April 26, 2023, is International Noise Awareness Day. Our cover story this month takes a special look at how audiologists can help treat, manage, and prevent noise-induced hearing loss in music industry professionals.
Hearing loss may pose a challenge in many professional settings, but for patients who work in the music industry, suffering hearing loss could also mean the loss of necessary skills needed for success on the job. For audiologists, the intricacies for treating these patients abound, but with attention to additional needs, this unique patient population can thrive.
HEARING LOSS IN THE MUSIC INDUSTRY
“Research shows an above-average incidence of hearing loss for professionals in the music industry, with between 30 to 50 percent of musicians experiencing some degree of tinnitus, most likely due to noise-induced hearing loss,” Glenn Schweitzer, author of Rewiring Tinnitus and Mind Over Meniere’s, and Ambassador Board Member for the Vestibular Disorders Association, said. Schweitzer, who was diagnosed with Meniere’s disease at age 24 and has since become a tinnitus coach, has worked one-on-one with musicians, sound engineers, producers, stagehands, and a variety of additional professionals in the music industry who suffer hearing loss and tinnitus, the large percentage of which, he says, is profound. “Hearing loss and tinnitus can and will alter the perception of sound in the acute phase, and for the patient, that feels like an existential threat, whether they are performing musicians or working behind the scenes,” he said. “If your career is based on being able to hear sound and create music, there is an emotional intensity when you suffer hearing loss. Many who do suffer in isolation for fear of reputational risk.”
Melissa Heche, AuD, CCC-SLP/A, FAAA, CSP, Doctor of Audiology and Clinical Voice and Swallowing Pathologist at New York Speech and Hearing, offers a unique perspective on treating musicians with hearing loss. Heche is herself a musician and performer with training in musical theater and sound engineering in addition to her qualifications as an audiologist and speech language pathologist. “This combination of training has made me uniquely skilled to really understand how someone has to hear sound on stage as a professional musician and has made me best able to support this patient population.”
IMPACTING JOB PERFORMANCE
For Heche, understanding that professional musicians have an additional pressure to hear well is integral to providing care. Schweitzer explained, “There is an emotional impact of hearing loss that can cause the patient to feel a high level of anxiety that impacts every level of life. Take the average person experiencing that distress and double it for someone who needs their ears to work well to do their job. Hearing loss can yield an existential threat to that person’s career, passion, the thing they love, and their creativity to the point that they feel powerless with no hope.” Schweitzer noted that while minor high-frequency hearing loss may not make or break a career, severe hearing loss likely would. “Any job in contact with music in a creative or musician role would be affected by hearing loss and could even prevent someone from pursuing a career in the field at a certain point. But if hearing loss is caught at an early stage, the right education and prevention of further loss could save their career.”
The biggest thing that should be drilled into every musician from day one of their music career, regardless of what it is, is that protection is worth everything, Schweitzer said. “Hearing protection is a must.” Heche noted that for some industries, such as construction and utility work, the Occupational Safety and Health Administration (OSHA) has strict requirements to regularly monitor workers’ hearing. “OSHA requires that any time there has been a change in an employee’s hearing it is classified as a company injury that is formally reported, necessitating a look at hearing protection to make sure the employee has properly fitting hearing protection and that they face no undue risk from their job.” In the music industry, those regulations do not exist, she said. “Musicians are exposed to loud noises, and there is no one there to regulate decibels or provide hearing protection, putting professionals in the music industry at far more risk.”
Heche recommends that audiologists treating those in the music industry screen patients annually so that hearing tests can be compared to a baseline of when the patient first started working. “If there is above a 10 decibel change in hearing from the annual test compared to the baseline, a full evaluation would be needed, as well as continued education on hearing protection,” she said. Audiologists should take several factors into consideration during the evaluation, such as what kind of music the patient plays, what instrument, whether they play acoustically or plugged in, what venues they perform at, and how often they are exposed to loud noise. “Every situation should be taken differently, with all factors taken into consideration before determining what hearing-related products are most appropriate.”
For many patients, education is a key factor. “Professional musicians often don’t know that it’s too loud,” she explained. “When you’re playing music for a number of years at a certain volume, the body can become accustomed to that level as the norm, and it no longer sounds loud to them. Research has shown that musicians with in-ear monitors will still try to reach the same level of volume they’re exposed to on stage because that is what they are used to,” she said. “It’s important to educate and counsel these patients that even with an in-ear monitor, listening too loudly is still detrimental. They must use caution and be aware of how things sound, and the audiologist must work to ensure that they can provide nonlinear attenuation across the frequency spectrum so that the patient can still hear music that is clear and crisp, which will encourage the patient to listen at a level that will conserve hearing.”
Heche added that talking with the patient about their treatment goals and going over different options based on those goals, the music they play, and their experience, is integral. “Perform sound demonstrations, verify with the instrument they play, and make sure that the actual music equipment they use still functions the way they need it to so they are attenuating the way we want them to and receiving the result they need,” she said.
Beyond good audiological care, it’s important to reassure professional musicians with hearing loss that hope is not lost. “Those with hearing loss are not powerless,” Schweitzer said. “In addition to clinical treatment from an audiologist, we can give patients support and hope by helping them focus their energy on changing their perception with coping tools, anxiety management techniques, and lifestyle management that will lessen the emotional state of anxiety.”
Continued education will also increase patients’ ability to manage. “Compared to how things were 5 or 10 years ago, there is a far greater amount of understanding, acceptance, and knowledge of hearing loss in the music industry today,” Heche said. “People understand more about the risks and are more proactive about how much they want to protect their hearing than ever before. Professional musicians today have a sense of how important their ears are as their instrument and as a tool for them to meet their professional goals.”
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