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Hearing Conservation Guidelines for the Performing Arts



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
March 2020
Rob Shepheard, Consultant Audiologist,
Dr. Finola M Ryan, Occupational Health Doctor
Paul Checkley, Audiologist
Claire Cordeaux, Director, BAPAM
Summary of recommendations 3
1. Background 4
The Law 4
Best Practice: The Gold Standard 5
Musicians’ Hearing Problems 5
sound exposure levels 6
2. How to recognise hearing damage 8
3. Developing a hearing conservation strategy 8
Assessing and Controlling Risk 9
Risk Assessment 9
Risk Management 9
Education & training 11
Health surveillance 11
Responsibilities of the individual to protect their own hearing. 12
A Comprehensive Strategy 13
Definitions & abbreviations used 14
Conflict of interest 15
References 16
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
Programmes should be monitored and easily audited to ensure their efficacy and that
they are cost-effective
Sound exposure is inevitable in our society. Prolonged exposure to intense sound is an integral part
of a musician’s every-day activities, both related to and outside performance. Healthy hearing is vital
to performers. Maintaining good function of this delicate sense, through recognition and management
of risks to hearing health is essential to a musician’s career ("Goldscheider v Royal Opera House,"
2019; Sataloff, 1991).
Education providers and industry organisations in the performing arts have legal and moral obligations
to their students’ health and wellbeing, and this will be reflected in local Health and Safety Policy
Statements. On-going research in a sample of over 3000 music students revealed evidence of noise-
induced hearing injury in every participant (Dance & Shearer, 2017). There is a need for music-specific
guidance on an appropriate hearing conservation strategy for music students, teachers, professionals
and organisations.
The Control of Noise at Work Regulations 2005 (‘The Noise Regulations’), which came into effect for
the music and entertainment sector in April 2008, set out the minimum standards required by law
aimed at preventing hearing injury in the workplace.
Although the ‘Noise Regulations may not apply directly to students since they are not employees,
there is a common law duty of care toward non-employees such as students, as well as the overarching
Health and Safety at Work etc. Act 1974, Section 3 and associated The Management of Health and
Safety at Work Regulations 1999 (the Management Regulations) that are applicable. It would be
sensible, therefore, on recognition of a risk such as sound exposure, to adhere to the exposure limits
set out in the ‘Noise Regulations, designed for the conservation of hearing. The Health and Safety
Executive (HSE) has issued practical guidance for employers outlining their responsibilities toward
their employees and others they may be responsible for.
“Every employer shall make a suitable and sufficient assessment of…the
risks to the health and safety of persons not in his employment arising out
of or in connection with the conduct by him of his undertaking, for the
purpose of identifying the measures he needs to take to comply with the
requirements and prohibitions imposed upon him by or under the relevant
statutory provisions…
The Management of Health and Safety at Work Regulations 1999
This guidance document has been developed by clinicians working with the British Association for
Performing Arts Medicine (BAPAM) at the request of the Healthy Conservatoires Network (HCN).
In establishing an effective hearing conservation strategy, the HCN is leading the way internationally.
BAPAM guidelines to the sector include all aspects of hearing conservation, which are not simply
compliant with current regulations but exceed these minimum standards in the prevention of
unnecessary injury to health. It provides recommendations on implementation of best practice, cost-
effective health conservation strategies to educational institutions, students, performers, teachers,
managers and venues on appropriate hearing conservation in a music-rich environment.
These guidelines are intended to assist managers develop and implement health conservation
strategies in educational institutions but is expected to be of interest to the wider industry. Aspects
which may be particularly useful, for example, to Junior Conservatoires, include the process of risk
assessment and risk management.
This guidance refers to aspects of the Health and Safety at Work etc. Act 1974, The Management of
Health and Safety at Work Regulations 1999 and The Control of Noise at Work Regulations 2005.
