceeded the allowable dose in the 2.45 mean reported hours of practice for this group. Two
of ten vocalists, data for whom are shown in Table 6, would have exceeded the allowable
dose in the 1.4 mean reported hours of practice for this group; one baritone exceeded the
maximum allowed exposure in one practice session. Six of the ten percussionists exceeded
the maximum exposure with pianists being the least likely to do so (Table 7).
42
Article
Table 6
Noise Dosimetry Results for the Vocalist Group, with Estimated Dose Measurements Based on the
Mean Reported Practice Time for this Group
Subject # Instrument Run Time Hr.Min. Lavg dB(A) Dose % 1.4 Hr Dose %
1 Soprano 50 88.3 22.14 37.5
2 Baritone 24 99.0 126.99 444.5
3 Voice 50 79.0 2.60 4.4
4 Baritone 26 85.6 6.08 20.1
5 Mezzo-
soprano 24 95.1 51.57 180.5
6 Tenor 50.5 82.7 6.20 10.3
7 Tenor 24 88.8 12.03 42.1
8 Bass 46 92.5 53.60 99.0
9 Mezzo-
soprano 52 87.0 17.20 27.8
10 Tenor 49 85.5 11.46 19.6
Table 7
Noise Dosimetry Results for Percussion instruments with Estimated Dose Measurements Based on
Mean Reported Practice Time for this Group
Subject # Instrument Run Time Hr.Min. Lavg dB(A) Dose % 2.4 Hr Dose %
1 Drumset 51.00 93.50 77.21 213.8
2 Drumset 56.00 94.60 107.21 275.7
3 Marimba 56.00 95.00 117.59 302.4
4 Marimba 185.00 91.30 165.23 128.6
5 Marimba 34.00 94.10 58.00 245.6
6 Piano 54.00 84.80 10.74 28.7
7 Piano 55.00 95.30 123.80 324.1
8 Piano 52.00 84.70 10.11 28.0
9 Piano 62.00 87.10 20.98 48.7
10 Marimba 55.00 83.50 8.10 21.2
Discussion
This study was undertaken to determine if students in a university music programme
are exposed to sound levels which are high enough to warrant a hearing conservation pro-
gramme. Mean sound levels (Leq) for instrument groups in this study were 87-95 dB(A),
which clearly suggests the need for attention to hearing health. These results are compa-
rable to the mean sound level found by Royster et al. (1991), which was 89.9 dB(A), and
those of Laitenen et al. (2003), which ranged across instruments from 88-98 dB(A). Aver-
age levels for brass players were significantly higher than those of other instrumentalists
by about 5 dB. Due to the potential for damage to the auditory system and the obvious
benefits of instruction in hearing health, hearing conservation programmes are suggested
for higher education music programmes.
Sound level measurements only tell part of the story. The amount of time spent prac-
ticing at these levels is crucial to an understanding of the risk involved to hearing. Partici-
43
Article
pants in this study indicated that they spend an average of 1.4 hours (for vocalists) to 2.7
hours (brass players) per day in individual practice, and that they practice on their own
between 4.6 and 6.7 times per week. In addition, they reported rehearsing within ensem-
bles an average of 3.1 to 4.7 times per week. Trombone player #1, who had an Lavg or 98
dB(A), reported that he practises individually for 3 hours per day seven days per week. He
reported also that he practises in an ensemble five days per week. If ensemble sound lev-
els are similar to those of his individual practice sessions, and last approximately one
hour, then in a four-hour practice day (including ensemble practice) he would accumulate
over 10 times more than the allowed sound exposure, or dose. With similar estimations,
nine out of ten brass players, two out of ten string players, two out of ten vocalists, five
out of ten woodwind players, and four out of ten percussionists would have exceeded their
allowed daily dose with one individual practice session and one ensemble practice session.
Some of these students did not have ensemble practice every day, which gave their audi-
tory systems a much-needed break.
Laitinen et al. (2003) reported that the average professional musician plays an average
of 5.5 hours per day. A student musician may practise alone for 2.5 hours per day in addi-
tion to playing in one or two ensembles each day for another 2-3 hours. However, when
rehearsing for a major opera production, additional evening rehearsal time may be five
hours per day for several weeks. Fearn (1993) reports that student musicians practise 10-
35 hours per week during the school year and additionally perform in orchestras for 2-3
hours 56 times per year. One concern Fearn raises is that students practise throughout the
day with short breaks, which does not allow for the 12 hours of rest from noise exposure
required to reduce temporary threshold shift (NIOSH, 1998).
