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Music, Noise & Hearing: How to play your part. I Musicians' Guide

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Output from the cross-sector partnership looking at the Control of Noise at Work Regulations as applied to the music industry 2008-2011)
MUSIC, NOISE AND HEARING:
HOW TO PLAY YOUR PART
A GUIDE FOR MUSICIANS
2
BBC © 2011. May be copied for non-commercial purposes provided the source is
acknowledged
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 3
HOWS YOUR HEARING?
Do you avoid parties and noisy restaurants because you can’t hear
conversations?
Do you often have to ask people to repeat things, or spell things out?
Do people say you have the TV on too loud?
Do you listen to music or podcasts on public transport?
Do you ever worry you’re playing / singing out of tune? Or too loudly / too
quietly?
Listen to these three clips of the third movement of Brahms’ Fourth
Symphony. You should be able to hear the differences within a few seconds.
1. Brahms 4 as it
should sound
2. As it would sound
with age-related
hearing loss
3. As it would sound
with noise-induced
hearing loss
Whatever the state of your hearing, the message is the same: you must look
after your ears. For you as a musician they are your most important tools of
the trade, and your hearing health is vital to your quality of life.
This guide is for musicians playing acoustic instruments and singers working
with orchestras, as well as being a reference tool for ensemble and venue
managers, sound engineers and teachers. It shows how you can look after your
hearing inside and outside your noisy workplace. It’s about how you can
maintain the highest artistic standards and ensure a long, healthy career as a
musician.
»
HOW TO USE THIS GUIDE
There are three ways you can use this guide:
If you are in a hurry, follow the yellow ‘speed-read’ boxes only. You can get
through them in 10-15 minutes and print off a handout at the end. Follow
the ‘fast forward’ » arrows.
If you have more time, or to find out more, read the white sections and ‘sound bites’
(case studies and quotations from colleagues developing real-world solutions).
If you are a manager or a Health & Safety representative, the Toolkit for managers (Part II)
covers the compliance aspects in more detail. This should be read in conjunction with
the official publications Controlling Noise at Work (L108) and Sound Advice (HSG 260), the
Sound Advice website www.soundadvice.info and the ABO’s A Sound Ear II
(www.abo.org.uk).
»
4
CONTENTS
Part I: Guide for musicians ...................................................................................................... 5
Why do we need this guide? ............................................................................................................................... 5
Sound, hearing and the musician’s ear .............................................................................................................. 7
How our ears work ......................................................................................................................................... 7
What can go wrong with your hearing? ...................................................................................................... 9
What musicians should know about sound and noise .......................................................................... 16
The Noise Regs and you: putting it into practice ........................................................................................ 23
Why do we have Noise Regulations? ....................................................................................................... 23
Looking after your hearing health .............................................................................................................. 25
Hearing protection ........................................................................................................................................ 28
Protecting your hearing with earplugs ...................................................................................................... 28
Assessing and controlling noise risks ........................................................................................................ 35
Controlling and eliminating noise: your contribution ........................................................................... 36
Training and information .............................................................................................................................. 42
Links, references and definitions ...................................................................................................................... 45
Acknowledgments ............................................................................................................................................... 47
The 2005 Noise Regulations: playing your part .......................................................................................... 48
Part II: Toolkit for managers is available as a separate document at
http://www.bbc.co.uk/safety/pdf/Safety-Musician_noise_guide_PartII.pdf
This guide was written
by Ruth Hansford, BBC
Safety, in partnership
with the organisations
shown here. The HSE
was a consulted
stakeholder. See the
acknowledgments
section for details of
editorial group
membership.
The Federation of Scottish
Theatre provides support,
including Health & Safety
advice, for the Royal Scottish
National Orchestra, the
Scottish Chamber Orchestra,
Scottish Ballet and Scottish
Opera. FST represented
them on the editorial group
for this guide.
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 5
PART I:
GUIDE FOR MUSICIANS
WHY DO WE NEED THIS GUIDE?
“The BBC is a significant employer of musicians. As an organisation it therefore has a
duty of care towards them, not least to help them to look after their hearing. In recent
years we have been playing a leading part in developing thinking in this area. I am delighted
that our 2008 research initiative looking at noise exposure in our five orchestras and the
BBC Singers has evolved into an important cross-sector collaboration from which many
more musicians (and the musicians of the future) can benefit.” – Roger Wright, Controller, BBC
Radio 3 and Director, BBC Proms
GOOD HEARING IS VITAL FOR YOUR CAREER AS A MUSICIAN AND FOR YOUR
QUALITY OF LIFE
You only get one chance with your ears. But there are many things you can do
to look after the hearing you have:
Get into good habits protect your hearing inside and outside work.
Invest in your hearing health and learn more about your ears.
Don’t ignore any problems.
Talk to your colleagues. Sharing the responsibility makes things easier.
»
We all know of musicians whose hearing is not what it was and yet still have a busy and
rewarding career. We may also know of musicians who have stopped because they feel it’s
too scary to play when they’re not sure how their sound is going to come out, or because
it’s physically too painful to their ears. Between these two sit the majority of musicians:
those who are worried about their hearing, those who think it’s just part of the job, or
those who wish they had taken better care of their hearing from the start or who fear
they are missing vital musical or verbal cues in rehearsal or in performance.
Making music is physically demanding and a career as a musician will take its toll on your
body. At all stages of your life and your career, and whatever the current state of your
hearing, you should get into the habit of looking after the hearing you have.
6
“It’s not that I have
anything against my colleagues,
it’s just that I don’t like the
noise they make.
You work in a noisy business. The fact that it’s hard to control noise in your particular
workplace doesn’t excuse inaction. There are things you can do for yourself, and there are
things your managers are obliged to do under the Control of Noise at Work Regulations.
This guide is aimed at all involved in the performance of orchestral music. It covers what we
all need to know about hearing, sound, noise and it explores how we can work together to
ensure musicians have a long, healthy and musically rewarding career. It does not cover
noise exposure of audiences, as they are not covered by the Noise Regulations. The focus is
on noise at work, and in work-related contexts, but the contribution of non-work-related
noise exposure must not be ignored.
“In my twenties I played in a rock
band as well as an orchestra. It never
occurred to me to worry about my
hearing then. But now I make a big
thing of telling my son to wear earplugs
when he’s playing with his band” –
violinist
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 7
SOUND, HEARING AND THE
MUSICIAN’S EAR
HOW OUR EARS WORK
The more we learn about our hearing, the more amazing it becomes. Yet it’s still one of the
areas we know least about. This section aims to address the many questions musicians have
asked about sound, hearing and our ears. It discusses how the ear works and how our
brains perceive and process sounds, and what can go wrong with our ears. To find out what
to do about the problems described, see the section on ‘Looking after your hearing health’.
WE HEAR WITH OUR BRAIN, NOT WITH OUR EARS
Outer ear (pinna): captures vibrations and sends them down the ear canal
to the ear drum; two for stereo sound.
Middle ear: eardrum oscillates and three tiny bones transmit vibrations to
the inner ear’ stapedius muscle and Eustachian tubes located here.
Inner ear (part of the brain): cochlea translates signals and sends them to
the brain; vestibular system for balance.
»
OUTER EAR
The outer ear (or pinna) captures the vibrations caused by tiny movements of air (sound
waves) and sends them down the external auditory canal to the ear drum or tympanum. The
folds and channels of the pinna determine the precise journey of the sound waves to the ear
drum. The fact that we have two ears binaural hearing helps us to locate sounds in the
space around us, as the sound waves arrive at each ear at slightly different times. This is why
it’s not generally a good idea to block or modify messages from one ear by wearing only one
earplug, as it makes it harder to judge where it is coming from and how loud it is.
MIDDLE EAR
In the middle ear a mechanical process takes place. The ear drum oscillates like a drum skin
and converts vibrations of the air into mechanical vibrations; it transmits these via three tiny
bones, the hammer, anvil and stirrup or malleus, incus and stapes to the oval window, at the
entrance to the inner ear. The three bones act to amplify or attenuate the vibrations and
optimise both the frequencies and the sound pressure on their way to the inner ear. A very
important muscle, the smallest skeletal muscle (ie, muscle that moves bones around) in our
bodies, is the stapedius muscle. Its function is to disengage the stapes to stop us from being
deafened by the sound of our own speaking voice, and it is assumed, by analogy, that this
reflex is triggered by any sound that we control ourselves.
8
The stapedius reflex, or aural reflex,
seems to be good news for musicians:
if we generate the sound ourselves or
if we know it is coming (by marking up
an imminent cymbal crash in the score,
for example), we trigger the stapedius
reflex to protect ourselves. However,
bear in mind the reflex does depend
on a muscle. Like any muscle, it is less
efficient if you are tired or under the
influence of alcohol or drugs.
The Eustachian tubes connect the
middle ear with the pharynx (throat)
and equalise the pressure with the
external environment. If this
mechanism is not working properly it
can cause problems for musicians, not
only because it is uncomfortable, but also because it can interfere with your sense of pitch.
Stapedius sound bites:
The BBC Singers found that when they are not singing the sound from a singer behind is
incredibly loud regardless of voice part.
Sopranos say that once they have started singing a high note they can’t hear much else.
The Canadian Audiologist Marshall Chasin has written widely on the theory that rock
musicians who sing or hum along as they play are triggering the stapedius reflex and
protecting their ears as they do so. Try it yourself in a noisy passage …
Nageris et al conducted a study of soldiers in the Israeli army and found that, regardless
of whether they were right- or left-handed, the left ear showed more noise-induced hearing
loss. Nageris suggested this is because the stapedius reflex is less efficient in the left ear.
INNER EAR
Whereas the middle ear is filled with air, the inner ear is filled with fluid. From now on the
processes are chemical (or electrochemical) rather than mechanical. The inner ear is, strictly
speaking, part of the brain. It contains the three semicircular canals or vestibular system,
which governs balance; this mechanism enables us to hear equally well whatever our body
posture (handy for opera singers who have dying scenes).
Also located in the inner ear is the cochlea. About the size of a pea, it is the snail-shaped
structure that houses the organ of Corti, a transducer that turns mechanical signals into nerve
impulses. On the inner surface is the basilar membrane, which covers thousands of tiny
flexible hair-like cells or stereocilia arranged in rows. The stereocilia bend in response to
sounds and release potassium ions that send impulses via the cochlear nerve to the auditory
cortex (the ‘hearing’ part of the brain). Under normal circumstances the stereocilia bounce
back and you get an effect like a Mexican wave along the basilar membrane. The higher
frequencies are processed at the front end or base of the cochlea, while lower frequencies
are processed at the apex the far end.
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 9
The cochlea analyses frequencies (the pitch) and
preserves the temporal structure (the timing) of
incoming sounds, and performs a volume-control
function (automatic gain control) so that quiet
sounds can be picked out among loud sounds. This last function accounts for our ability to
pick out specific sounds across an orchestra and conversations (and gossip) across a noisy
room: the cocktail party effect.
This is a very simplified version of a complex and fascinating process, one that is all the
more interesting and mysterious when you factor in music, our brain and our emotions.
Later in this guide you will find suggestions for further reading if you want to learn more.
WHAT CAN GO WRONG WITH YOUR HEARING?
Hearing problems may or may not affect your career as a musician; there are many skills and
tricks that you develop: muscle memory, habit, breathing together, responding to visual cues
and to vibrations rather than sounds, and so on. On the other hand, hearing problems will
affect your social life and general wellbeing if, for example, you start to avoid social
situations because you can’t hear your friends.
Individual differences play a huge part in the story of our hearing and hearing health. Two
musicians who sit side by side will not have the same hearing history, and there is no
infallible way of predicting what will happen to our hearing. Hearing problems can have
many causes besides noise: genetics, head injury, childhood illnesses, certain drugs and other
ototoxic (poisonous to the ear) substances or simply bad luck (the literature talks about
‘tough’ and ‘tender’ ears). It’s important not to leave it to chance.
Here are some of the main hearing-related problems reported by musicians. It is not an
exhaustive list, but focuses on some of the things we can do something about (as well as
ageing, which we can’t do anything about).
AGE AND NOISE: A POTENT COCKTAIL
Ageing: you lose the ability to hear the higher frequencies as you get older.
You can’t do anything about that.
Noise: you lose the ability to hear 4-6kHz (including the consonants in
speech); noise can trigger tinnitus or hyperacusis. You can do something to
prevent the effects of noise.
The combination of age and noise will exacerbate hearing problems.
»
The cochlea looks like a drinking
straw wrapped 2½ times around a pencil.
Click to see and hear the cochlea and
stereocilia in action.
10
Workers in the Lancashire cotton mills were routinely taught to lip-read in the
expectation that they would lose their hearing as a result of their noisy jobs. The Les
Dawson character Cissie (as in Cissie and Ada) demonstrates this skill in action.