Whilst the HSE are able to impose sanctions as a result of criminal liability, both staff and students are
also able to undertake civil claims against organisations, if they are able to prove any injury to their
hearing health is a result of negligence or failure to take reasonable care to prevent such injury. Before
implementation, you may wish to take your own legal advice.
This guidance will be reviewed and updated if necessary in March 2022.
Loud sounds are not necessarily unpleasant or classified as noise; they include sounds we enjoy
listening to, such as music. Exposure to very loud sounds or prolonged exposure to moderate sounds
can injure the vulnerable hair-like structures of the inner ear, figure 1 and lead to permanent and
irreversible hearing loss, known
as Noise-Induced Hearing Loss
(NIHL) (Zhao, Manchaiah,
French, & Price, 2010).
Sound exposure can also cause
other hearing problems such as
tinnitus (ringing in the ears)
hyperacusis (reduced
tolerance to louder sounds)
diplacusis (problems with
pitch perception) (Zhao et
al., 2010)
Figure 1: Vulnerable Hair-Like Structures In The Inner Ear
Preparing Students for their future career
Conservatoires and educational establishments have an ideal opportunity to prepare students for
their future healthy practices to protect and preserve their hearing at the start of their professional
journey. These institutions are well placed to address this issue while in the educational setting, and
lead by example using protective scheduling, balanced repertoire choices and healthy practice and
performance environments.
Students enrolled in Conservatoires may go on to become an employed musician or a freelance
musician. Those who go on to work as freelance musicians will not have employer protection and
have more individual responsibility to preserve their own hearing health. They may be reliant on
external organisations decisions about environment and scheduling with little opportunity to
influence these decisions. Employers, on the other hand, will be required to have risk reduction
strategies in place to protect their employees. Freelance performers, therefore, will not be able to
rely as heavily on this and must be aware and prepared to engage in appropriate risk reduction
strategies. These avoidable problems can seriously threaten a performers career in music (Di Stadio
et al., 2018), and this guidance outlines how educational institutions, performers and those working
in the performance environment can work together to conserve auditory health.
Sound exposure is influenced by the duration, intensity and proximity to the sound source. For the
purposes of hearing conservation in performers, this should be measured in units called decibels (dB)
with an ‘A’ weighting. This measurement is known as noise dose, when referring to a daily or weekly
Exposure limits are set out in the HSE publication, Sound Advice (Health and Safety Executive, 2008),
and the excerpts on page 7 are taken directly from this guidance. The full document can be viewed
online and includes estimates of the representative noise levels of different instruments and
ensembles and how much time it might take for a player to reach their exposure limit if playing at the
level of a typical symphony performance.
The BBC Musicians’ Noise Guides have further worked examples of a musicians’ typical noise dose
available for musicians and a toolkit for managers.
What about Electronic Audio Devices?
Whilst it is common place for electronic audio devices such as headphones, earphones or in-ear-monitors to be
employed by performers, guidance specific to the use of such devices currently exceeds the scope of this
document. However the authors of these guidelines would advise that operational diffuse-field sound levels
from this type of equipment should at least, be considered in the same way as that of ambient levels of sound
and not exceed those set out in European Directive 2003/10/EC, and ideally used as per standards BS EN 13819.
If in addition to listening to some form of audio output the use is also to provide hearing protection then they
must comply with standard BS EN 352.
The noise exposure level (often referred to as the ‘noise dose’) takes account of both the sound pressure level and how
long it lasts. Generally the potential for hearing to be damaged by noise is related to the noise ‘dose’ a person receives.
Being exposed to a noise level of 105 dB (a not unusual sound level for a pub band, or that generated by a brass or
woodwind instrument at full blast) for 5 minutes would be the same dose as being exposed to 94 dB (a nightclub bar) for
1 hour, or 88 dB (chamber music) for 4 hours.