Measurement of only one practice session is a limitation of this study. Another potential
limitation is the brevity of some of the measured practice sessions. It may be that a short
practice session allows for greater sound levels without endurance difficulties. If that
were true, then sound levels may have been higher for shorter sessions than they might be
for longer sessions. Two examples can be seen in two of the vocalists in Table 6, where
sound levels were high and practice times short (24 minutes). However, several of the
brass players, as well as one or more of the string and woodwind players also have high
sound level averages with longer practice sessions.
Does exposure to these high sound levels cause hearing loss in musicians? According to
Hart, Geltman, Schupbach, and Santucci (1987), 52% of classical musicians exhibit a hear-
ing loss. These findings suggest that permanent hearing loss is greater among classical mu-
sicians than pop/rock musicians, which is only 37% even after 25 or more years of playing
(Axelsson, Eliasson, & Israelsson, 1995). The lower incidence among rock musicians may be
due to several factors, including the low-frequency emphasis of the music, the absorption
of sound by the crowds of people listening, and the amount of time spent in practice.
Classical musicians often play 5-10 hours per day, including individual practice, ensemble
practice and teaching, while rock musicians may only play on weekends (Shafer, 2006).
Permanent hearing loss has also been found in classical musicians by several other in-
vestigators (Axelsson & Lindgren, 1981; Westmore & Eversden, 1981; Karlsson, Lundquist,
& Olaussen, 1983; Ostri, Eller, Dahlin, & Skylv, 1989; Royster, Royster, & Killion, 1991).
Kahari, Axelsson, Hellstrom, and Zachau (2001) found that the noise notches typically
found with noise exposure occurred in orchestral musicians at 6000 Hz, but were not out-
side normal limits. Noise notches are a decrease in sensitivity related to noise exposure
that occurs between 3000-6000 Hz. There is some dissent among these researchers about
whether the losses incurred can be interpreted as being outside the expectations for nor-
mal aging. It is noted that the results of these studies are similar; however, the interpre-
tations tend to vary.
In another study that involved music students, Fearn (1993) reported that one third of
44
Article
student orchestral musicians had elevated thresholds, 75% of which were at 6000 Hz, with
half of all hearing losses in one ear only. Fifty percent of student musicians on this campus
of the current study demonstrated notches in their hearing sensitivity at 6000 Hz, with the
majority in one ear only (Phillips, Shoemaker, Mace, & Hodges, 2008). Fearn contrasts this
with the 54.5% of orchestral musicians over the age of 30 who demonstrated a decrease in
hearing at 6000 Hz.
Each musician is affected by sound exposure differently with regard to variables such as
instrument type, age, seating position in the orchestra, the music played and overall
length of time playing (Royster, Royster, & Killion, 1991). Woodwind and brass players
have been shown to be at most risk for hearing loss (Westmore & Eversden, 1981; McBride,
Gill, Proops, Harrington, Gardiner, & Attwell, 1992). Unilateral hearing loss has been
documented in the left ear of violinists (Axelsson & Lindgren, 1981) and double-bass play-
ers (Karlsson, Lundquist, & Olaussen, 1983). The right ear of violinists is protected by the
“shadow” of the head and also by being farther from the sound source. It is therefore im-
portant to compare sound level exposure by instrument type.
All previous studies of hearing in musicians have been conducted as cross-sectional
studies. The authors are currently conducting a longitudinal study of student musicians’
hearing over the course of their four-year programme of study. Other areas for future
study include real ear measurements of sound levels at the tympanic membrane, with and
without musician’s earplugs, to determine whether body-conducted sound is a contribut-
ing factor in musicians who create their music orally. Comparing frequency resolution
among musicians with and without demonstrated high frequency loss is also an area of in-
terest.