Present-day deaf musicians such as flautist Ruth Montgomery talk about focusing on
teamwork, understanding the language and the shapes: When people say to me You must
feel the vibrations I just sigh that’s not the only thing about music.”
AGEING
Our hearing deteriorates as a natural part of the ageing process. Age-related hearing loss is
known as presbycusis (or presbyacusis). After the age of about 20 our ability to hear the
higher frequencies (usually above 16kHz) decreases, and this continues as we get older. The
extent of presbycusis depends on family history, gender (men’s hearing deteriorates more
markedly than women’s), and luck (again). It happens slowly so we don’t notice it we just
assume everyone else is mumbling, but we are losing our ability to hear the higher
frequencies, which includes the consonants in speech.
“My hearing’s fine. But young
people these days don’t know how
to speak properly. They all
mumble.”
OUTER AND MIDDLE EAR PROBLEMS
Problems affecting the outer or middle ear can result in conductive hearing loss. Processes in
these parts of the ear are more or less mechanical, and can often be fixed: one of the
theories is that Beethoven’s deafness was caused by otoscelerosis a condition which can be
treated nowadays, sometimes by replacing the tiny bones of the middle ear.
The middle ear is prone to infections and some musicians are more susceptible than others.
Perforated eardrum can be caused by an ear infection or trauma. Fortunately the eardrum can
heal quickly, and so the condition is usually temporary, though repeated occurrences mean
the healing process becomes less effective because of the increase in scar tissue.
OUTER AND MIDDLE EAR PROBLEMS
Conductive hearing loss
Ear infections and perforated eardrum
»
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 11
INNER EAR PROBLEMS
Problems affecting the inner ear can result in sensorineural hearing loss. Noise-induced
hearing loss (NIHL) is sensorineural, and there is currently no cure. If the stereocilia are
subjected to constant high sound levels they lose their ability to bounce back once they have
sent the message to the brain. They can even break in response to extremely high sound
levels. Though medical research is working on regenerating damaged stereocilia, it is a long
way from finding a way of restoring hearing to its former healthy state.
Exposure to prolonged high levels of sound leads to auditory fatigue. This is known as a
Temporary Threshold Shift (TTS). After a long day in a noisy environment we need to turn up
the volume if we want to hear what we think are the same levels (which is why your car
radio is invariably turned up higher on the way home from a noisy show). It is assumed that
TTS builds up and leads to a Permanent Threshold Shift (PTS) actual physical damage if
you don’t give your ears a sufficient chance to recover after a period of exposure. Hence it
is vital to rest your ears often.
Noise-induced hearing loss (NIHL) is a result of exposure to high levels of sound over a
long period. It has specific characteristics that are recognisable on an audiogram: a ‘dip’ in
the audiometric curve at 4-6kHz. Often NIHL and other hearing problems co-exist, but you
may equally well have tinnitus and a normal audiogram.
INNER EAR PROBLEMS
Auditory fatigue
Temporary and eventually permanent threshold shift
Sensorineural hearing loss
»
The Australian audiologist Robert Patuzzi devised an elaborate experiment (albeit only
on himself) whereby he exposed his ears to intermittent and constant sounds, in order to
find out, by measuring oto-acoustic emissions, the extent of temporary threshold shifts and
recovery times. He found that if there were enough quiet moments between periods of
noise the ears would recover.
Tinnitus is commonly reported among musicians. It can manifest itself as a ringing, buzzing,
whooshing, or any number of other unwanted noises noises that don’t exist in the real
world in one or both ears. It may be more troubling in a quiet environment, or in a noisy
environment, or when combined with stress or fatigue, and it may be temporary or
permanent. It can interfere with your sense of pitch, especially if you have perfect pitch.
Possible causes are one or a number of: noise exposure, stress, certain medications, or
lifestyle factors, grinding teeth (known as bruxism which is often related to stress), and
problems with the temporomandibular (TMJ jaw) joint. If you are lucky the tinnitus will go
away of its own accord, especially if it has been brought on by stress, illness or medication.
But it is equally likely that it will start to appear for longer, even to the point where it can
stay with you all day and night. Tinnitus may or may not be accompanied by a measurable
hearing loss as shown on an audiogram. People have very different responses to tinnitus:
12
there’s a world of difference between
someone who ‘has’ tinnitus and is able to
ignore it, and someone whose tinnitus stops
them from sleeping or concentrating.
Tinnitus is not well understood in the
medical profession; brain research is
increasing our understanding but a cure is a
long way off. In the meantime, there are
ways of managing your symptoms. Speak to
your GP and your dentist as well as your
audiologist, to rule out any other underlying
causes. A dentist may also prescribe a
mouth guard to make it impossible to grind
your teeth. Some violinists chew gum to
keep their jaw relaxed, though this may not
be appropriate on stage.
With tinnitus the best approach is education and prevention.
Some manifestations of tinnitus: buzz off and screechy violin courtesy of the RNID.
Smetana’s tinnitus can be heard in the last movement of his Quartet no. 1 From my life
the first violin’s high E cutting through. Martinů wrote his (head-injury-induced) tinnitus into
his Sixth Symphony.
Hyperacusis is an increased sensitivity to certain sounds. It seems to be a problem with our
brain’s automatic gain control (AGC volume knob) associated with certain frequencies. It
can be brought on by overly loud sounds or even moderately loud sounds at a certain
pitch, and can create huge discomfort. The anticipation of a loud sound can be as bad as, or
worse than, the sound itself. As with tinnitus, relaxation and behavioural therapies can help.
Recruitment is another example of the AGC going wrong. It is a loss of ability to cope with
an increase in dynamics, and sounds get much louder all of a sudden. It is assumed to be
linked to damage to the stereocilia, as the healthy cells are compensating for the lost cells.
Diplacusis is the term used to describe the situation where the brain does not process the
information from each ear in the same way. Asymmetric hearing problems make it more
difficult to locate a sound
and to assess its intensity
and pitch.
The cocktail party
effect refers to our
ability to pick out
specific sounds or
frequencies when there
are high levels of
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 13
background noise. It’s a skill we take for granted until we lose it. It seems to be related to
the fact that we have binaural hearing, and can hear across the frequency and dynamic
ranges. If you lose that ability it means not only failing to hear cues in an orchestra but
missing out in social situations too.
Acoustic trauma is a loose term referring to symptoms musicians have described after
sudden exposure to a blast of exceptionally loud noise. This can cause perforated eardrum,
it could destroy the stereocilia instantly, or it could leave you with tinnitus. If accompanied
by other factors such as stress and fatigue, it can cause temporary, long-term or permanent
damage. It’s another case where prevention is vital. If you do experience this, you should get
your hearing checked out as soon as you can after the event.
Other. The hearing problems described above are linked to exposure to high levels of
sound, and are commonly mentioned in the literature on musicians’ hearing and reported by
musicians themselves. Other conditions that can affect hearing are Ménière’s disease and
other problems that affect balance, acoustic neuroma (also known as vestibular
schwannoma) which is a benign tumour in the brain. These are rare, but as with all medical
concerns, you must seek proper help.
HEARING PROBLEMS AND WHAT YOU CAN DO ABOUT THEM
Act sooner rather than later if you have any concerns.
Get the most out of your occupational health provider, GP and/or
audiology service.
By all means use the internet to learn about hearing, but remember it is not
specific to your particular case and it is not a substitute for medical help.
»
WHAT DO WE KNOW ABOUT MUSICIANS’ HEARING?
We really don’t know if musicians’ hearing is better or worse than that of the general
population. Musicians do perform well in hearing tests; the years spent training your ears
means you’re used to detecting the quietest sounds. However, studies done on musicians to
date have been on a relatively small-scale; the large-scale historical studies were done on
populations of workers in heavy industry. Furthermore, much of what we know about
hearing is based on work on human cadavers or live animals. The literature is only just
beginning to take into account the leisure-noise exposure of the iPod generation. Though it
is too early to see the long-term effects on the hearing of iPod users, it has already had a
sufficiently high profile to have been the subject of a major study funded by the European
Commission.
Here are some well-documented theories that may tip the balance in favour of musicians.
Remember, though, that these are usually small-scale studies using a tiny sample (that may
also include rock musicians) and so it is risky to extrapolate. Follow up the references cited
in the Literature Review document for more information on this.
14
Trumpeter's noise exposure, Verdi Requiem
Duration: 85mins. Leq: 94dB(A)
50
60
70
80
90
100
110
Time
Leq
LAeq
85dB
ppp
fff
Stapedius reflex. The stapedius reflex, or acoustic reflex, comes into play at the onset of a
loud sound. Hence the importance of marking up the score in advance to protect yourself.
It is also thought that humming can trigger the stapedius reflex. However, it is not clear
whether the reflex can be trained or whether it loses its efficiency and ultimately expires
with continued use. It seems to be more effective at lower frequencies. Don’t rely on it.
Intermittent nature of classical music. Unlike
industrial noise, (classical) music is
characterised by its wide dynamic range:
typically 40-50dB difference between the
loudest and quietest passages. During the
quiet passages your ears get a chance to
rest, possibly by resetting the stapedius
muscle. That’s why it is vital to find quiet
places to spend your breaks.
Training effect. It has been suggested that training can strengthen certain processes (known
as olivocochlear systems) in the brain, just as physical exercise improves general health.
Liking the music. There is some evidence in the literature that if you like the music, the blood
supply to the cochlea is more efficient possibly because you are producing antioxidants
that ‘mop up’ free radicals that can harm hearing. However, there are no doubt occasions in
any musician’s career when you find the music hard to like. Moreover, there are many rock
stars of a certain generation who are now prepared to speak out about their noise-induced
hearing problems; we can only assume they liked the music they were making
Case study: In 1995 Kähäri et al re-tested the hearing of a group of 56 classical musicians
at the Gothenburg Symphony Orchestra who had been the subject of a study 16 years
earlier. They found that on the whole the musicians’ hearing had not deteriorated
significantly more than that of the general population in that time. However, the male
musicians’ hearing had deteriorated more than the female musicians’ hearing (which is
typical in the general population). [Unfortunately there are not many studies like this.]
It must be emphasised that science still has an incomplete picture. It will take many years to
investigate the effects of exposure to high sound levels over a career in music not to
mention the contribution of lifestyle factors. Meanwhile, it is vital to take the risks seriously.
DONT PLAY RUSSIAN ROULETTE WITH YOUR EARS
You can reduce the likelihood of damaging your hearing if you:
reduce the volume of the sounds to which you are exposed
reduce the duration of the exposure (by giving yourself breaks, and by
saving up your allocation for when it really matters)
mark up the score
wear hearing protection whenever you can.
»
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 15
MUSIC AND NOISE AND THE BIGGER HEALTH PICTURE
A frequently used definition of ‘noise’ is an ‘unwanted signal’. Clearly, most industrial noise
can be defined like that, but music is something deliberate and wanted. However, it would
be disingenuous to say that all music is wanted: the tinny sound that leaks out of your
neighbour’s mp3 player in the quiet carriage of a train may not be loud but it will certainly
annoy you. Equally, if you are playing repertoire you don’t like, or if you are not in the best
frame of mind, you will respond negatively to what you hear, even if it is not ‘loud’.
There is evidence, from studies published by the World Health Organisation (WHO), of
increased cardiovascular risk and other long-term health risks associated with exposure to
‘nuisance’ noise, even where levels are not high. In 2011 the WHO published a report called
The burden of disease from environmental noise. Studies also link unwanted noise exposure to
a decreased ability to concentrate.
For a musician, the sound of your colleagues’ instruments may well contribute to increased
stress levels, for example between the back desks of the strings and the trumpets or
piccolo, or between the horns and percussion, but in general players of louder instruments
are receiving higher doses themselves. Perhaps counter-intuitively, the received wisdom is
that you receive half of your noise dose from your own instrument, though it is difficult to
assess this. Similarly, dissonances (deliberate or not) can seem louder to our ear and set up
a beating effect that can be fatiguing and/or stressful. In this case relaxation techniques can
be beneficial to hearing as well as decreasing blood pressure and improving general
wellbeing.
It is important to bear in mind that ‘stress’ is notoriously difficult to define and means
different things to different people. The adrenaline rush you thrive on in performance can
turn under certain circumstances to unhealthy stress that is associated with raised blood
pressure, compromised immunity and changes to metabolism. Musicians describe aspects of
their careers as stressful, without adding unwanted noise into the equation: being on tour,
long hours, job insecurity and any number of other factors may conspire against your health
in general and your hearing health in particular.
YOU CANT SWITCH YOUR EARS OFF
We often don’t realise what our noise exposure is.
Though we may like the music we make, we can’t assume it’s not harming
us.
If we don’t like it we can become more fatigued and stressed by it.