Each 3 dB added doubles the sound energy (but this is only just noticeable to a listener). When 10 dB is added, the energy
is increased ten-fold, while adding 20 dB is a hundred-fold increase. Therefore:
If the sound intensity is doubled, the noise level increases by 3 dB.
Two instruments with the same noise level of 85 dB together produce 88 dB.
A noise level reduction of 3 dB halves the sound intensity (and reduces its propensity to damage).
Halving the noise dose can be achieved either by halving the exposure time, or by halving the noise level, which
corresponds to a reduction of 3 dB. These noise exposures are identical: 80 dB for 8 hours 83 dB for 4 hours 86 dB for 2
hours 89 dB for 1 hour 92 dB for 30 minutes
Average noise level
Time taken to receive a dose equivalent to
the upper exposure action value (85 dB)
8 hours
95 dB
45 minutes
100 dB
15 minutes
105 dB
5 minutes
110 dB
Under 2 minutes
115 dB
Under 30 seconds
Reproduced from Sound Advice, HSE 2008
The nois e regulations require employers to take specific action at cert ain action values. T hese rel ate to:
The levels of exposure to noise of employees averaged over a working d ay or week; and
The maximum noise (peak sound pres sure) t o which employees are exposed in a working day.
The values are:
Lower exposure action values (LEAV):
daily or weekly exposur e of 80 dB;
peak sound pressure of 135 dB;
Upper ex posure acti on values (UEAV):
daily or weekly exposure of 85 dB;
peak sound pressure of 137 dB.
There are also levels of noise exposure which must not be exceeded (but take account of any reduction in exposure
provided by hearing protection):
exposure limit values (ELV):
daily or weekly exposure of 87 dB;
peak sound pressure of 140 dB.
Reproduced from Sound Advice, HSE 2008
NIHL is typically diagnosed using a hearing test called Pure Tone Audiometry (PTA). This test is
designed to diagnose hearing problems which may cause difficulty interpreting speech. PTA detects
changes in hearing levels only after major damage is caused and is irreversible and likely to result in
significant symptoms. Musicians are known to be more adept at PTA than the normal population so
PTA testing over time may not be an accurate reflection of any impact on their hearing (Dowling &
Harwood, 1985; Einhorn, 2009; Jansen, Helleman, Dreschler, & Laat, 2009). PTA is very useful for the
assessment and management of hearing loss however the aim of any hearing conservation
programme is to prevent hearing loss, not measure it.
In the early stages of damage to the inner ear, a significant proportion of hair cells can be impaired,
but without any noticeable symptoms of hearing loss, or associated problems such as tinnitus,
diplacusis or hyperacusis. Since these early changes cannot be detected by PTA, this traditional test
provides no opportunity to take steps to prevent progressive injury and development of symptoms.
Alternative hearing tests, known as ‘Otoacoustic Emissions’ (OAE) testing, is capable of detecting
these early changes (Job et al., 2009). When explained and displayed in an easily understandable
format, this allows early recognition of sound-related changes to these vulnerable structures, thus
enabling people to alter their individual behaviour and their way of working, to protect themselves
from further injury (Mansfield, Baghurst, & Newton, 1999).
An effective hearing conservation program will involve several simultaneous actions:
risk assessment,
proactive intervention with control measures, known as risk management and
feedback on efficacy of control processes through health surveillance and audit
This dynamic process will motivate participants, allowing them to take shared ownership of how their
auditory health is protected (Fligor, 2013; Murray, LePage, & Mikl, 1998).
Those responsible for music environments have a statutory duty to all people using, performing,
studying and working in those settings. At a minimum, risk assessment and health surveillance where
there is a risk to health identified must be undertaken. The HSE advises employers and managers to
‘think about what might cause harm to people in your workplace and decide whether you are taking
reasonable steps to prevent or control that harm.’
Risk assessment is the initial step and involves:
1. Identification of potentially hazardous sound source and those at risk
Consider music rehearsal, tuition or performance
2. Characterisation of sound: variation according to the instrument, environment, duration,
intensity etc.