Additional measurements of sound levels during student ensemble practice and per-
formance are also needed. Position of musicians within the orchestra vastly changes their
level of exposure. Levels are highest in front of the brass instruments and near the percus-
sion instruments. Musicians in these positions include woodwinds, second violins, violas
and cellos. Brass players may receive high levels of exposure from their position relative
to other brass and percussion as well. It is also important to measure exposure levels for
conductors of the various ensembles. Long-term dosimeter studies are indicated.
All music students who participated in this study, regardless of instrument group, are at
risk of experiencing sound levels that exceeded maximum permissible exposure levels as
regulated by the NIOSH 1998 standard. If these musicians were working in industry and ex-
posed to these levels for eight hours a day they would mandatorily be enrolled in a hear-
ing conservation programme. As it stands, with the number of hours of reported individual
practice at these levels, 48% exceeded allowed exposure levels. It is important to note
that students also report participating in ensemble rehearsals, which increase sound level
exposure. Since hearing requirements for the career of professional musician are high, it is
crucial that university level music programmes provide instruction to their students on
how to protect their hearing.
The hearing conservation programme as recommended by NIOSH would require the in-
clusion of five components: environmental noise measurements of all practice and per-
formance spaces, audiometric testing of hearing for all students on an annual basis, intro-
duction to and instruction in the use of hearing protectors, education and training, and
record keeping. Routine audiometry can help specialists indicate which musicians are ex-
periencing hearing loss, and environments in which continued measurements of sound lev-
els are necessary.
Any student identified with a high frequency hearing loss should be required to wear
hearing protection designed for musicians, which provides an even attenuation across the
frequency range. Objections to wearing earplugs should be addressed by outlining the dif-
ferences between traditional foam earplugs and musicians’ plugs, emphasizing the need to
45
Article
protect hearing as a crucial part of their musical skill. Proper insertion is critical for
maximal protection as well as reduction of the plugged-up sensation called the occlusion
effect, and should be carefully practised during training sessions. The cost of musicians’
earplugs ranges from minimal for the non-custom ETYPlugs/HI-FI (Killion, Stewart, Falco,
& Berger, 1992) to a cost similar to that of a textbook for custom earplugs. Earplugs could
be considered a required expense for performance studio classes or large ensembles. The
acoustic environment of the practice rooms deserves considerable attention in terms of
acoustic absorption materials on walls, ceilings and floors. This is particularly important in
small practice rooms.
The education and training portion of the hearing conservation programme should in-
clude an accurate description of the group’s noise exposures, the group’s hearing test re-
sults, the use, care and fitting of a variety of hearing protection devices designed for mu-
sicians, and any engineering controls which have been put in place or are planned for the
future. Students should be taught the value of down-time from exposure to loud music,
ideally 24-48 hours, but a minimum of 12 hours. Although music students are typically in-
troduced to the concepts of acoustics and psychoacoustics, they would also benefit from a
basic knowledge of the anatomy and physiology of hearing, and from understanding what
happens to these anatomical structures during noise exposure. An additional segment on
how these changes in physiology could result in hearing loss and tinnitus would motivate
them to be more aware of their listening environment and to understand the importance
of hearing protection. As part of the Hearing Protection Policy, such educational training
would occur yearly. Students should be encouraged to avoid outside exposures to noise as
well.
ACKNOWLEDGEMENTS The authors are grateful to Patricia Sink for her advice and help in
the UNCG School of Music, and to Quest Electronics for the loan of the dosimeters.
References
Axellson, A., Eliasson, A., & Israelsson, B. (1995). Hearing in pop/rock musicians: A follow-
up study. Ear & Hearing, 16(3), 245-253.
Axelsson, A., & Lindgren, F. (1981). Hearing in classical musicians. Acta Otolaryngol
Suppl, 377, 3-74.
Backus, B.C., Clark, T., & Williamon, A. (2007). Noise exposure and hearing thresholds
among orchestral musicians. In A. Williamon & D. Coimbra (Eds.), Proceedings of the
International Symposium on Performance Science, 23-28. Utrecht, The Netherlands:
The European Association of Conservatoires (AEC), ISBN 978-90-9022484-8.
Chasin, M., & Chong, J. (1991). In situ hearing protection program for musicians. Hearing
Instruments, 18(3), 26-28.
Ericsson, K.A., Krampe, R.T., & Tesch-Römer, C. (1993). The role of deliberate practice in
the acquisition of expert performance. Psychological Review, 100, 363-406.