»
We still have an incomplete understanding of the link between exposure to high levels of
musical sound and hearing problems. Hearing research is one of the least well-funded areas
of medical research, but it is an exciting field. Acousticians are working with architects to
improve the comfort of many workplaces, new and refurbished. In spite of these
improvements, you have a responsibility towards yourself to look after your ears.
16
WHAT MUSICIANS SHOULD KNOW ABOUT
SOUND AND NOISE
DESCRIBING AND MEASURING SOUND
The sensory experience that can’t be measured but can be described
subjectively.
The physical phenomenon that can be measured in terms of pitch, sound
energy (intensity) and duration.
Sound can be measured in terms of pitch, intensity and duration.
»
Of course, musicians know a great deal about sound. You can describe the effects of the
sound you make, or what you need to do to modify a sound. This is sound as the intangible,
sensory experience. Fewer musicians are fluent in the language to describe the physical,
measurable phenomenon. What follows are the basics of the science of sound as a physical
phenomenon. It doesn’t do justice to the complexities of music and hearing, but it does go
some way to helping us understand those aspects we can do something about.
Sound can be measured in terms of pitch and sound energy or intensity. The other
measurable aspect is duration exposure over time.
PITCH ESSENTIALS
Frequency (pitch) is measured in Hertz (Hz) or cycles per second.
The human hearing range is 20-2,000Hz (less as we get older).
Noise-induced hearing loss (4-6kHz) means missing out on upper harmonics
in music and consonants in speech.
High frequencies are easier to block out.
Certain sounds can tire you (eg. a pure tone or a dissonance).
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FREQUENCY (PITCH)
Pitch is the ‘human’ version of frequency. It is measured in Hertz (Hz) or cycles per second.
The range of human hearing is between 20Hz and 20,000 Hz (20 kiloHertz, or 20kHz).
Below 20Hz we feel a vibration but can’t hear anything. The upper limit of hearing
perception decreases as we get older. Children can hear 20kHz and above, but the ability
falls off with age, so that by the age of 50 it is rare to hear 16kHz. The loss of high
frequencies with age tends to be more marked in men than women, and the left ear is
usually less resilient than the right.
The frequency we all recognise is 440Hz concert pitch. The octave below that is 220Hz
and the octave above is 880Hz. Each octave is a doubling or halving of the frequency. As a
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 17
pure tone 1,000Hz or 1kHz is a sharp B5 or flat C6 (two octaves above middle C). The C at
the top of the piano is about 4kHz.
For humans the most sensitive range is 1-5kHz. But we also need frequencies above that for
music (for the upper harmonics). For understanding speech 4kHz is vital because that is
where the consonants such as s, t, and k are; vowels are at lower frequencies. Noise-induced
hearing loss (NIHL) is characterised by a decreased ability to hear sounds between 4-6kHz.
Sound waves reflect off surfaces in a room (which is why it can be unsatisfying to perform in
the open air) and can be absorbed by things such as drapes around the walls and the
bodies of the audience or your colleagues, as well as distance. The trained, healthy ear, or
rather, a pair of ears and the brain, plus your musicianship and experience, can adjust to
these acoustic variations, and create a consistent performance regardless of the space.
Sound waves at different frequencies behave
differently. High frequencies are more directional,
and it’s easier to stop them in their tracks – which
means it is possible to create a barrier between the
bell of a trumpet and a viola player, or for the
trumpeter to adjust the angle of playing (within the
bounds of what is appropriate for the repertoire,
obviously). It’s also why the drum kit should ideally
be put inside a ‘goldfish bowl’ in crossover music.
Meanwhile, a trombone sound cannot be stopped
so easily. Low frequencies are less directional, and
it is harder to stop them travelling or absorb them,
as anyone who has played a gig with loud bass
guitar will know. But low frequencies can also provide a ‘cushion’ so we perceive the sound
levels to be lower. A large orchestra with full string strengths playing fortissimo Wagner
tends to feel less loud than a modern work, where the orchestration may be sparser. This is
because the frequency content of the Wagner is richer. It’s like with speaking voices: a high-
pitched voice cuts through background noise but you won’t want to listen to it all day.
DECIBEL ESSENTIALS
Sound intensity is measured in decibels (dB).
A reduction or increase of 3dB is a halving or doubling of sound intensity.
Key figure to remember: 85dB(A) over an eight-hour period.
Some examples typical sound levels taken over a short duration:
20dB(A) rustle of leaves in a forest
80db(A) solo piano, cello, double bass
85dB (A) solo violin, oboe playing mf
90dB(A) solo trumpet, horn playing mp
130dB(C) cymbal crash.
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18
SOUND PRESSURE LEVEL AND THE 3DB RULE
Sound intensity (sound pressure level, sound energy) is measured in decibels (dB). The
absolute threshold of hearing is 0dB or, more realistically, around 20dB taking into account
background noise and the sound of your own pulse and breathing. The threshold of pain,
where noise can do instantaneous and irreversible damage, is 140dB though it can be
much lower This is the level of a jet engine taking off, or a gunshot, or a balloon bursting in
a confined space. In reality, hearing thresholds vary for different frequencies; the bass/treble
or the ‘loudness’ button on a car radio is there to help you hear over engine noise. In
addition, acousticians talk about the ‘threshold of discomfort’ and the ‘threshold of
annoyance’, especially in relation to high frequencies and dissonances. While these won’t
necessarily harm you, they can add to fatigue or stress and affect your concentration.
Drawing by S. Blatrix
from Promenade
around the cochlea
www.cochlea.org by R
Pujol et al. INSERM and
University of Montpellier.
The 3-decibel rule is a useful thing to remember. Decibels are expressed on a logarithmic
scale, like the Richter scale. A 3dB increase is a doubling of the sound pressure level (SPL),
while a 3dB decrease is a halving of the SPL. A 10dB increase is ten times the sound energy.
However, we only perceive a 10dB increase as being twice as loud, not ten times as loud.
Or, to put it another way, to make your orchestra seem twice as loud you need ten times
the forces. This is because of the ‘automatic gain control’ function in a healthy ear.
Sound energy is measurable but loudness is subjective, which means you don’t realise how
much exposure you are getting. Sound energy decreases with distance. If you double the
distance from a single sound source, you reduce the sound pressure by 3dB in the real
world (in an anechoic chamber with no reflective surfaces or in the open air it would be
6dB). In an ensemble, you will halve the exposure by doubling the distance between yourself
and the sound source, though it won’t feel like that if you are not in control of the sound.
The ‘A’ weighting, used when measuring intensity, reflects the fact that we don’t hear all
frequencies equally. It gives increased weighting to the frequencies we are most sensitive to
(1-5kHz). The ‘C’ weighting is used for high-intensity sounds, where the frequency content is
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Musicians’ guide to noise & hearing | 19
irrelevant. So a continuous level of sound (Leq), or a daily dose (Lepd), is expressed in
dB(A) while an instantaneous peak is expressed in dB(C).
Pitch and decibels work together and as we lose the ability to hear certain frequencies we
need to boost those frequencies to aid comprehension. We usually just turn the volume up
to enable us to hear the consonants. Because this is a slow process we adjust over the
course of a long musical career and use other cues to keep us in tune and in time.
At 20 years old we hear 5kHz and 2kHz at the same intensity
At 40 years old we hear 5kHz approximately 8dB less than 2kHz
At 60 years old we hear 5kHz approximately 25dB less than 2kHz.
DURATION
Apart from when talking about high instantaneous peaks, decibels only make sense when the
duration of exposure is taken into account.
The Leq or Equivalent Continuous Sound Level gives an average Sound Pressure Level over
a period (T), such as the duration of a rehearsal or a piece. The Lepd is the Daily Personal
Exposure Level, an individual’s dose averaged out over an eight-hour working day. Both are
usually ‘A’ weighted; they are properly expressed as LAeq in dB, Leq in dB(A) or LEP,d in dB(A).
DURATION ESSENTIALS
Leq (or LAeq) refers the level over a given period of time (T).
Lepd is exposure calculated over an eight-hour day: aim for 85dB(A) Lepd.
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MAKE FRIENDS WITH THE 3DB RULE
3dB is a doubling or halving of the sound pressure level.
Doubling the number of (identical) sound sources increases the level by 3dB:
if 1 trumpet @ 1m distance = 93dB
2 trumpets @ 1m distance = 96dB
4 trumpets @ 1m distance = 99dB.
Doubling the distance from a single sound source reduces the level by c.3dB:
if 1 trumpet @ 1m distance = 93dB
1 trumpet @ 2m distance = 90dB
1 trumpet @ 4m distance = 87dB.
Doubling the duration increases your exposure by 3dB, so to halve your daily
dose you need to halve the exposure time:
85dB over 8hrs is the equivalent of:
88dB over 4hrs (time to reach 85dB Lepd)
91dB over 2hrs
94dB over 1hr
97dB over ½hr (eg solo trumpet; if you reach these levels so quickly you must
consider what other exposure you have during that day).
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Again, the 3dB rule helps: a 3dB reduction in sound pressure means you can double the
exposure time, and (in theory at least) a 10dB reduction means you can increase the
exposure time tenfold. So 85dB(A) over an eight-hour day is the same as 88dB(A) over four
hours. That does not take into account any other exposure such as practising, warming up,
teaching, commuting or listening to the radio. Also, it is only practical to use the 3dB rule
for certain levels and over a decent time scale: for three or four minutes’ exposure it is not
useful. Exposure levels below 75dB are currently considered insignificant to hearing health,
though other factors do have a bearing on general health, especially night-time noise and
unwanted low-frequency noise.
MEASURING YOUR DAILY NOISE DOSE
As a musician it helps if you take your own measurements, so you can see your exposure
levels for yourself and build up your own picture. Noise meters that are available as an app
can give a useful indication of noise levels. You need to spend a few pounds rather than
using the free ones (£10 or more will buy you a reasonably accurate version provided it is
calibrated properly), but even then they can only be used for information purposes as they
do not conform to any British Standard. If you really want to make sense of the data you
should use a dose badge and place it as close to your ear as you can or use a hand-held
meter and note the Leq or average. You may be surprised by what the meter tells you.
This chart shows relative sizes of sections of an orchestra and typical daily dose of each. It is based
on data collected over a range of projects at the BBC during 2008/09. Singers are not shown but
they would be at the right of the diagram.
IT ALL ADDS UP
Consider measuring your noise dose inside and outside the workplace.
Your ears don’t differentiate between ‘at work’ and other exposure.
You do have some control over your daily exposure.
You can reduce your daily dose by using earplugs.
By taking off 3dB you halve your daily dose.
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Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 21
As far as the Noise Regulations are concerned, 85dB over an eight-hour day is the key
figure to remember. Musicians don’t often work eight-hour days, so you need to calculate
the exposure level for the actual working day. Roughly speaking, if you work six hours in a
typical two-session day your continuous exposure figure will go down by about 1dB when
averaged out over eight hours. It will also go up by about 1dB if you work a three-session
day. This is because of the way decibels work.
The Regulations allow the dose to be calculated over a week, but it doesn’t help unless your
daily dose varies by more than 5dB from one day to the next. On the other hand, if you are
having a noisy week you should limit your other noisy activities so that you give your ears a
rest. Your 85dB(A) daily dose or Lepd translates to 88dB if your day is only four hours long,
and likewise if you are exposed to 91dB over two hours it still amounts to an 85dB Lepd.
It must be stressed that your noise exposure ‘at work’ in the music business is rarely your
only exposure. To calculate your daily dose you could look at your exposure in terms of
Leq (average) over a specified duration, and then calculate what that means over a longer
period. You can use this simple online Noise calculator for musicians from any browser, or
if you have Excel you can use the HSE’s online Noise Calculator. Here are some worked
examples of how a musician’s typical daily exposure adds up (Leq unless otherwise stated).