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) provide estimates of the representative noise levels of different
instruments and ensembles.
3. Exposure assessment: document the nature and extent of expected exposure
Measurement of personal sound exposure, known as dosimetry
Comparison with published Action Values/Limits
4. Estimation of risk: what is the probability of hearing damage due to sound exposure in the
identified context?
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.
A sample flowchart for risk assessment can be found in Sound Advice (Health and Safety Executive,
2008) and the BBC Musicians Noise Guide (Hansford, 2012) has a useful risk template.
Risk management requires a value judgement to decide between possible courses of action to control
the issues identified during risk assessment. Risk management should reflect the interests of all
people who may be affected by the decision about what is required to control risks.
When implementing control measures, the hierarchy of control model defines the order to follow
when planning to risk reduction and should be considered in the following order:
1. Controlling sound at source
2. Prevent and control transmission of sound to individual
3. Individual protection
The HSE is very clear that management should not skip ahead to the easiest solution, but must reduce
risk as low as reasonably practicable”.
1. Controlling sound at source
Eliminate the risk: this is unlikely to be a reasonable solution music is the desired product
rather than an unwanted by-product of sound exposure, therefore evaluation and control of
this unavoidable exposure is essential
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, 2012) and Sound Advice (Health and Safety Executive, 2008). Consider:
o Planned rest/quiet time and provision of quiet space for recovery
o Development of standards on timetable structure with a reduction of risk by
awareness of design of playing space
avoidance of prolonged exposure
o Consideration of appropriate design of practice and performance space (i.e. small
rooms with untreated walls/mirrors potentially represent more significant risk than
large, sound-treated performance areas)
o Investigation of recent innovations such as noise mapping for orchestras
o Limit or avoid non- vocational and personal sound exposure (e.g., transport,
personal music-players)
Substitute sound source
o Careful consideration of repertoire alternating louder, intense pieces with quieter
work, allowing time for recovery from exposure
o Using appropriate instruments (e.g. Baroque instruments for Baroque music,
solutions for electronic versus classical instruments)
2. Prevent and control sound exposure
Adequate distance between musicians. Sound Advice suggests 2m2 per musician Be aware
that providing space may not always decrease exposure, as discovered by the BBC Singers’
Noise Day.
Record, respond to, and reduce the duration and intensity of exposure
Consider Informative visual aids/noise levels indicators
Personal sound level apps can provide useful information
If not possible/practical to reduce exposure to loud sounds then
PROPER provision of adequate and suitable protection is essential.
3. Provision of personal hearing protection
If it is not practical for the risk presented by loud sound to be reduced at source then it is vital that all
those exposed are adequately protected.
Use hearing protection appropriate to the assessed risk. 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.
Verification by fit testing at time of supply is strongly recommended, to ensure the degree of
protection is as close to laboratory figures as possible. When custom moulded hearing protection
products designed for musicians are sourced then the fit must be verified when supplied and regularly
verified to ensure continued protective levels. Errors can occur during manufacture to affect the fit so
although comfortable some samples will not fit properly and this leakage will result in a significant
reduction of the real world protective value (British Standards Institution, 2002; Hager, 2011; Schulz,
All staff and students should have training on hearing conservation, the risks presented by the
performance environment and on hearing protection. Records of attendance and participation in
instruction and education should be maintained and be the responsibility of a designated person, (e.g.
manager, Health & Safety co-ordinator or other named member of staff). Refresher training will be
required on a 1-2 yearly basis, because new risks will be identified, and new technology available to
assist with control. Online modules would be very suitable if completion can be recorded.
Evaluation of prevention and control measures is essential for a successful hearing conservation
strategy. Health surveillance is a system of ongoing health checks to
1) detect adverse effects early, and
2) provide information on effectiveness of control processes and to minimise further harm
being caused.