Fearn, R.W. (1993). Hearing loss in musicians. Journal of Sound and Vibration, 163(2),
372-378.
Hart, C.W., Geltman, C.L., Schupbach, J., & Santucci, M. (1987). The musician and occu-
pational sound hazards. Medical Problems of Performing Artists, 2(3), 22-25.
Jansson, E., & Karlsson, K. (1983). Sound levels recorded within the symphony orchestra
and risk criteria for hearing loss. Scandinavian Audiology, 12, 215.
46
Article
Kahari, K.R., Axelsson, A., Hellstrom, P., & Zachau, G. (2001). Hearing development in
classical orchestral musicians. A follow-up study. Scandinavian Audiology, 30(1),
141-149.
Karlsson, K., Lundquist, P.G., & Olaussen, T. (1983). The hearing of symphony orchestra
musicians. Scandinavian Audiology, 12, 257-264.
Kiang, N.Y.S., Liberman, M.C., Sewell, W.F., & Guinan, J.J. (1986). Single unit clues to
cochlear mechanisms. Hearing Research, 22, 171-182.
Killion, M.C., Stewart, J.K., Falco, R., & Berger, E.H. (1992). Improved audibility earplug.
US Patent 5,113,967.
Laitinen, H.M., Toppila, E.M., Olkinuora, P.S., & Kuisma, K. (2003). Sound exposure among
the Finnish National Opera personnel. Applied Occupational Environmental Hygiene,
18(3), 177-82.
McBride, D., Gill, R., Proops, D., Harrington, M., Gardiner, K., & Attwell, C. (1992). Noise
and the classical musician. British Music Journal, 305, 1561-1563.
Occupational Safety and Health Administration. (1983). Occupational noise exposure;
Hearing conservation amendment: Final rule. (Fed. Reg. 48:9738-9785). Washington,
D.C.: U.S. Dept. Of Labor Publication.
Ostri, B., Eller, N., Dahlin, E., & Skylv, G. (1989). Hearing impairment in orchestral musi-
cians. Scandinavian Audiology, 18, 243-249.
National Institute for Occupational Safety and Health. (1998). Preventing occupational
hearing loss – A practical guide (Publication No. 96-110). Washington, D.C.: U.S.
Dept. of Health and Human Services Publication.
Phillips, S.L., Shoemaker, J., Mace, S.T., & Hodges, D.A. (2008). Environmental factors in
susceptibility to noise-induced hearing loss in student musicians. Medical Problems
of Performing Artists, 23(1), 20-28.
Royster, J.D., Royster, L.H., & Killion, M.C. (1991). Sound exposures and hearing thresh-
olds of symphony orchestra musicians. Journal of the Acoustical Society of America,
89, 2793-2803.
Sabesky, I.J., & Korczynski, R.E. (1995). Noise exposure of symphony orchestra musicians.
Applied Occupational Environmental Hygiene, 10(2), 131-135.
Shafer, D. N. (2006). High Notes: Audiologist serves as consultant to orchestra. The ASHA
Leader, 11(4), 10.
Suter, A.H. (2000). Standard and Regulations. In E.H. Berger, L.H. Royster, J.D. Royster,
D.P. Driscoll, & M. Layne (Eds.), The Noise Manual (pp. 639-668). Fairfax, VA:
American Industrial Hygiene Association.
Westmore, M.B., & Eversden, I.D. (1981). Noise-induced hearing loss and orchestral musi-
cians. Archives of Otolaryngology, 107, 761-764.
SUSAN L. PHILLIPS is a professor of audiology in the Department of Communication Sci-
ences and Disorders and a member of the Music Research Institute at the University of
North Carolina at Greensboro. She earned her Ph.D. at the University of Maryland at Col-
lege Park. Her research addresses factors associated with hearing loss in musicians, includ-
ing genetic susceptibility and gene-environment interactions.
SANDRA MACE is Programme Coordinator for the Music Research Institute at the University
of North Carolina at Greensboro. She is a certified Hearing Conservationist with the Occu-
pational Safety and Health Administration. Her research addresses sound level exposures
in musicians, music faculty, ensembles and ensemble directors. She earned her Ph.D. at
the University of North Carolina at Greensboro.
47
