Hearing and hearing conservation practices among Australia’s professional orchestral musicians Ian O’Brien, Bronwen J. Ackermann, Tim Driscoll1 Discipline of Biomedical Sciences, School of Medical Sciences, The University of Sydney, Lidcombe, 1Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
Abstract 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. Keywords: Music, noise induced hearing loss, orchestra, sound exposure
Introduction In a professional orchestra musicians constantly strive to produce highly nuanced timbres across a wide dynamic range. Unfortunately, the moderately high levels of sound produced by these musicians over time have been shown to be potentially harmful to their hearing.[1,2] Protecting an orchestral musician’s hearing without interfering with the balance, acoustics or the acuity they require is a vexing issue for researchers and musicians alike. While questions have been raised regarding orchestral noise exposure assessment procedures and calculations used to measure sound levels in the orchestral environment—particularly due to the highly variable nature of sound levels in orchestral music and the limitations of Access this article online Quick Response Code:
Website: www.noiseandhealth.org DOI: 10.4103/1463-1741.134920 PubMed ID: ***
189
using periodic assessment methodologies[3] – it is broadly accepted that sound levels may be hazardous depending upon key variables such as instrument played, repertoire, venue, and orchestral set-up. Those in particularly high exposure areas are players of brass instruments[1,2,4] and musicians who work predominantly in orchestra pits.[4,5] There have been many audiological investigations into noiseinduced hearing loss (NIHL) among professional orchestral musicians, all relying upon data from volunteer cohorts. Some have found limited evidence of hearing loss,[6-8], but many have found professional orchestral musicians exhibit greater incidence of noise-related hearing pathologies (including permanent threshold shift, tinnitus, and hyperacusis) than the general population.[2,9-11] In terms of studies relying on self-reported hearing loss, one investigation of professional orchestral musicians found around 25% reported at least some hearing impairment,[12] while another found these rates to be 31%.[13] Both figures are higher than rates of hearing loss due to any reason in the broader population, which have been estimated to be around 13%.[14] In addition to these findings, professional orchestras are generally bound by workplace health and safety regulations that oblige them to provide a safe working environment that Noise & Health, May-June 2014, Volume 16:70, 189-195
O’Brien, et al.: Hearing and earplug use in Australia’s orchestras
conforms to the restrictions stipulated in this legislation. To comply with these regulations and to ensure the musicians progress through their careers with intact hearing, workplace hearing conservation measures and noise risk management strategies are necessary. Developing and maintaining a successful hearing conservation strategy within a professional orchestra is a complex task involving a fine balance of legislative requirements, control measures, exposure assessment, audiological monitoring, and educational programs that must integrate with artistic, financial, and political concerns. Similar to approaches in other industrial settings, a successful hearing conservation strategy initially aims to control or modify the level of risk to which a worker is exposed through a range of measures designed to minimize the need for personal protective equipment (PPE) like earplugs, which are seen as the final control measure. Several organizational approaches to exposure management in this setting have been suggested, including a series of measures proposed initially by the Association of British Orchestras[15] and then expanded in a series of British Broadcasting Corporation guides.[16] While these approaches detail administrative and engineered controls, each acknowledge that inevitably PPE are required at least some of the time, particularly among musicians playing in more exposed positions in the orchestra. Acceptance and utilization of this final control measure is essential in cases where factors such as artistic or financial demands or the acoustic properties of the venue may lead to an inability to reduce the risks to an acceptable level. As traditional hearing protectors such as earmuffs and disposable foam earplugs introduce occlusion and a highdegree of spectral distortion, which severely impedes
musicians’ ability to play their instrument and communicate with their colleagues,[17] researchers in the late 1980s developed a hearing protector specifically for musicians. This device was an earplug custom-molded to the ears incorporating a filter providing 15 or 25 dB (and subsequently 9 dB) of attenuation, which the developers claimed would cause minimal spectral distortion up to 8 kHz.[18] Since their commercial release relatively few objective investigations have been conducted into the impact of custom-molded earplugs on the aural perception and musical output of musicians wearing them. While two studies suggest these earplugs have little effect on auditory perception,[19,20] sound localization difficulties have been identified.[21] In one study, the use of these earplugs has been shown to potentially alter the spectral characteristics and sound levels produced by musicians (most significantly the brass) while playing in ensemble.[22] Despite ongoing debate as to their performance, these earplugs have become widely used in the music industry in preference to other styles of earplug, and there are now various manufacturers producing a range of filtered custom-molded earplugs specifically for musicians. Although these earplugs are widely available there appears to be ongoing resistance to their use by professional orchestral musicians. This is evidenced by several reports dealing directly with this topic [Table 1], with similar take-up rates and difficulties reported among tertiary music students.[23-25] Based on the findings summarized in Table 1, it is apparent that the use of earplugs among orchestral musicians is poor. The studies indicate that these musicians believe they are unable to carry out their craft at the level required while wearing earplugs due to a range of factors, with main barriers identified including:
Table 1: Earplug usage studies in professional orchestras Study Laitinen, 2005
Cohort 196 musicians from 45 orchestras and one military band
Laitinen and Poulsen, 2008
145 musicians from three orchestras
Zander et al., 2008
429 musicians from nine orchestras
Jansen 241 musicians from et al., 2009 five orchestras
Usage rates Constant use 6%; less frequent use 35%
Earplug type 47% of earplug users wore custom-molded musicians earplugs; 25% used disposable foam earplugs; 12% used “other” (generic musician’s, cotton wool, fingers etc.); 16% used a combination of the above 35% used custom molded In rehearsals: 13% used earplugs “often” or “always”; musician’s earplugs; 39% 49% “seldom” or “sometimes” used disposable foam earplugs; 16% used generic In performances: 11% used musician’s earplugs; 10% earplugs “often” or “always” “other” (cotton wool, etc.) and 42% “seldom” or “sometimes” 38.4% used hearing