DAILY AND WEEKLY DOSE: SOME WORKED EXAMPLES
AN OBOISTS DAY
1hr commute (tube) 83dB(A)
3hr session Leq 88dB(A)
1hr lunch (canteen) 85dB(A)
1hr commute 83dB(A)
1hr teaching (home) 83dB(A)
1hr practising 85dB(A)
TOTAL 86dB(A)
Lepd
A (BUSY) BASSISTS DAY
¾hr commute (bicycle) 77dB(A)
3hr session (orch) Leq 84dB(A)
¾hr commute (bicycle) 77dB(A)
1hr teaching 82dB(A)
1hr commute (car/R4) 81dB(A)
1hr jazz reh + 2hr gig 91dB(A)
1hr commute (car/jazz on radio)
87dB(A)
TOTAL 88dB(A)
Lepd
A HORN-PLAYERS DAY (NO
EARPLUGS)
½hr commute (m’bike) 93dB(A)
3hr session Leq 93dB(A)
1hr lunch (canteen) 85dB(A)
3hr session 94dB(A)
½hr commute (m’bike) 93dB(A)
1hr DIY w/ drill 90dB(A)
TOTAL 93dB(A)
Lepd
A TRUMPETERS DAY OFF
1hr practising on & off: 98dB(A)
7hrs walking in country, reading
paper, etc Leq 77dB(A)
TOTAL 89dB(A)
Lepd
A FREELANCE VIOLINISTS
WEEK
Mon (day off) Lepd 78dB(A)
Tues (rec session) 85dB(A)
Wed (rec session) 85dB(A)
Thurs (rec session) 85dB(A)
Fri (crossover reh+gig) 90dB(A)
Sat (oratorio gig) 87dB(A)
Sun 3hrs string quartet 86dB(A)
TOTAL 88dB(A)
Lepw
A HORN-PLAYERS DAY
(WITH 9DB ATTENUATING
EARPLUGS)
½hr commute (m’bike) 84dB (A)
3hr session Leq 84dB(A)
1hr lunch (canteen) 85dB(A)
3hr session 85dB(A)
½hr commute (m’bike) 84dB(A)
1hr DIY w/ drill 81dB(A)
TOTAL 85dB(A)
Lepd
You may wonder why you need to to worry about what seem like only a few decibels. It’s
because of the 3dB rule. You can double your exposure time if you reduce the exposure by
3dB. So look at your day and protect your hearing (taking off say 9dB by wearing musicians’
earplugs) for the periods when you feel you can. It all helps. Bear in mind it’s notoriously
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difficult to be exact about measuring sound levels in the real world over a period of time;
the figures below are intended to give a rough idea. Consider creating your personal ‘noise
diary’ so you can see for yourself how much noise you are exposed to over a given period.
Exposure from instantaneous peaks is measured with a single figure and is ‘C’ weighted. The
main people at risk from peaks are those sitting near the noisy percussion instruments,
though an unexpected howl from a foldback monitor may be unpleasant, and can trigger
tinnitus, headaches or nausea. There have been reports of adverse reactions to sudden loud
noise reported for exposure of 118dB(C) or lower.
WHATS YOUR DOSE? SOME TYPICAL EXPOSURE FIGURES
Ranges given above are based on typical daily doses (Lepd) for two-session days in BBC Maida Vale
studios or Studio 7, Manchester, of rehearsals or studio concerts of classical repertoire (not
recording sessions, not concert-hall concerts and not amplified repertoire). String readings come
from tutti players; violin 1 upper figure is high because some readings were taken from in front of
percussion or piano.
Some typical noise measurements for non-work activities (Leq over a period):
Cycling (½hr in Central London)
77dB(A)
Motorbike (½hr on A40)
93dB(A)
Quiet coach on a train
79dB(A)
Tube in rush hour (1hr on Central Line)
83dB(A)
iPod levels (figure to add when listening on public transport)
Add 4-10dB(A)
Busy canteen (1hr)
85dB(A)
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Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 23
THE NOISE REGS AND YOU:
PUTTING IT INTO PRACTICE
THE NOISE REGULATIONS ARE FOR YOU
Take advantage of them to help you to look after your hearing (and that of
your colleagues and pupils), whilst maintaining the highest artistic standards.
They apply whether you are employed on a contract or as a freelancer.
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WHY DO WE HAVE NOISE REGULATIONS?
Everyone has the right to expect not to be harmed by their work. We have had health and
safety legislation in the UK since 1833. The key piece of legislation now is the 1974 Health &
Safety at Work Act, which obliges employers to protect employees from risks in the
workplace. It covers three types of obligations: a moral obligation to look after employees
and colleagues (and ourselves), a financial obligation, and a legal obligation: employers not
complying can be prosecuted in the criminal courts, and there is provision for civil claims,
with implications for compensation and insurance.
Noise is long established as a health risk; as long ago as 1963 the British Ministry of Labour
and Central Office of Information published a leaflet called Noise and the Worker. The 2005
Control of Noise at Work (CNAW) Regulations replace the 1989 Noise at Work
Regulations and are based on a European Directive 2003/10/EC. The Regulations have
applied to all workplaces without exception since 2008.
WHAT DO THE NOISE REGULATIONS SAY?
Regulation 4 sets out the exposure levels.
Five Regulations require action on the part of the employer, but to translate
them in terms that relate to you as a musician…
Assessing risk: how to identify what might go wrong? (Reg 5)
Controlling noise: what can be done about it? And what can you do? (Reg 6)
Hearing protection: what are your options? (Reg 7)
Hearing health surveillance: how can you invest in your hearing? (Reg 9)
Instruction, information and training: how do you find out more? (Reg 10)
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Applying the Regulations to acoustic music and musicians poses particular challenges. Your
‘workplace’ can range from a state-of-the-art studio or concert hall to an acoustically
challenging teaching room or domestic workspace. You may work one, two or three
sessions a day, often in more than one workplace and for more than one employer (or on a
voluntary basis). And you may not feel making ‘noise’ describes what you do. Music you
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make yourself is not unwanted, but because it is ‘at work’ or arising ‘in connection with
work’ it comes within the scope of the legislation. The Regulations exist because of the link
between prolonged exposure to noise and hearing problems. In the general population
noise-induced hearing loss is one of the most common industrial diseases, though it can take
many years to manifest itself; it is said to have a ‘long latency’.
THE FIGURES
Daily dose (Lepd) over an eight-hour working day:
80dB(A) = LEAV (Lower Exposure Action Value)
85dB(A) = UEAV (Upper Exposure Action Value)
87dB(A) = ELV (Exposure Limit Value) (with hearing protection).
Peaks:
135dB(C) = LEAV
137dB (C) = UEAV
140dB (C) = ELV
LEAV: at the Lower Exposure Action Value the employer must provide information and training
and make hearing protection available.
UEAV: at the Upper Exposure Action Value the employer is required to do as above plus
implement reasonably practicable measures to reduce noise exposure, to enforce the wearing of
hearing protection and provide hearing health surveillance.
ELV. The Exposure Limit Value is what you need to aim below when taking into account the
effects of hearing protection.
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There is also a requirement that management and employees work together to find
solutions. In the case of music, where venues and employers are usually separate entities,
venue managers should collaborate with ensemble managers.
Health and safety law does not differentiate between freelance and employed workers. The
only exception to this is that employers are obliged to provide hearing health surveillance to
musicians on contract but not to freelancers. However, it is recommended that ensembles
employing the same freelancers on a regular basis should provide hearing surveillance as
well.
The next two sections cover those Regulations requiring action by managers, looking at
them mainly from the perspective of the musician, in terms of what you can expect to see,
and how you can play your part. The first section discusses how you can look after your
hearing health and your options for hearing protection, and the second section explores
your contribution to assessing risks and to controlling noise exposure (an activity that
should extend beyond the workplace). The corresponding sections in Part II, the ‘Toolkit
for managers’, cover the same topics from the managers’ perspective.
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 25
LOOKING AFTER YOUR HEARING HEALTH
HEALTH SURVEILLANCE ESSENTIALS
Invest in your hearing health and learn how best to protect yourself.
Take advantage of regular hearing tests if your employer offers them.
Don’t put off a visit to your GP or an audiologist.
Ask as many questions as you need to at the hearing test.
If you have a problem, help is available and you can carry on making music.
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Hearing tests are an important way of investing in your health and longevity as a musician.
As with many health problems, you may think ignorance is bliss, but not getting your hearing
tested won’t change your hearing – and it will go a long way to identifying any problems at
an early stage. Indeed you may find out that any worries you had were unfounded.
Whatever your employment status, you should get your hearing tested regularly, and don’t
ignore any problems you may be aware of. If you do find you have a problem, you need to
work extra hard to protect the hearing you have, inside and outside the workplace.
Health surveillance is intended to help identify early signs of a problem so that you and your
managers can intervene appropriately. The hearing test, or audiometry, used in hearing
health surveillance provides evidence of the state of your hearing based on your responses
to pure tones presented at octaves. We know that age-related hearing loss is identified by a
decrease in the ability to hear at the higher frequencies, and that noise-induced hearing loss
is characterised by a ‘dip’ or threshold shift at 4-6kHz and (usually) a recovery at 8kHz.
Your employer bears the cost of audiometry. This may be delivered in-house, by a
university department or teaching hospital, a commercial audiologist or some arrangement
with the NHS. In some cases the audiologist also takes the impressions of your ear canal for
custom-moulded earplugs. If employed, you should have a hearing test on joining the
organisation, then after one year and subsequently at intervals as agreed by the audiologist
(2-3 years is typical, but this may be more frequent). Some of the ‘freelance’ orchestras are
moving towards this model too and if offered, it is wise to take advantage of this.
If you are self-employed, you will have to pay for the audiometry, but discounts are available
through the MU, ISM, Equity and BECTU, and BAPAM via the Musicians’ Hearing Passport.
WHAT HAPPENS IN A HEARING TEST?
Your hearing test will take up to 30 minutes in all. You should ensure that you have not
been in a noisy environment for at least 12 hours (some texts recommend as long as 24
hours but 16-18 is adequate if you have no choice) because you are likely to have a
temporary threshold shift that will skew the results. If you have been in a noisy concert the
night before, or if you have just stepped out of a rehearsal, make sure the audiologist is
aware and notes it on your record.
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Before the test you will be asked to fill in a questionnaire with relevant aspects of your
medical history and that of your family (hearing problems often run in families). You will be
asked about tinnitus, hyperacusis, any head injuries, dizziness, relevant medications and
childhood illnesses as well as significant past exposure and relevant lifestyle factors such as
smoking. All of this will be put on your record; this record is confidential but for in-house
tests you consent to the broad hearing category being communicated to your manager.
You will be given an otoscopic examination to check the health of the ear canals and
eardrums. The presence of (excessive) wax will affect the results of your test so you may
need to get your ears syringed and make another appointment. If you do have tinnitus you
should describe it to the audiologist who may then adjust the way the test is carried out.
The test itself will take place in a soundproof booth or studio, or failing that a quiet room
(the test should not be carried out if there is background noise over 35dB). It lasts about
seven to 10 minutes, and you will need to concentrate quite hard throughout.
Pure tones in octave bands (with a few extra frequencies in between) are presented
randomly through headphones and you will be given a clicker to signal that you have heard
the tone. The most common test is Pure Tone Audiometry (PTA) but occasionally the
Békésy test is used, which gives a pulsing sound. You will feel a bit confused and wonder if
you can hear things or not. This is normal, and the test is designed to take this into account.
Occasionally oto-acoustic emission (OAE) testing is used to measure the vibrations in the ear
canal, or a bone-conduction test may be used to detect a problem in the middle ear. Both
are currently rare in occupational health surveillance.
“It took me ages to get round to making an appointment but it’s better to know
what’s going on with your ears rather than sit around fearing the worst” – freelance violinist.
WHAT DO THE RESULTS MEAN?
The audiometry machine will generate a paper report with the results on or occasionally
the audiologist will plot the results manually. It will show two curves, one for each ear, with
the hearing thresholds at all the frequencies measured. Ask as many questions as you need
to, so you understand the shape of the curves and what that means for you. Ask for a copy
of this report and keep it for future reference.
If the test has been provided by your employer, a summary report will go back to your
manager categorising your hearing into very broad bands that are adjusted for age and
gender. This category is derived by adding up your responses in each ear at 1, 2, 3, 4 and 6
kHz. You will be tested at frequencies above and below this and sometimes at intermediate
frequencies too but these are not used to calculate the category in health surveillance.
Category One: normal hearing. Your hearing is within the normal range for your age and
gender.
Category Two: warning. Mild hearing impairment. In the general population this is the level
experienced by one person in five.
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 27
Category Three: referral. This may suggest significant hearing loss. In the general population
this is the level experienced by one person in 20.
Category Four: rapid hearing loss. If there is a reduction of >30dB in three years (or less).
If the totals for each ear are significantly different (40dB or more) this shows a unilateral
hearing loss and you will see (u) plus L or R referring to the ear with lower thresholds.
If your hearing shows Category 3 or 4, or if you report any unexplained ear pain, dizziness
or severe or persistent tinnitus, the audiologist will refer you to an ENT specialist either
direct or via your GP. In practice many audiologists choose to refer musicians at Category 2
as well. If you find your GP or audiologist is unfamiliar with the specific needs of musicians,
you should take time to explain things to them; alternatively you can seek out the musician-
friendly practitioners via BAPAM. You may be able to access grants to help with funding any
treatments you need from the Musicians’ Benevolent Fund.