“health surveillance means assessment of the state of health of an
employee, as related to exposure to noise”
The Control of Noise at Work Regulations 2005
Hearing tests measure the impact of exposure to noise and should be undertaken at regular intervals
as part of a health surveillance programme. Health surveillance should provide the earliest indication
of effects from exposure to risk. Ideally, changes would be detected before hearing loss occurs, and
control measures can be revised or increased. Long-term, regular health surveillance in the form of
hearing tests will demonstrate the efficacy of control measures.
There are two types of tests used in health surveillance:
Pure Tone Audiometry (PTA) which detects irreversible hearing damage
Otoacoustic Emissions (OAE) which provides early indication of changes in function of the inner
ear as a result of exposure. This test shows early damage that is not detected by PTA test.
Initially, a combination of both tests is recommended as a baseline assessment. Comparison of OAEs
over time allows performers to detect any deterioration in their auditory health. As previously stated,
OAEs are particularly useful for musicians’ health surveillance because they give an early warning of
irreversible hair-cell damage, re-enforcing vigilant use of control measures and hearing protection.
Health surveillance should include otoscopy (visual inspection of the outer ear with a light) and
tympanometry (a test of the middle ear). These hearing tests allow for complete and comprehensive
assessment at time of entry and appropriate tests should be repeated on a regular basis. Table 1
displays a suggested protocol for heath surveillance.
If a hearing health problem is identified by an individual, specialist help should be sought via a GP
referral or private self-referral to a hearing specialist and ENT services.
Baseline assessment
Yearly/2-yearly as per risk assessment
Baseline PTA
(add PTA if significant deterioration observed)
+/- referral to specialist service
Table 1: Recommended Protocol of health surveillance. This can be applied to student and professional performers
Responsibilities of the individual to protect their own hearing.
The institution is responsible for the risk assessment and consequent management, control measures
and health surveillance. The individual working or studying within the institution also has
responsibility for their own health, as set out in Section 7 of the Health and Safety at Work etc Act
1974. In terms of hearing health, this includes:
Attending education, instruction and supervision
Reducing recreational exposure time. (Smartphone Apps can inform daily personal exposure
can be helpful for personal monitoring.)
Having regular hearing tests and engaging in health surveillance
Obtaining and wearing appropriate hearing protection
A Comprehensive Strategy
Implementation of the recommendations in this guidance, through risk assessment and
effective strategies for harm minimisation will significantly impact on hearing conservation
for musicians. These Strategies to educate and motivate individuals within an organisation or
institution should be offered as part of a complete hearing conservation programme and not
in isolation. Historic hearing conservation programmes have generally proved unsuccessful in
conserving hearing health, likely, at least in part, to their fragmented approach (O'Brien,
Ackermann, & Driscoll, 2014; Royster & Royster, 1990).
A comprehensive and systematic organisational approach comprising risk assessment, risk
management, health surveillance and regular audit is strongly recommended. Continuous
reassessment over time ensures adequate controls are in place and is essential to both
hearing conservation and cost-effectiveness.
A designated manager or responsible person must be identified to ensure the process is fit
for purpose. They will also be responsible for keeping records of staff and students'
attendance and participation in instruction and education on hearing conservation.
Meaningful change can be brought about by;
Encouraging access to evidence-based advice
Fostering individual responsibility for healthy music-making behaviours
Ensuring education starts early and that educators lead by example
Building success through a comprehensive and well-resourced programme
In providing truly beneficial, evidence-based advice, we can develop the paradigm and impact
musicians’ behaviour, which will be the key to achieving the desired outcome. With directive
and instructive counselling as part of a programme, we can change behaviour. Musicians who
recognise the positive benefits of maintaining healthy hearing and their individual
responsibilities are more likely to engage with and accept risk assessment and health
surveillance and to embrace the control measures identified as necessary for hearing
These guidelines will assist organisations in creating a strategy to build a healthy hearing
policy for their environments, thereby not only preserving the hearing health of their
students, employees and other musicians, but also allowing their programme to be self-
monitored and easily audited. This will demonstrate how cost effective, successful, and
beneficial their healthy hearing policy proves to be.