Abstract 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. Keywords: Music, noise induced hearing loss, orchestra, sound exposure
Introduction In a professional orchestra musicians constantly strive to produce highly nuanced timbres across a wide dynamic range. Unfortunately, the moderately high levels of sound produced by these musicians over time have been shown to be potentially harmful to their hearing.[1,2] Protecting an orchestral musician’s hearing without interfering with the balance, acoustics or the acuity they require is a vexing issue for researchers and musicians alike. While questions have been raised regarding orchestral noise exposure assessment procedures and calculations used to measure sound levels in the orchestral environment—particularly due to the highly variable nature of sound levels in orchestral music and the limitations of Access this article online Quick Response Code:
Website: www.noiseandhealth.org DOI: 10.4103/1463-1741.134920 PubMed ID: ***
189
using periodic assessment methodologies[3] – it is broadly accepted that sound levels may be hazardous depending upon key variables such as instrument played, repertoire, venue, and orchestral set-up. Those in particularly high exposure areas are players of brass instruments[1,2,4] and musicians who work predominantly in orchestra pits.[4,5] There have been many audiological investigations into noiseinduced hearing loss (NIHL) among professional orchestral musicians, all relying upon data from volunteer cohorts. Some have found limited evidence of hearing loss,[6-8], but many have found professional orchestral musicians exhibit greater incidence of noise-related hearing pathologies (including permanent threshold shift, tinnitus, and hyperacusis) than the general population.[2,9-11] In terms of studies relying on self-reported hearing loss, one investigation of professional orchestral musicians found around 25% reported at least some hearing impairment,[12] while another found these rates to be 31%.[13] Both figures are higher than rates of hearing loss due to any reason in the broader population, which have been estimated to be around 13%.[14] In addition to these findings, professional orchestras are generally bound by workplace health and safety regulations that oblige them to provide a safe working environment that Noise & Health, May-June 2014, Volume 16:70, 189-195
O’Brien, et al.: Hearing and earplug use in Australia’s orchestras
conforms to the restrictions stipulated in this legislation. To comply with these regulations and to ensure the musicians progress through their careers with intact hearing, workplace hearing conservation measures and noise risk management strategies are necessary. Developing and maintaining a successful hearing conservation strategy within a professional orchestra is a complex task involving a fine balance of legislative requirements, control measures, exposure assessment, audiological monitoring, and educational programs that must integrate with artistic, financial, and political concerns. Similar to approaches in other industrial settings, a successful hearing conservation strategy initially aims to control or modify the level of risk to which a worker is exposed through a range of measures designed to minimize the need for personal protective equipment (PPE) like earplugs, which are seen as the final control measure. Several organizational approaches to exposure management in this setting have been suggested, including a series of measures proposed initially by the Association of British Orchestras[15] and then expanded in a series of British Broadcasting Corporation guides.[16] While these approaches detail administrative and engineered controls, each acknowledge that inevitably PPE are required at least some of the time, particularly among musicians playing in more exposed positions in the orchestra. Acceptance and utilization of this final control measure is essential in cases where factors such as artistic or financial demands or the acoustic properties of the venue may lead to an inability to reduce the risks to an acceptable level. As traditional hearing protectors such as earmuffs and disposable foam earplugs introduce occlusion and a highdegree of spectral distortion, which severely impedes
musicians’ ability to play their instrument and communicate with their colleagues,[17] researchers in the late 1980s developed a hearing protector specifically for musicians. This device was an earplug custom-molded to the ears incorporating a filter providing 15 or 25 dB (and subsequently 9 dB) of attenuation, which the developers claimed would cause minimal spectral distortion up to 8 kHz.[18] Since their commercial release relatively few objective investigations have been conducted into the impact of custom-molded earplugs on the aural perception and musical output of musicians wearing them. While two studies suggest these earplugs have little effect on auditory perception,[19,20] sound localization difficulties have been identified.[21] In one study, the use of these earplugs has been shown to potentially alter the spectral characteristics and sound levels produced by musicians (most significantly the brass) while playing in ensemble.[22] Despite ongoing debate as to their performance, these earplugs have become widely used in the music industry in preference to other styles of earplug, and there are now various manufacturers producing a range of filtered custom-molded earplugs specifically for musicians. Although these earplugs are widely available there appears to be ongoing resistance to their use by professional orchestral musicians. This is evidenced by several reports dealing directly with this topic [Table 1], with similar take-up rates and difficulties reported among tertiary music students.[23-25] Based on the findings summarized in Table 1, it is apparent that the use of earplugs among orchestral musicians is poor. The studies indicate that these musicians believe they are unable to carry out their craft at the level required while wearing earplugs due to a range of factors, with main barriers identified including:
Table 1: Earplug usage studies in professional orchestras Study Laitinen, 2005
Cohort 196 musicians from 45 orchestras and one military band
Laitinen and Poulsen, 2008
145 musicians from three orchestras
Zander et al., 2008
429 musicians from nine orchestras
Jansen 241 musicians from et al., 2009 five orchestras
Usage rates Constant use 6%; less frequent use 35%
Earplug type 47% of earplug users wore custom-molded musicians earplugs; 25% used disposable foam earplugs; 12% used “other” (generic musician’s, cotton wool, fingers etc.); 16% used a combination of the above 35% used custom molded In rehearsals: 13% used earplugs “often” or “always”; musician’s earplugs; 39% 49% “seldom” or “sometimes” used disposable foam earplugs; 16% used generic In performances: 11% used musician’s earplugs; 10% earplugs “often” or “always” “other” (cotton wool, etc.) and 42% “seldom” or “sometimes” 38.4% used hearing