LOOKING AFTER YOUR HEARING GENERALLY
Your ears are at risk from other things as well as noise. Flying can cause problems with your
middle ear, especially if you fly with a cold, but discomfort is usually temporary. The
standard advice is to drink a lot of water (not alcohol as it dehydrates), be awake when
landing (the Eustachian tubes don’t work properly when we are asleep), and to yawn and/or
swallow to open the Eustachian tubes. Using a Valsalva-type manoeuvre is a dramatic way of
solving this problem but it can do more harm than good.
Ear infections can be more troublesome for musicians as they can affect your sense of pitch.
If these are painful and the pain lasts, you must get medical help. Ear wax is our ears’ own
cleaning system, but if it builds up too much or too quickly it can affect your hearing. This is
one of those things some people suffer from while others are spared. DIY solutions to
removing it are not recommended. Get your ears syringed by a health practitioner.
If you are prescribed medication for other conditions, ask
your GP about any potential side effects on hearing.
Don’t dismiss the idea of a hearing aid on aesthetic or
musical grounds. Hearing aids are getting smaller and more
sophisticated all the time. The important thing is how it is
programmed, and you need to be sure the audiologist
understands your needs as a musician. Getting the settings
right for music is a process of trial and error and you may
have to wait longer on the NHS than if you go privately. Do
get specialist help, and do persevere.
“I’ve been a professional opera singer for 30 years despite having a severe/profound,
progressive hearing loss. There is some great technology out there. Digital hearing aid
quality today is just fantastic, with specific channels for music. Take heart. Being deaf most
certainly doesn’t mean the end of your career!” Janine Roebuck
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HEARING PROTECTION
Protecting your hearing is not just about earplugs in the workplace. It’s about making the
right choices outside work as well. If you are not ready to wear hearing protection at all
times in the workplace (and not many musicians are), think of yourself as having a daily
allocation of noise and make your own decisions about how to spend it.
Active noise-cancelling headphones are a wise investment. They cancel out unwanted
external noise on planes and tour buses, which means you don’t increase your iPod volume
too much; they prevent headaches and of course help prevent NIHL. On the other hand,
they do cut you off from the world around you. Remember that when you are crossing the
road…
PROTECTING YOUR HEARING
Your ears are an important tool of your trade invest in them:
- at work (rest, earplugs),
- on tour (noise-cancelling headphones, especially when flying),
- at leisure (protect your ears during noisy hobbies and when swimming).
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PROTECTING YOUR HEARING WITH EARPLUGS
Earplugs (hearing protectors) are classed as personal protective equipment (PPE). They
should be used as a last resort when other means of reducing noise exposure have been
explored and exhausted. Unfortunately, in the music workplace other interventions to
control noise may not result in a sufficient reduction, so earplugs will be the only available
option. Fortunately there are a number of different types available to suit personal
preferences or different projects. While some musicians find wearing hearing protection
very straightforward, others need time to get used to them and there are some who feel
they will never be able to do their job properly wearing ear plugs.
EARPLUG ESSENTIALS
Use just enough protection (don’t reduce your exposure more than you
need to).
Find something that suits you (your ears, your instrument).
Always carry your earplugs around with you.
See it as a long-term project. Don’t expect to get used to them
immediately; your brain needs time to adjust.
Don’t expect to cope if you stick them in just before you go on stage.
Use them for private practice and rehearsals.
Use them to protect your ears in other situations (plane, tube, amplified
concerts).
»
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 29
THINGS TO BEAR IN MIND WHEN CHOOSING HEARING
PROTECTION
Dynamic range of music. Industrial noise and amplified music tends to have a consistent
sound level, whereas classical / acoustic music has a much wider dynamic range, with the
typical difference between the quietest and loudest parts c.40-50dB. You need to hear
the quiet parts, and you need to get used to how loud it sounds to the outside world
when you are wearing earplugs (rely on the conductor to balance the ensemble).
Frequency range of music. You need to hear across the whole frequency range (20Hz up
to 20kHz), and if you shut out high frequencies you miss out on the upper harmonics.
Occlusion effect. Our ears emit vibrations that escape via the ear canal. If the ear canal is
blocked, as with an earplug, the vibrations don’t have a chance to escape and create a
‘boomy’ effect that is particularly disconcerting for brass and wind players and singers.
Hands-free and comfort. It’s tricky to keep inserting and removing earplugs when you
need both hands for holding your instrument. If you can’t manage to wear them at all
times, you need to find a way of keeping them handy without dropping them. If they fit
properly you should be able to wear them for long periods even under studio lights.
Attenuation (noise reduction). It is not advisable to reduce exposure below 70dB; below
that figure the risk is insignificant, and you need to hear sounds below 75dB in order to
hear your colleagues (and yourself). This should be taken into account when choosing
hearing protection. Look at the figures on the pack. Hearing protection sold in the UK
must carry this information. It will say, for example: SNR 22, SNR 28 (Single Number
Rating one-size-fits-all). ‘Real-world’ adjustment is c.4dB. Sometimes you will see (for
example) SNR=28, H=30, M=24, L=22. This refers to the attenuation at different
frequency ranges high, medium and low (this can be useful if you want to block out a
specific frequency range). Look at your exposure levels: you need to aim for a daily dose
of 80dB, so an earplug that takes off 20dB or more when your dose is 90dB is too much.
For string players 9dB is plenty; musicians who play noisier instruments may need more.
Either way it is a good idea to have a choice, depending on the repertoire and the venue.
CE mark. This is required on hearing protection sold in the UK; it may be on the earplug
itself but you are more likely to find it on the pack or instruction / specification sheet.
OTHER THINGS TO TAKE INTO ACCOUNT
Peer-group pressure. Do what’s right for you and don’t take any notice of colleagues who
tell you it’s impossible.
‘I can’t hear the conductor’. An enlightened conductor will be aware that the musicians are
wearing earplugs and will speak louder, addressing all players and not just the front row
of the strings. If you can’t hear the conductor, say so – you’re probably not alone!
‘I don’t like the sound I make with earplugs in’. The easy response to this is to say your job
is to make a sound that the paying public will like. However, we do need to get pleasure
out of the sound we make. Once again it’s a balancing act. And indeed, many players find
they can hear themselves better with earplugs in.
30
WHAT TYPE IS BEST FOR ME?
Hearing protection is a fast-changing field and you should keep abreast of developments.
Broadly speaking there are three main types of earplug on the market and in general the
more expensive ones provide better protection whilst not cutting out the speech
frequencies. There follows a summary of the features of each type:
TYPES OF HEARING PROTECTION
Foam disposable (cheap, but can over-protect)
Pre-moulded re-usable (more subtle protection)
Custom-moulded (vented version also available).
»
FOAM DISPOSABLE
Attenuation can be in the high 20s+, possibly too much
as they cut off valuable musical and speech information.
Attenuation is more efficient in the higher frequencies.
They have a habit of easing themselves out of your ear.
They need to be inserted properly: rolled up so they can
go as far as possible into the ear canal.
They are porous, and if you keep putting your fingers in
your ears to readjust them you risk getting an infection.
If you are on TV the camera people don’t like the loud
colours they come in (but don’t let them veto them).
Fine for emergencies but not ideal. Treat yourself to
something more appropriate.
There are some more sophisticated versions on the
market, made of mouldable soft silicone or wax, or foam
with a rod in the middle.
Cost: max 20p a pair, some venues and orchestras
provide them free of charge.
PRE-MOULDED RE-USEABLE
Attenuation is usually 15-20dB.
The attenuation is more ‘linear’ or flat than the foam
ones, and they don’t muffle speech so much.
They are relatively easy to insert. You can get them with
a cord attached so you can remove them.
They need to be kept clean: the flanges can harbour dirt
and they are easy to drop if they don’t have a cord.
They should be replaced at intervals as they lose their
effectiveness with time.
Cost: between £10 and £15.
Also known in the trade as ‘Christmas tree’ or
‘mushroom’.
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 31
CUSTOM-MOULDED
Attenuation can be 9dB, 15dB or 25dB. The attenuation
is much more even so you get the full frequency range of
the sound you are hearing but quieter.
They are not cheap because they are custom moulded to
fit your own ear.
You may find they stop working so well in time as your
ear canal changes shape. You may need to have the
impressions re-done; four years is the recommended
shelf life.
You can get a range of filters so you can change the
attenuation according to the project you are working on.
The occlusion effect is problematic for some (especially
brass and wind players and singers). There is a ‘vented’
version available called the PRO series; it allows the
vibrations to escape, and so lessens the effect of
occlusion. Attenuation for these is 15, 17 and 20dB. A
10dB attenuating earplug is in development.
Cost: £140-165 or more; often part of a package
including audiometry. Discounts via MU, ISM, Equity,
BECTU and BAPAM (Musicians’ Hearing Passport).
OTHER
Cotton wool and tissues are not hearing protection.
They make no difference whatsoever.
Don’t fall into the trap of believing earwax will protect
you …
Foam ear plugs or even industrial ear defenders should
be used when you are doing noisy DIY. Musicians’
custom earplugs do not provide enough attenuation.
SOME SUGGESTIONS FOR DIFFERENT MUSICIANS
Here is a summary of musicians’ experiences of different types of hearing protection and
some suggestions as to what might work for you. It is vital to find a solution that works for
your own circumstances, so you should experiment. If you need glasses to correct your
eyesight you will know that it can take a while to find something that enables you to see
everything you need to see. The same applies to hearing protection.
32
UPPER STRINGS
You need to hear your own high-frequency sounds.
Left ear is exposed more (and left ear does seem to be
more susceptible to hearing problems anyway).
You need to be protected from piccolo (especially)
and/or brass behind.
If you sit downstage you may need to be protected from
big-voiced solo singers.
Earplugs that remove only high frequencies are not
suitable.
Flat-response ER9s are usually adequate.
Avoid the temptation to use hearing protection in one
ear only.
“I find the moulded
earplugs make it easier to
hear myself. viola player
“I wear the custom-
moulded earplugs as much as
possible, especially in
crossover stuff. If ever I
forget them I use the foam
ones and the top notes of
the violin just disappear.
Very disconcerting.” –
violinist
LOWER STRINGS
You need to hear your own instrument which is a long
way from your ear.
You need to hear low frequencies from your own
instrument (and your own instrument is quieter than
your neighbours’).
If you sit close to the trumpets you need to be protected
from their sound.
You may find you only need 9dB attenuation.
“It’s quite calming to
wear earplugs when you’re
doing an amplified gig. But I
do have to watch out I don’t
relax so much that my
performance is too laid
back. double bassist
WOODWIND
For a piccolo player it is especially important to protect
your ears.
Piccolo players and flautists don’t seem to suffer the
effects of occlusion so can cope with flat-response
custom-made earplugs.
Clarinettists, oboists and bassoonists can find the
occlusion effect a problem and it is difficult to monitor
your own sound levels. The buzzing of the reed on
clarinettists’ teeth is particularly difficult. Pre-moulded ,
reusable earplugs seem to be more comfortable, and the
vented custom-moulded earplugs may be appropriate.
“I practise with my
musicians’ earplugs all the
time so I can get used to the
sensations and the sound I
make with earplugs in.
piccolo player
“I wore the Christmas
tree earplugs for years when
I was playing in an orchestra.
I was a bit of a pioneer at the
time, but it was just a sense
of self-preservation. I wanted
to look after my hearing for
the long haul. bassoonist
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 33
BRASS
The occlusion effect and the pressure that builds up in
your head can make custom-moulded plugs tricky.
You may think you will never get used to them but
then, people said that about seat belts in cars
There may be situations when wearing them is out of the
question. If you are playing an exposed passage with very
little rehearsal you won’t want anything to put you off.
If you have longer to prepare, you can experiment.
Record yourself with and without earplugs; hear for
yourself the difference in the sound you make (there may
not be any, though it may feel different), match the
sensation rather than the sound in your head.
Vented earplugs may work if you can’t cope with the
non-vented custom-made plugs.
“When the chunks of
railway line come out behind
us, the earplugs go in,
without fail. trombonist
TIMPANI AND PERCUSSION
You may be sitting for long periods without playing.
If you over-protect your ears you may not get the levels
right when you do need to play.
Flat-response earplugs should work for you.
“I’m sitting at the end of
a row of eight horns in the
Rite of Spring. Definitely a
case for earplugs.
percussionist
PIANO, HARP, CELESTA
You can be tacet for long periods next to noisy
instruments.
You must protect your ears while tacet at the very least.
“In some venues you can
be right up against a wall,
counting bars rest. Without
earplugs it makes it a long
evening. orchestral pianist
SINGERS
You may be standing tacet behind a row of horns and/or
percussion for long periods.
The sound in your head will feel strange; get used to the
earplugs when you don’t need to deliver – as for brass
players.
Custom-moulded or vented earplugs.