‘Management Regulations
The Management of Health and Safety at Work Regulations 1999
‘Noise Regulations’
The Control of Noise at Work Regulations 2005
see British Association for Performing Arts Medicine
British Association for
Performing Arts Medicine
A healthcare charity giving medical advice to people working and
studying in the performing arts
a difference in hearing by the two ears so that one sound is heard
as two
see Healthy Conservatoires Network
Health & Safety Executive
The Health and Safety Executive (HSE) is Britain’s national
regulator and enforcer for workplace health and safety
Health surveillance
a system of ongoing health checks. These health checks may be
required by law for employees who are exposed to noise
Healthy Conservatoires
A forum of UK conservatoires aiming to create environments that
promote and enhance the health and wellbeing of performing
artists, enabling them to achieve their full potential and to build
healthy, sustainable careers
see Health & Safety Executive
everyday sounds seem much louder than they should
see Music-related hearing disorders
Music-related hearing
Symptoms experienced by performers including tinnitus,
sensitivity to sound, pain and difficulty with pitch perception
see Noise-Induced Hearing Loss
Noise-Induced Hearing Loss
Hearing impairment resulting from exposure to sound
see Otoacoustic emission
Otoacoustic emissions
sounds of cochlear origin, which can be recorded by a microphone
fitted into the ear canal
An examination that involves looking into the ear with an
see Pure Tone Audiometry
Pure Tone Audiometry
Hearing test to screen or diagnose hearing impairment
Risk assessment
The process of identifying processes which may cause harm to
people in the workplace and decide whether you are taking
reasonable steps to prevent or control that harm
Tinnitus is the name for hearing noises that are not caused by an
outside source
an examination used to test the condition of the middle ear and
mobility of the eardrum and the conduction bones by creating
variations of air pressure in the ear canal
Authors did not receive any financial support for this work.
Rob Shepherd: none declared
Finola Ryan: none declared
Paul Checkley: none declared
Claire Cordeaux: none declared
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Full-text available
Professional musicians (PMs) are at high risk of developing hearing loss (HL) and other audiological symptoms such as tinnitus, hyperacusis and diplacusis. The aim of this systematic review is to A) assess the risk of developing HL and audiological symptoms in PMs and B) evaluate if different music genres (Pop/Rock Music – PR; Classical Music – CL) expose PMs to different levels of risk of developing such conditions. Forty-one articles including 4618 PMs were included in the study. HL was found in 38.6% PMs; prevalence was significantly higher among PR (63.5%) than CL (32.8%) PMs; HL was symmetric in 68% PR PMs and in 44.5% CL PMs. Tinnitus was the most common audiological symptom, followed by hyperacusis and diplacusis. Tinnitus was almost equally distributed between PR and CL PMs; diplacusis was more common in CL than in PR PMs, while prevalence of hyperacusis was higher among PR PMs. Our review showed that PR musicians have a higher risk of developing HL compared to CL PMs; exposure to sounds of high frequency and intensity and absence of ear protection may justify these results. Difference in HL symmetry could be explained by the type of instruments used and consequent single-sided exposure
Full-text available
Output from the cross-sector partnership looking at the Control of Noise at Work Regulations as applied to the music industry 2008-2011)
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As part of their occupational health and safety program, the hearing of members of a Sydney orchestra was tracked over a period of five years, using both air conduction pure tone audiometry and click-evoked otoacoustic emissions. All pure tone audiometry was carried out by the WorkCover Authority of New South Wales at frequencies of 0.5, 1, 1.5, 2, 3, 4, 6 and 8 kHz. Click-evoked otoacoustic emissions with 260 repetitions of the pulsed click train were recorded by the authors at a stimulus screening level of 80 (±1.5) dB peak SPL. Results have been analysed on an individual, instrumental section and whole orchestra basis. Group hearing levels (whole orchestra) as a result of pure tone audiometric testing have not declined significantly, although there are significant differences between sections. Results of otoacoustic emission testing are described in terms of the Otodynamics Analyser parameter called 'WAVEREPRO%'. When analysed on a section or whole orchestra basis these have not declined significantly either. Within sections, however, there is considerable variation between individuals and a number of musicians have a significant decline in otoacoustic emissions without a comparable decline in pure tone audiometry. Ears with low WAVEREPRO% and greater changes over time were seen from players seated in front of the brass section in particular. These changes over time are discussed in regard to test/retest variations.
