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Advancing Tinnitus Awareness Through Animation

Gilliver, Megan PhD; Sewell, Jane PhD; McGinnity, Siobhan; Beach, Elizabeth PhD

doi: 10.1097/01.HJ.0000525523.41184.42
NAL News

(L-R) Dr. Gilliver is a researcher at the National Acoustic Laboratories (NAL) focusing on hearing health promotion. She is a project manager at HearSmart, along with Dr. Sewell, who is also the communication and education manager at the HEARing Cooperative Research Centre (CRC). Ms. Mcginnity is a research audiologist at the University of Melbourne Audiology and Speech Pathology Clinic and a founder of Melbourne-based collective, Musicians 4 Hearing. Dr. Beach is a senior research psychologist at NAL and a researcher at the HEARing CRC.

With a livelihood that involves daily and prolonged exposure to sounds, musicians face a significant risk of hearing loss. Hearing protection devices are available to help reduce this occupational hazard, but the need for robust awareness—one that will drive behavioral changes—remains unmet. To this end, HEARsmart, along with Australian Hearing, Musicians 4 Hearing, and the University of Melbourne Audiology and the Speech Pathology Clinic, launched a unique animated video campaign to promote tinnitus prevention and management among musicians.

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MUSICIANS AND BEHAVIOR CHANGE

HEARsmart, an initiative aimed at promoting hearing health in young adults, was born out of a long running collaboration between National Acoustic Laboratories (NAL) and the HEARing Cooperative Research Centre (CRC). At its core, the program has an evidence-based philosophy, utilizing research into people's behavior, attitudes, and awareness of hearing health to create targeted prevention activities.

The idea for the video campaign came from a music industry group which approached HEARsmart to develop an informative video about tinnitus for musicians—an idea that resonated well with the HEARsmart team.

Musicians are considered a particularly relevant group for hearing health education for several reasons; they are exposed to music not only through practice and performance but also through listening to music for leisure. These sound exposures may be at high levels, increasing the risk of hearing damage in this population.

On a positive note, musicians recognize hearing as essential, fuelling their strong desire to preserve it. From a theoretical standpoint, it is likely that many musicians are in the “contemplation” stage and have less distance to travel before reaching the point of changing their behavior. To effect this change, however, they may require support and education to take the steps to protect their hearing. Thus, the campaign aims at helping musicians better understand their susceptibility to hearing difficulties and recognize the impact that such damage may have on their daily lives.

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TINNITUS MESSAGING

The campaign focuses on tinnitus in recognition of its significant impact as a symptom and a warning sign that suggests a hearing injury and sense of urgency. Tinnitus is a relatively common experience for those with high levels of noise exposure, with numerous studies showing a relationship between the two (Ear Hear. 2013;34[1]:75 http://bit.ly/2hGbOJV;Int J Audiol. 2017;56[4]:219 http://bit.ly/2hH3Sbm). Musicians, in particular, are up to four times more likely to experience tinnitus (Int J Audiol. 2003;42[5]:279 http://bit.ly/2hHMUcG). Furthermore, tinnitus is a distinctively recognizable symptom that has the potential to motivate behavioral change.

With this in mind, and using health behavior theory as a guide, the video campaign was developed to inform musicians of their increased susceptibility to tinnitus and alert them to its potentially severe effects. The video promotes the benefits of healthy hearing habits such as monitoring sound levels, taking breaks, and wearing hearing protection. It also seeks to disarm one key barrier to earplug use—the belief that earplugs negatively affect sound quality. Finally, the video campaign also includes tips on managing existing tinnitus.

Overall, the campaign offers practical ways to prevent and manage tinnitus. Incorporating these messages required a tough balancing act of stressing the impact of tinnitus while not further distressing those already suffering from it.

To maintain the necessary equilibrium, clinical accuracy, and engaging messaging, it was important to include input from a range of experts—clinicians, hearing health and science communicators, psychologists, and musicians themselves. At key stages along the development process, the group sought feedback from the target audience to ensure the approach was broadly on track.

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ANIMATION AND SOCIAL MEDIA

Developing the storyboard and characters was as important as any other part of the process. Noting the age range of the target audience, an animation style was chosen to allow for greater levels of control, flexibility, and creativity in presenting the message. The medium is also popular among the target audience and enables opportunities for social media sharing, humor, and visual reinforcement of key elements.

Social media demands that messages be brief (optimally, 30 seconds) to engage and maintain interest. However, such a brief time frame can't effectively cover all the key details. As such, the single video message is divided into shorter segments for flexible delivery opportunities.

The animated video features a relatable lead character, Alex, a musician who experiences tinnitus for the first time (Fig. 1). She has little knowledge about the dangers of loud music, including tinnitus, so she asks many questions about the new sound in her world—what it is, why it is happening, what impact it might have on her long-term musical performance, and how it can be managed. The message unfolds from her first-person perspective as her character is used as a proxy for the target audience. Although presented as female, Alex is not distinctively gendered or characterized as belonging to any specific cultural group. The supporting characters also cover a range of genders, ages, and backgrounds.

Alex's tinnitus is represented by a buzzing bee, a useful characterization to visually illustrate the constant presence of tinnitus. It was important to show the level of annoyance and intrusion that constant tinnitus can bring while making sure that the narration is clearly audible, particularly to viewers who may have hearing difficulties and sensitivity to sound. Thus, Alex's tinnitus is presented at varying volume levels to mimic the changeable nature of tinnitus. This is mirrored by the tinnitus bee, which correspondingly gets larger, smaller, or just “hangs in the background” (Fig. 2).

The animation shows how tinnitus can cause distress and frustration, but this message is balanced with reassurances from an audiologist who provides practical management tips. Importantly, Alex ultimately learns how to manage both tinnitus and the exposure to the loud sound that triggered it. The message is clear: Tinnitus can be managed, but minimizing one's risk is the best preventive measure. To encapsulate a simple takeaway message, the video outlines the aspects of volume, duration, and frequency of music exposure, and suggests ways to monitor them.

With the online https://hearsmart.org/what-problem/tinnitus release of the final animation in August 2017, the collaborative team behind this successful campaign holds the same hope—that the animation will resonate with musicians and professionals in the music industry around the world to raise tinnitus awareness and motivate healthy hearing behaviors in this vulnerable population.

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