“I’ve developed a
discreet way of putting them
in when the horns and
percussion are going all out.
singer
GENERAL POINTS
It is not recommended that you wear hearing protection in only one ear. We have two ears
to enable us to locate sounds in space and so we need to get information in both ears.
34
Don’t be surprised if you find it hard to cope. It’s well documented that it takes a while to
adjust. But persevere. It may not be as hard as you thought. And once you have got used to
it, spread the word to colleagues and students.
Finally, and crucially, remember the Noise Regulations require the manager to enforce the
wearing of earplugs (it’s probably written in your contract in some form too). You need to
discuss this with your manager if there is a real problem.
Score extract on this page and those on page 38 are
from Lady Macbeth of Mtsensk.
© Copyright by Musikverlag Hans Sikorski. Sole agent
for UK, British Commonwealth (ex Canada) and Eire,
Boosey & Hawkes Music Publishers Ltd. Reproduced
by kind permission of Musikverlag Hans Sikorski and
Boosey & Hawkes Music Publishers Ltd.
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 35
ASSESSING AND CONTROLLING NOISE RISKS
RISK ASSESSMENT: DOING YOUR BIT
A risk assessment is more than a form; it’s the practical steps that are being
taken to protect your hearing.
Everyone has a role to play in health and safety.
Be an extra pair of eyes and ears.
Remember, you have a unique perspective on the noise risks in a project.
Speak up if you have concerns.
»
WHAT DOES A MUSICIAN NEED TO SEE IN A RISK-
ASSESSMENT DOCUMENT?
Assessing risk is the managers’ responsibility; it is a process that might relate to a series or a
one-off project. Managers of venues and ensembles are expected to produce a written
record that this process has taken place and you are entitled to see the resulting document
unless there is anything confidential in there (relating to an individual’s health, for example).
In it you can expect to see these questions answered:
What significant risks might there be in this project? And who might be affected?
What specific precautions are being taken to eliminate or reduce these risks?
You can expect to be informed (though not necessarily in writing) what will happen if things
change on the ground, and also how we can capitalise on what we have learned, to make
sure things are better next time around. A risk assessment must be specific in describing
risks, but can be generic in relation to the usual activities of the ensemble. However,
anything out of the ordinary should be reflected in a document that refers to venue(s) used
for the rehearsal and performance, to the repertoire being played and to individual needs.
HOW CAN MUSICIANS CONTRIBUTE TO THE RISK-
ASSESSMENT PROCESS?
Every musician will have a unique perspective on the noise risks they are exposed to. You
know better than anyone where the noise ‘hot-spots are, and you should communicate this
to the management, so that they can put into place suitable controls, often working with the
venue management. This is equally true of a newly built or refurbished venue and of a venue
you have been using for years. You may be the first one to point out a problem relating to
the layout for a particular piece. You can also help managers to persuade the venue
management to invest in acoustic improvements. In short, you can provide an extra pair of
eyes and ears and conscience to flag up potential problems and suggest solutions.
Anyone who has concerns can raise them. If you are freelance you should find out what the
communication routes are for the ensemble you are working with. You may prefer to do
this via the orchestra’s Health and Safety Rep, rather than the manager or section leader,
but don’t let the fact that you’re only there for a short time stop you from speaking up.
36
TIMING IS EVERYTHING
You can contribute to this process at various stages:
In the long term you can help shape your ensemble’s noise ‘policy’ or any protocols as
they are being developed. You can take part in discussions about scheduling, to ensure
there are suitable gaps between sessions. You may even be able to influence artistic
planning, as you know what a venue is like from your own perspective.
In the medium term you can have some input into the stage or pit layout: for example,
on a layout plan instruments may look close together but if the noisy instruments are
only playing a few bars in the whole piece it won’t be so bad.
In the short-term, if the conductor makes changes in the rehearsal (with the layout, for
example), you can say how it affects you.
Don’t hold back. You do have a right to be listened to, but you should also bear in mind
that there will be many perspectives, and the management may need time to implement
what you are asking for. The important thing is to communicate your concerns at the
appropriate point. If you wait until the end of the rehearsal before the concert it may be too
late for anyone to be able to do anything about it.
CONTROLLING AND ELIMINATING NOISE:
YOUR CONTRIBUTION
CONTROLLING NOISE: WHAT CAN YOU DO?
There is rarely one single solution.
Two things to aim for: actual reduction in dBs and giving your ears a rest.
Technical solutions: screens, layout.
‘Soft’ solutions: marking up the score, breaks, careful practice and warming
up, communication.
Earplugs as a last resort.
»
Regulation 6 of the Control of Noise at Work Regulations requires managers to eliminate
noise risks or reduce the risk to as low a level as is reasonably practicable. The 1999
Management Regulations state that organisational solutions to workplace safety (and health)
risks should have priority over individual solutions. Attempts should be made to ‘engineer
the problem out’ before the use of personal protective equipment is required.
In our workplaces the noise risks are experienced by individual musicians, and this varies
according to the venue or repertoire. Hence the responsibility must be shared.
The section below gives an idea of the difference various protective measures can make to
noise exposure, with some discussion of the issues around their use. It is impossible to
differentiate between technical and ‘soft’ solutions, and everything requires a conversation
with colleagues. Bear in mind that, while some measures will result in an actual reduction in
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 37
the decibels you are exposed to, more often the benefit is to give your ears a rest and
reduce the build-up of temporary threshold shift (TTS) which reduces stress and fatigue.
ACOUSTIC SCREENS
Typical reduction: 3-6dB(A) if used properly. Take care not to convert your
own reduction into an increase for the player behind you.
»
The effectiveness of screens depends on distance from the musician’s ear, height, which
instrument is behind and how much they’re playing, spacing of musicians and screens,
angle and shape of screen.
Manufacturers of screens rarely make claims for the attenuation. This is because there
are so many variables. When used inefficiently they can halve a viola player’s exposure,
whilst doubling the dose of the trumpeter behind and creating a ‘beating’ effect. You
need to check with colleagues
that the screen is not doing
more harm than good.
There are limits to the
usefulness of screens: musicians
who play in pits sometimes say
they prefer to have extra elbow
room and leg room rather than
to use a screen that takes up
valuable space. Otherwise, look
out for a ‘zero-footprint’ screen.
Acoustic screens are more
useful for protecting you from
high-frequency instruments, not
so good for low frequencies.
Acoustic screens: dos and don’ts
Mirror, signal, manoeuvre discuss with the person behind to let them know you need
it, check they are not being blasted by their own sound (for example the tacet second
trumpet when the principal has a solo).
Be fair: if the piccolo only has a few notes to play in a piece, both the piccolo player and
the second violin will benefit from the extra leg room if you don’t use a screen.
Put the screen as close to your head as possible (20cm).
It is meant to protect you, not wreck the hearing of the person behind you (put it close
to you not to them).
Make sure your ears are in the middle of the screen; adjust the height.
Try tilting at c.45° to deflect trumpet sound upwards if you can.
Make sure it is on a stable base.
Look at the ‘footprint’: how much space is it taking up on the floor?
You also have a right to a screen if you are on TV regardless of what the director says.
Don’t use it as a coathanger (good for absorption but makes the screen very unstable).
38
Case study: the Bournemouth Symphony Orchestra Brass Experiment
The brass section of the BSO wanted to find an acoustic screen that would protect the
string players in front whilst not adding to their own noise dose. One player designed
various prototype screens (soft cover, hard cover, flat, curved…), a colleague measured
noise exposure while the trumpets played the fanfare from Dukas’ La Péri ten times. The
preferred screen was flat and covered with acoustic foam on the back: it took off 5dB for
the players in front and made no measurable difference to the brass players behind. BSO
took the findings to Bournemouth University who commissioned a design project to make
the screen available more widely. The process has also helped with dialogue between brass
and viola sections, including an understanding that if there are no risers at a venue, the solid
screens can’t be used because they interfere with sight lines.
Sound bite: a bassoonist was offered a screen in a cramped pit. He asked the
percussionist behind how much that particular instrument (a xylophone) was going be used,
marked up his score to prompt him to put earplugs in, and opted for extra leg room.
SHIFTING YOUR POSITION SLIGHTLY
In theory, 3dB reduction for every doubling of distance from the sound source.
»
Even moving 20cm to one side can make a difference.
This is a balancing act between the needs of the ensemble and the need to reduce noise
exposure. When making a recording, players are often spread out more to minimise
‘bleed’ for the microphones.
MARKING UP THE SCORE
It won’t affect Lepd but you can avoid peaks of 120dB and over (you can also
use it as a cue to put your earplugs in).
»
If you’re playing a new
piece for the first time,
find out when the loud
passages are and put a
note in your part. When
the parts are re-used by
another ensemble, your
markings will prove useful
too.
(Lady Macbeth extracts: see credits p
38)
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 39
HOW YOU SPEND YOUR BREAKS
You could reduce your daily exposure by 1-2dB if you made a choice to spend
your breaks quietly.
»
This is an area where you have a choice: you should prioritise giving your ears a rest in
the breaks. The worst thing you can do is spend your 15 minutes practising for another
gig: it’s not fair on your colleagues either.
Ask yourselves: do you really need to have the telly on in the green room?
Noise exposure figures for two musicians during a long pre-concert break were
compared: the musician reading a book had a dose of 76dB(A) while the one who went
outside to make a long phone call in the street had a dose of 86dB(A) that’s ten times as
much over that period and over the course of the day it could make 1-2dB difference.
When developing their noise ‘Code of Conduct’ the players of the BBC Scottish
Symphony Orchestra agreed to hold off practising the tricky passages for a minute or two
after the end of a rehearsal or the beginning of the break. It gives colleagues a chance to get
out of the way with a bit of peace and quiet.
HOW YOU WARM UP/DOWN/PRACTISE
Don’t overdo it. Spare your ears (and those of your colleagues) and find other
ways of practising.
»
One hour of private practice on a trumpet has been measured at 98dB(A) Leq; 40mins
of oboe practice came out at 87dB(A) Leq; a soprano singing for an hour can average
103dB(A) Leq.
For brass players, use a practice mute when you can.
Remember, a lot of this work can be done without making a noise (better for your joints
and muscles too).
Bear in mind when you’re practising in the studio or performing space you’re not the
only one whose noise exposure is increasing. Be fair.
Case study: mental rehearsal.
There is a growing body of literature on the benefits of mental practice which involves
imagining a performance of a piece rather than playing or singing it for real. It will benefit
your joints and muscles as well as your ears. It is common in sports psychology and has
been used by the likes of Pablo Casals and Anton Rubinstein in the past. Your colleagues will
also appreciate the lower sound levels if you can master the art of mental practice during
the rehearsal breaks. It has been written up in Williamon, A (ed.) Musical Excellence, Oxford:
OUP, 2004. See Chapter 12.
40
COMMUNICATION
Can take many forms, for example, a 3dB reduction for any conversation that
results in a doubling of distance. There are also benefits to workplace harmony
if you discuss potential problems and how you might be affected.
»
All in all, the most important
control measure is
communication with colleagues.
In the longer term this may be
about engaging with the
development of policies and
protocols, and in the shorter
term it may make a practical
difference (such as making
screens more efficient).
This also goes for communication
with the conductor: you could
agree not to give a full fortissimo
in rehearsal, especially if the
rehearsal space is smaller than
the performing venue. Remember
the conductor’s job is to balance
the forces for the show. If a singer is facing you in the rehearsal and stopping you from
hearing your own instrument, ask the conductor to have them face away from you.
Section heads and rank-and-file players should talk together about noise; a long-standing
string section leader may have forgotten what it is like to be in front of the piccolo in a
Shostakovich symphony.
Communication between musicians and management can take many forms: formal and
informal; direct and via reps or section leaders. The main thing is to keep the issue out in
the open.
Musicians have many roles: if you also work as a conductor, don’t forget how it feels to
be in the middle of the ensemble.
REDUCING YOUR NOISE EXPOSURE OUTSIDE WORK
Noise reduction figure varies but reducing your non-work exposure means
you can save up your noise exposure for when it matters most.
»
It is easier said than done, but you should find ways of saving your noise exposure for
the workplace. Your workplace is noisy, but you can protect your ears when commuting
(for example). Be aware how loud you are listening to your car radio, or your iPod on
public transport.
iPods are currently under scrutiny but it is too early to see the effects across the
population that uses them. Research has shown that you only need to listen to them for
five hours per week to exceed the exposure limits for noise at work. Because they are
usually listened to in noisy environments, it’s easy to have them on too loud. Levels of
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 41
93dB(A) have been measured if you add the iPod to the background noise on the tube.
That’s the same as a trumpet blowing in your ear for the duration of the journey.
Furthermore the mp3 format allows the use of use compression to make the lower and
higher frequencies audible against background noise, and this can become fatiguing if the
dynamic range is narrow.