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It has been generally accepted that excessive exposure to loud music causes various hearing symptoms (e.g. tinnitus) and consequently leads to a risk of permanent hearing damage, known as noise-induced hearing loss (NIHL). Such potential risk of NIHL due to loud music exposure has been widely investigated in musicians and people working in music venues. With advancements in sound technology and rapid developments in the music industry, increasing numbers of people, particularly adolescents and young adults, are exposing themselves to music on a voluntary basis at potentially harmful levels, and over a substantial period of time, which can also cause NIHL. However, because of insufficient audiometric evidence of hearing loss caused purely by music exposure, there is still disagreement and speculation about the risk of hearing loss from music exposure alone. Many studies have suggested using advanced audiological measurements as more sensitive and efficient tools to monitor hearing status as early indicators of cochlear dysfunction. The purpose of this review is to provide further insight into the potential risk of hearing loss caused by exposure to loud music, and thus contribute to further raising awareness of music induced hearing loss.
Orchestral musicians are an at-risk population for noise-induced hearing loss. Following strategic approaches to mitigate exposure, many must use earplugs to safeguard their hearing, although reported usage rates are poor. Australia has progressive hearing conservation programs within many of its orchestras, yet little is known of earplug usage rates, abilities with earplugs or self-perceived hearing loss in this population. To help direct and inform future approaches to hearing conservation in Australia's orchestras a questionnaire assessing hearing conservation behaviors and the prevalence of self-perceived hearing loss was distributed. A total of 580 musicians across eight professional orchestras were surveyed, with 367 completed surveys (63%) returned. Eighty percent of respondents reported a risk of hearing damage in the orchestra, 64% used earplugs of some type at least some of the time and 83% found this use difficult/impossible. Forty-three percent reported a hearing loss, including 54% in pit orchestras and 46% of those ≤50 years of age. Brass players were least likely to use earplugs, most likely to report usage difficulties and most likely of those ≤50 years of age to report a hearing loss. While earplug usage rates in Australia are encouraging and may be linked to hearing conservation measures in the orchestras, the widespread difficulty reported with the use of these earplugs, the prevalence of self-reported hearing loss and the continued vulnerability of those most at-risk indicate improvements in both earplug design and further education for musicians are required to progress hearing conservation options for this population.
Individual fit-testing of earplugs is an exciting new trend in hearing conservation. This article reviews how this technology is being used to protect noise-exposed workers. Earplug fit-testing systems are becoming more commercially available and more feasible for field use. Individual fit-testing is no longer used only for research investigations but is being incorporated in Hearing Conservation Programs (HCP) to improve training, document protection and evaluate the effectiveness of the hearing protector element of an effective HCP.
The performance of hearing protection devices (HPD) worn by individual workers in specific noise-exposure environments has been difficult to assess using the hearing protector ratings printed on HPD packages. Because the role of the HPD in prevention of hearing loss remains as a vital last line of defense against the effects of noise exposure, proper assessment of their performance is increasingly critical. HPD fit-testing procedures now allow the individual fit-testing of HPD to assist in appropriate selection of HPD for individual workers, to aid in training workers on proper use of HPDs, and a range of other applications. Understanding these technologies, their strengths and weaknesses, and appropriate application of the results of fit-testing may enable employers to make improvements in their hearing loss prevention program performance.
Distortion product otoacoustic emissions (DPOAEs) are known to represent the contractile amplifier function of cochlear outer hair cells. It is known that low or absent DPOAEs are associated with hearing loss on audiograms. However, low DPOAEs can also be found associated with normal audiograms. It is unknown whether low DPOAEs in normal hearing ears are risk markers for subsequent early hearing loss when subjects are exposed to noise. A 3-year follow-up study was carried out on a population of pilots aged 20-40 years (n=521). Data collection consisted of tonal audiograms, DPOAEs measurements with a calculation of an index of abnormality (the IaDPOAE). Of the 521 pilots enrolled, 350 (67%) had follow-up data 3 years later. In pilots with normal audiograms (n=219, all frequencies=10dB HL), we observed the occurrence of hearing threshold shifts after 3 years depending on whether the IaDPOAE was initially high (group 1) or low (group 2). We used this index to test the hypothesis that reduced DPOAEs levels are potential ear vulnerability biomarkers in apparent normal hearing ears. After a 3-year follow-up, the initial IaDPOAE in normal hearing subjects was correlated with final noise-induced hearing threshold shifts at high frequencies (p<0.01). The occurrence of abnormal audiograms was significantly higher in group 1 compared to group 2 (p=0.003). In group 1, 13% of audiograms were found with at least one frequency 25dB HL compared to 3% of audiograms in group 2. In both groups, impairments occurred at high frequencies and hearing in the 4kHz frequency range was significantly more impaired in group 1 (p=0.035). Group 1 was associated with a relative risk of 2.29 (95% CI 1.26-4.16, p=0.005) of sustaining early hearing loss. There was no significant differences between groups for age and noise exposure. In adults with a normal audiogram, ear vulnerability to noise could be elicited by the use of objective DPOAE measurements. A high IaDPOAE that corresponded to reduced DPOAE levels constitutes a risk for early hearing loss. This study emphasised the interest of DPOAE measurements in public health and occupational noise prevention policies. The IaDPOAE calculation may also be interesting for clinicians because no DPOAE index of abnormality is currently available.
Hearing is of special vocational importance in musicians. Musical performance may create sounds sufficiently intense to cause sensorineural hearing loss. Although such losses are usually not severe enough to be compensable under American Academy of Otolaryngology guidelines for occupational hearing loss, they may interfere with the musician's ability to perform the daily tasks of his or her profession. A review of the literature on occupational hearing loss in musicians reveals a substantial need for further research.
Popular concern about widespread damage to the hearing from exposure to amplified music continues, although there has been little firm evidence of permanent effects in casual listeners. Measurement of transient evoked otoacoustic emissions (TEOAEs) provides a sensitive technique for testing outer hair cell (OHC) function, and was used in this study of 28 young adults aged 18-25 years, whose only significant source of noise exposure was loud music, to look for evidence of poorer cochlear function in those of greater exposure; they provided 27 right ears and 27 left ears suitable for measurement of TEOAE strength. Estimates of subjects' total noise dose were obtained from self-reports of the duration and intensity of their exposure to music and other sources of noise. Ears with greater exposure to loud music showed significantly weaker TEOAEs than less exposed ears in response to a 4 kHz tone burst, or in response to a saturating (82 dBSPL) click if the response was treated with a high-frequency bandpass filter (2-4 kHz) (p<0.05). Differences between more exposed and less exposed groups of ears were most marked in the 2 kHz half-octave band for right ears, and in the 2.8 kHz half-octave band for left ears. A hypothesis is proposed that weakness in TEOAEs as a result of exposure to loud music is seen first in the 2 kHz region of the emission spectrum, and later at higher frequencies; and that for a given amount of exposure, TEOAE weakness (or OHC damage) is more advanced in left ears than in right.