The charity Deafness Research UK suggests you use the 60:60 rule for iPods: use it at no
more than 60% of the volume for no more than 60 minutes a day.
When on tour or commuting on public transport, use noise-excluding or active noise-
cancelling headphones so that you don’t turn the volume up to drown out the plane,
coach or train noise.
You will add to your noise dose if you spend your spare time on noisy hobbies: for
example, if you do DIY, use proper hearing protection when using power tools.
If you’re in a restaurant and you can’t hold a conversation with the person across the
table, ask the staff to turn the music down. You’ll find that many people will be grateful
to you including the restaurant staff who are struggling to take your order (they are
subject to the Noise Regulations too).
“Something you don’t hear: ‘Went to a great gig – lasers shining right in my eyes for
four hours couldn't see a thing for a week afterwards! It was terrific!’ You don't hear
people boasting about abusing their eyes, and it's not cool to brag about abusing your ears
either.” David McApline, Director, UCL Ear Institute
LOOKING TO THE FUTURE
It won’t make a difference to your own hearing, but you can help the next
generation of musicians and encourage them to get into good habits from the
outset.
»
If you teach, encourage your students to practise with earplugs in and get used to the
sound they make.
If you have ‘side-by-side’ or shadowing schemes, take the opportunity to talk about noise
and hearing to the young musicians who are shadowing you.
Education of the next generation of professional musicians is critical. The Royal
Academy of Music places a particular focus on the education of its students as to the
dangers of noise exposure to musicians and the protection of their hearing. This is achieved
through a series of seminars, audiometric tests and the involvement of students in
monitoring, measuring and managing noise levels and testing new solutions. Nicola Mutton,
Director of Artistic Planning, Royal Academy of Music
42
TRAINING AND INFORMATION
TRAINING AND INFORMATION ESSENTIALS
It’s vital to be aware of your noise exposure and its effects.
Employers are obliged to provide information and training related to noise
and hearing.
Music, noise and hearing are fascinating subjects and vital to your career as
a musician. Learn more, and spread the word.
»
Noise, acoustics and hearing are big, complex subjects and there is a lot to learn. But they
are at the centre of your career as a musician. It’s often said that musicians pay more
attention to looking after their instrument than to looking after their own health. Some
might find it all a bit technical, while others might find it endlessly fascinating, but either way
you owe it to yourself to have an understanding of the basics and what they mean to you.
This short section covers the essentials you’re entitled to know, and how to find out more
without getting overwhelmed. If you teach, use your position to instil good hearing-
conservation habits and inspire a fascination for the subject in the next generation too.
WHAT YOU SHOULD FIND OUT FROM YOUR MANAGERS
Likely noise exposures.
What’s being done to reduce exposure.
What can you do for yourself (earplugs, screens, mark up the score).
What to do if there is a problem.
»
WHAT INFORMATION TO EXPECT FROM YOUR MANAGERS
Your managers have obligations under Regulation 10 of the Noise Regulations. As a
minimum, they should inform all musicians, regardless of status, of the following:
Likely noise exposures and potential risk to hearing.
What is being done to control noise exposure.
Where to get hold of hearing protection, acoustic screens and so on, and where to go
for advice on their use.
Lines of communication if there are problems (this is particularly important on a
complicated project where third-party contractors are involved).
Responsibilities under the Noise Regulations.
What hearing health surveillance you will be provided with (if relevant).
Information can be provided in a range of ways. For example: on your notice-board; an
announcement before a rehearsal for a loud piece about what is in store and how to get
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 43
hold of screens; discussions or workshops involving some or all colleagues. Some ensembles
have a ‘noise team’ whereby representatives meet regularly to discuss noise issues.
Even if this seems potentially repetitive, there are usually some colleagues hearing it for the
first time, and it is always good to be reminded. Furthermore, there are invariably hazards
that are specific to a venue or a programme and these need to be communicated.
WHAT YOU SHOULD FIND OUT FOR YOURSELF
Your other non-work exposure.
Your family hearing history.
How we hear and how to look after your ears.
»
WHAT YOU NEED TO FIND OUT FOR YOURSELF
As we have seen, noise ‘at work’ is not all you are exposed to, so you should do some of
your own work to complete the picture. Here’s the kind of thing you need to find out for
yourself, with some suggestions as to how to go about it:
Work out your noise exposure outside the workplace. It doesn’t have to be accurate,
but you may not realise how much your teaching, commuting or hobbies contribute to
your daily dose. Even a simple noise meter such as you can get on your phone can give
you an indication, but you need to pay £10 or more to get one that is reasonably
accurate, and bear in mind they can be used for information purposes only. Use a noise
exposure calculator such as the one here.
Find out about the hearing-health history of people you are related to. It will go some
way to predicting what is in store for you, as a predisposition to certain types of
conductive and sensorineural hearing loss is inherited.
Learn more about how sound works and how your ears translate it to messages in your
brain.
JUDGING THE VALUE OF INFORMATION
Ask:
Who wrote it?
Why?
Is it relevant for your circumstances?
»
WHAT INFORMATION IS OUT THERE AND HOW DO YOU
KNOW IF IT WILL MEET YOUR NEEDS?
There’s a great deal of information on the internet relating to sound and hearing. You could
easily become overwhelmed. Here are some questions you can ask yourself when trying to
assess how relevant and how authoritative it is:
44
Who wrote it? An academic? A publicly funded organisation? A patient? A commercial
company?
What are the credentials of the author? Has the material gone through the peer review
process for academic publishing?
What is the evidence base? What’s the science behind it?
Why are they writing it? To sell you something? To share what they know? To make a
political point?
Is it written for a UK audience?
Is it specifically about classical musicians?
Remember how you feel when you read something on the internet on a subject you
know a lot about … you may feel it doesn’t do justice to the subject, or there may be
factual errors. The same applies to a subject you don’t know as much about.
Even if your GP needs to go away and do some research, it is infinitely preferable to get
a diagnosis from a medical practitioner than to attempt to self-diagnose via material you
find on the internet.
Case study: the London Philharmonic Orchestra Noise Day
The LPO and London South Bank University undertook a joint research / information
project and towards the end of the project set aside a three-hour session involving the
whole orchestra, management team and principal conductor, to present the findings of the
noise-measuring exercise and discuss noise-management strategies and hearing-protection
options. For more information on the partnership see the ‘Toolkit for managers’.
Case study: BBC Singers’ Noise day
The BBC Singers wanted to find out the implications of altering the spacing between
them as they sang. With their Chief Conductor they performed one short piece (a Bruckner
motet) in their usual layout and with increased horizontal and vertical space between them.
As well as the exposure measurements, the Singers were asked to give subjective feedback
about how they experienced noise levels, their own voice, the rest of their voice part and
the rest of the ensemble. The results were surprising, in that exposure was generally higher
when the singers had more space around them: they felt more like soloists and sang louder
to fill the space. This was an initiative that came from the musicians themselves, and it
generated interesting discussion in the ensemble and with managers.
FINALLY
Health and safety is everyone’s responsibility. The Noise Regs were introduced
to protect you, and though they focus on managers’ responsibilities, there’s a
lot you can must do for yourself. And you should take opportunities to
pass on good habits to colleagues and the next generation of musicians.
CLICK ON THE STOP SIGN TO SEE AND PRINT THE SPEED-READ SUMMARY
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 45
LINKS, REFERENCES AND DEFINITIONS
ORGANISATIONS AND KEY PUBLICATIONS
The Health and Safety Executive
(HSE) provides its own
guidance on Noise in the Music
and Entertainment Sector, The
Control of Noise at Work Regula-
tions 2005, and supports subse-
quent industry-led guidance,
Sound Advice. This is the recog-
nised source of guidance for
compliance with the law, and
can be found on its website at
www.hse.gov.uk
Musicians’ Union:
www.musiciansunion.org
MU members’ handbook
contains a section on health
and safety. Regular features
on noise and hearing in the
quarterly journal The
Musician.
Incorporated Society of
Musicians: www.ism.org
Equity: www.equity.org.uk
BECTU: www.bectu.org.uk
Members of all of these, plus
MU, are entitled to dis-
counts on hearing tests.
Association of British
Orchestras: www.abo.org.uk
Sound Ear II (2008)
downloadable from the site.
The Healthy Orchestra
Charter is a joint initiative
with the Musicians’ Benevo-
lent Fund www.mbf.org.uk
on health and wellbeing in
orchestras.
British Association for
Performing Arts Medicine:
www.bapam.org.uk
Clinics and information on all
aspects of performers’ health.
Association of Medical
Advisers to British Orches-
tras (AMABO).
British Association of Concert
Halls (BACH). Forum for
managers of concert halls
and theatres. Secretariat
provided by Sue King
s.king2@cardiff.gov.uk
RNID: Action on Hearing Loss:
www.rnid.org.uk
Activities include informa-
tion, awareness-raising cam-
paigns and funding research.
Deafness Research UK:
www.deafnessresearch.org.uk
Information, research. Pro-
vides the Bionic Ear Show, a
fun, interactive guide to how
the ear works.
British Tinnitus Association:
www.tinnitus.org.uk
Advice line and information
on all aspects of tinnitus.
SELECTED FURTHER READING AND LISTENING ON SOUND AND MUSICIANS HEARING
Text of the EU Directive
2003/10/EC can be found at
http://eur-lex.europa.eu
(search by CELEX number:
32003L0010).
ISO 7029 (age-related
hearing loss).
ISO 1999 (noise-induced
hearing impairment).
During 2008/09 a literature
review was carried out of
the peer-reviewed literature
on noise, acoustics, hearing
and music. The Q&As that
prompted them are here and
the literature review is here.
Music Matters extract (10’)
on musicians and tinnitus.
Twenty Minutes: The Pleasure
of Noise.
British Flute Society article
(not only for flautists) on
psychoacoustics for musi-
cians:
www.bfs.org.uk/psychoacous
tics.htm
Williamon, A (ed) Musical
Excellence. Oxford: OUP,
2004. (Chapter on ‘Mental
skills training’).
Oliver Sacks Musicophilia:
tales of music and the brain.
London: Vintage, 2007.
46
LINKS QUOTED IN FULL
To locate video clips on
YouTube:
Tinnitus: “RNID Buzz off”,
“RNID Tune out tinnitus”
Cochlea: “cochlear
animation”, “dancing hair
cell”.
Noise calculators:
www.hse.gov.uk/noise/calcul
ator.htm (needs Excel)
www.xpglobe.com/bbc/noise
/calc/
Audio clips: all © BBC:
Brahms Symphony No 4 in E
minor, BBC SO, rec Maida
Vale Studios, 20/04/11. Music
Matters extract, broadcast
02/04/11. Twenty Minutes
broadcast 18/02/11.
YOUR OWN CONTACTS: SUPPLIERS OF AUDIOMETRY AND ACOUSTIC SOLUTIONS, ETC
ACRONYMS AND SELECTED DEFINITIONS
‘A’ weighting
Used for Leq (qv), it gives additional weight to the frequencies the human
ear is most sensitive to
‘C’ weighting
Used for peaks, it treats all frequencies equally
AGC
Automatic Gain Control (your ear’s volume knob)
dB
Decibel measurement of sound intensity
High frequencies
Usually means above 5kHz
Hz
Hertz cycles per second
Lepd
Daily personal noise dose
Lepw
Weekly personal noise dose
Leq
Equivalent continuous sound level (=average)
Low frequencies
Usually means frequencies up to 300Hz (D4)
Mid frequencies
Usually means between 300Hz and 5kHz
NIHL
Noise Induced Hearing Loss characterised by a notch in the audiogram
at 4-6kHz
OAEs
Otoacoustic emissions vibrations in the ear canal
PTA
Pure-tone audiometry
PTS
Permanent threshold Shift
Reasonably
practicable
Reducing noise to as low a level as reasonably practicable involves
weighing a risk against the trouble, time and money needed to control it
SNR
Single number rating (for hearing protection)
The 3dB rule
Reduction or increase of 3dB is a halving or doubling of sound intensity
TMJ
Temporomandibular jaw joint.
TTS
Temporary Threshold Shift
Music, noise and hearing: how to play your part
Musicians’ guide to noise & hearing | 47
ACKNOWLEDGMENTS
This guide is the result of many years’ work in the BBC and around the sector, and dozens if
not hundreds of people have contributed along the way.
When the Noise Regulations came into force for the music and entertainment sector in
2008 the six BBC Performing Groups (PG6), together with the Controller of Radio 3 Roger
Wright and Radio 3’s Head of Station Management Ben Woolland, agreed to fund a one-
year project to investigate what more could be done in the BBC’s five orchestras and the
BBC Singers. That year involved a great deal of measurement and many conversations with
musicians, managers, acousticians, engineers and doctors, and two main conclusions
emerged: one, solutions have to be found for individual musicians as well as for workplaces
and ensembles, and two, controlling noise requires sustained management over a long
period to make a lasting difference. It was also clear that sharing solutions would bring
wider benefits.
Paul Greeves, head of BBC Safety and Chris Burns, Audio & Music, agreed to take the work
forward, as the BBC was an early signatory to the HSE’s ‘pledge’ to ‘be part of the Health
and Safety solution’. Steve Gregory, BBC’s Head of Production Safety, saw the scope for
cross-sector working and a seminar was organised in July 2010 bringing together musicians,
ensemble managers, acousticians, occupational health colleagues and safety practitioners and
others. Out of that came a working group which acted as an editorial group for this guide.
Working group membership was as follows: Leo Beirne, Colin Chatten and Anne Wright
(Noise & Vibration Unit, HSE), Phil Boughton (Welsh National Opera), Roanna Chandler
(London Philharmonic Orchestra), Sally Mitchell (Royal Opera House), Keith Moston
(ABO), Nicola Mutton (Royal Academy of Music), Simon Webb (CBSO), Helen Wilson
(Opera North), Euan Turner (Federation of Scottish Theatres) and Bill Kerr, Morris Stemp
and Diane Widdison (Musicians’ Union). From the BBC Performing Groups: Susanna
Simmons (BBC Symphony Orchestra) and Richard Wigley (BBC Philharmonic). From BBC
Safety: Laura Baker, Louise Bisdee and Wendy Pelaez.
Many others have had a hand in this guide and their ideas and contributions have been
incorporated in some form or another: acousticians Steve Dance and Georgia Zepidou
(London South Bank University) and Richard Cole (BBC) and many engineers including Ian
Astbury, Andy Leslie and Dougal Proudlock (BBC), Brad Backus (UCL Ear Institute). Medical
colleagues whose contribution is in here include Paul Checkley (Musicians’ Hearing
Services), audiologist and epidemiologist Dr Christian Meyer-Bisch, Chris Rhodes (Capita
Health Solutions), Dr Martin Rosenberg and Dr Colin Thomas (BBC’s Chief Medical
Officer). Dom Stiles of the RNID Library provided access to the literature. Countless
musicians have helped to influence what has gone into the guide (and what’s been left out)
and particular thanks go to Andy Cresci and Jamie Pullman (Bournemouth SO), Sarah
Freestone and David McCallum (BBC Concert Orchestra) and Chris Bowen (BBC Singers).
Jayne Bailey, Chris McNally and Nick Walker are among the many BBC Safety colleagues
who have provided help. Philip Burwell of BBC Radio 3 prepared the Brahms sound clips.
Photos are mostly by Euan Turner; percussionist Alasdair Malloy (BBC CO) took the photo
of Sir Henry Wood. Violinist Julian Gregory of the BBC Philharmonic has captured in his
cartoons of the kind of scenarios we hope will become a thing of the past.
48
THE 2005 NOISE REGULATIONS:
PLAYING YOUR PART
Time
-line
Musicians
Managers
(coloured text refers to a duty
under the Noise Regs)
Venues
General activity
Minimise extra-curricular
noise exposure.
Get used to wearing
earplugs.
Have hearing tests.
Provide audiometry to
in-scope musicians.
Go on noise awareness
training to understand
duties under CNAW.
Information provision to
musicians.
Put documentation
together and make it
available.
Artistic
planning
Contribute to Risk
Assessment.
What are the noise
implications of this
project? (rep+venue).
Risk assessment.
Measuring if no figures
exist.
Can the venue
accommodate this
project? (stage? acoustic
treatments?)
Sched-
uling
Inform management of
potential noise risks.
Ensure there are
adequate rest periods in
the schedule
Rehearsal
Mark up score.
Ask for screen if
necessary.
Discuss noise problems
with colleagues.
Wear hearing protection
Rest ears during breaks.
Adjust staging
Provide screens and
check they are
positioned correctly
Encourage musicians to
leave the stage when not
required
Remind re: hearing
protection
Adjust staging and
acoustic (treatments) of
room if possible.
Before the
show
Ask again: do I need this
screen?
Give your ears a rest.
Check position of
screens.
Reminder re: hearing
protection.
Dynamic risk assessment.
Show
Earplugs.
Stage mgt to add or
remove screens
according to the
repertoire.
After the
event
Feed back to manage-
ment and each other.
Don’t add to your noise
exposure.
Feed back experiences to
venues.
Revisit risk assessment:
what can we learn?
Listen to the feedback;
use it for business case
for improvements.
... • Consider all music-related sound exposure: performance, rehearsal and personal practice time. • For students, this will include both time on-site in conservatoire rehearsal spaces AND exposure outside the structured learning environment • Sound Advice (Health and Safety Executive, 2008) and BBC Musicians Noise Guide (Hansford, 2011) Once controls are put in place, the risk assessment will need to be repeated on a regular basis to ensure adequate control is being achieved. It is recommended that risk assessments are revised every 2 years at a minimum. ...
... • Modify the process to reduce sound exposure as low as reasonably practicable. Several worked examples of these processes can be found in the BBC Noise Guides Part 1 & 2 (Hansford, 2011(Hansford, , 2012 and Sound Advice (Health and Safety Executive, 2008 ...
... If potential exposure presents only a marginal risk then suitable protection may be different from that required by someone who will be exposed to higher risk. Examples of the requirements of different instrumentalists can be found in the BBC Musicians Noise Guide (Hansford, 2011) Published attenuation levels of various types of hearing protectors arrived at in laboratory conditions during the certification process do not adequately predict real world attenuation and often over estimate protective values (HSE RR720 2009;HSE CRR24 1990). This is concerning because musicians may believe they are being protected when they are not. ...
Article
Full-text available
Healthy hearing is essential for musicians. Education providers and industry organisations must recognise the risk of sound exposure to performers. Those who manage these institutions have a legal duty to identify hazards to health and take appropriate steps to minimise the risk of causing harm. To achieve effective hearing conservation, implementation of a complete and cohesive programme should be undertaken. Measures performed in isolation will result in less successful outcomes, and serve more as an exercise in regulatory compliance. • Full and appropriate risk assessment must be undertaken. • When sound levels demonstrate that risk to health is evident, If possible, protection is best achieved by reducing the sound at source. If not possible then consider the hierarchy of controls for noise. • If it is impractical to reduce exposure by any other means then suitable personal hearing protection must be provided. if custom moulded earplugs are employed these should be individually verified to ensure protection. • Hearing health surveillance tests are an integral part of a hearing conservation programme. Early recognition of changes to musicians’ hearing is best identified with a test called ‘Otoacoustic Emissions’. Tests must be repeated regularly to ensure risk management strategies in place are adequate. • Instruction and continuous education for all staff and students must be available and recorded. • Programmes should be monitored and easily audited to ensure their efficacy and that they are cost-effective
... They also experience vocal fatigue due to a need to sing louder. [10][11][12] They may adopt a forward head position to hear better, and this affects neck posture and leads to muscular tension and strain. 13,14 Healthy hearing is, therefore, vital for a singer to continue to perform at their best. ...
... 24 Singers may also receive the majority of their exposure from their own voice when singing in ensemble and the behavioral influence on attempts at controlling this exposure by increasing the space between singers has been explored previously, with the paradoxical result of increased sound exposure. 12 While it is accepted that threshold shift represents physiological changes within the inner ear, the possibility of TTS representing an adaptive process, potentially protecting the cochlea from injury by extending the intensity range of hearing, rather than an injury response is being investigated. 25,26 It may be the case that the ear is responding in a protective manner to self-produced sound such as singing. ...
... A solo soprano may reach intensity levels of >100dBA L eq over an hour. 12 A similar study to this pilot with solo sopranos as subjects may yield interesting results and present less methodological challenges. ...
Article
Exposure to high- and moderate-intensity sound is inevitable for professional singers during their working day, the majority of which is spent in rehearsal, preparing for a performance. The impact of self-produced sound exposure on singers' hearing within the rehearsal setting has not been examined. Objectives: This original pilot field study investigates the feasibility of data collection and hypothesis testing of singers' hearing within the rehearsal environment. Methods: 18 professional choir singers are examined for hearing threshold changes following routine rehearsal sound exposure. Pure Tone Audiometry is measured before, immediately after, and approximately 24 hours after rehearsal. Results: This study does not identify definitive Temporary Threshold Shift in this population under these conditions. That said, mean temporary threshold shift was found 3.61 dB higher than the recovery threshold shift in the right ear at 3000 Hz (P = 0.06), and this may be important to look at for future studies. Conclusions: Methodological challenges of this field study include dynamic experimental conditions intrinsic to the rehearsal process, environmental and musical influence on Pure Tone Audiometry results and estimation of sound intensity exposure.
... Other education-based programmes have similarly low levels of evidence to support their efficacy or long-term effectiveness for increasing HPD use by musicians (e.g. Chesky 2006;Hansford 2011;Wright-Reid and Holland 2008). The 'Sound Practice' project implemented in eight Australian professional orchestras was effective at increasing HPD use, in particular those orchestras that incorporated numerous hearing conservation strategies, such as the provision of custom-moulded musicians' earplugs, compulsory annual audiological assessments, weekly risk assessments for each member of the orchestra, and compulsory annual education sessions (O 'Brien, Driscoll, andAckermann 2015, 2012;O 0 Brien, Ackermann, and Driscoll 2014). ...
Article
Full-text available
Objective: The current study aimed to: i) determine the patterns of hearing protection device (HPD) use in early-career musicians, ii) identify barriers to and facilitators of HPD use, and iii) use the Behaviour Change Wheel (BCW) to develop an intervention to increase uptake and sustained use of HPDs. Design: A mixed-methods approach using questionnaires and semi-structured interviews. Study sample: Eighty early-career musicians (age range = 18-26 years; women n = 39), across all categories of musical instrument. Results: 42.5% percent of participants reported using HPDs at least once a week, 35% less than once a week, and 22.5% reported never using HPDs for music-related activities. Six barriers and four facilitators of HPD use were identified. Barriers include the impact of HPDs on listening to music and performing, and a lack of concern about noise exposure. Barriers/facilitators were mapped onto the Theoretical Domains Framework. Following the systematic process of the BCW, our proposed intervention strategies are based on 'Environmental Restructuring', such as providing prompts to increase awareness of noisy settings, and 'Persuasion/Modelling', such as providing credible role models. Conclusions: For the first time, the present study demonstrates the use of the BCW for designing interventions in the context of hearing conservation.
Article
Full-text available
Context and aims: Many musicians suffer for their art, and health is often compromised during training. The Health Promotion in Schools of Music (HPSM) project has recommended that health education should be included in core curricula, although few such courses have been evaluated to date. The aim of the study was to design, implement and evaluate a compulsory health education course at a UK conservatoire of music. Methods: The course design was informed by a critical appraisal of the literature on musicians' health problems and their management, existing health education courses for musicians, and the HPSM recommendations. It was delivered by a team of appropriately-qualified tutors over 5 months to 104 first-year undergraduate students, and evaluated by means of questionnaires at the beginning and end of the course. Thirty-three students who had been in their first year the year before the course was introduced served as a control group, completing the questionnaire on one occasion only. Items concerned: hearing and use of hearing protection; primary outcomes including perceived knowledge and importance of the topics taught on the course; and secondary outcomes including physical and psychological health and health-promoting behaviors. The content of the essays written by the first-year students as part of their course assessment served as a guide to the topics they found most interesting and relevant. Results: Comparatively few respondents reported using hearing protection when practicing alone, although there was some evidence of hearing loss, tinnitus, and hyperacusis. Perceived knowledge of the topics on the course, and awareness of the risks to health associated with performing music, increased, as did self-efficacy; otherwise, there were negative effects on secondary outcomes, and few differences between the intervention and control groups. The topics most frequently covered in students' essays were managing music performance anxiety, and life skills and behavior change techniques. Conclusion: There is considerable scope for improving music students' physical and psychological health and health-related behaviors through health education, and persuading senior managers, educators and students themselves that health education can contribute to performance enhancement.
Chris McNally and Nick Walker are among the many BBC Safety colleagues who have provided help. Philip Burwell of BBC Radio 3 prepared the Brahms sound clips. Photos are mostly by Euan Turner; percussionist Alasdair Malloy (BBC CO) took the photo of Sir Henry Wood
  • Jayne Bailey
Jayne Bailey, Chris McNally and Nick Walker are among the many BBC Safety colleagues who have provided help. Philip Burwell of BBC Radio 3 prepared the Brahms sound clips. Photos are mostly by Euan Turner; percussionist Alasdair Malloy (BBC CO) took the photo of Sir Henry Wood. Violinist Julian Gregory of the BBC Philharmonic has captured in his cartoons of the kind of scenarios we hope will become a thing of the past.