Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

Filtering by Tag: hearing

S.O.H.- Save Our Hearing!

Hearing Loss in the Orchestra.jpg

As we finish up another week of loud pops playing in which I sat next to the piccolo and in front of the percussion, I'm reminded once again of the auditory perils of orchestral playing.  Let's back up though first, and review the process of hearing in itself (simplified).


Sound waves travel to the outer ear (pinna), which then magnify the sounds and direct them inward through the auditory ( or ear) canal.  At the end of the tunnel is the eardrum or tympanic membrane.  The three bones of the middle ear, which I had to memorize at some point as the hammer, anvil, and stirrup, then convert the sounds from the eardrum into higher pressure sounds at the oval window, which is sort of like the exit.  Simply put, the three bones of the middle ear (ossicles) are the malleus, incus, and stapes, and when they vibrate, they increase the vibrations to be perceived by the oval window, which is 30 (!) times smaller than the eardrum.  

Beyond the oval window is the cochlea, or the tubes that look like a snail shell.  Within the cochlea is the organ of Corti, which is the organ filled with hairs that translate the liqueous vibrations into nerve impulses for the auditory nervous system. (If you're not a visual learner, this video may help to illustrate these issues a bit better through image and sound.)

Now back to musicians- sensorineural hearing loss is when the hair cells in the organ of Corti are damaged over time, either due to prolonged high volume sounds, short doses of high intensity sounds, etc.  Next post will illustrate some of the frequencies of instruments, and why using earplugs is crucial in the orchestra (and non-orchestra) setting.

Hearing Loss By the Numbers

Hearing Loss By the Numbers.jpg

A few years ago, the internet was abuzz with Janet Horvath, longtime musician health advocate, author of "Playing Less Hurt," and former cellist in the Minnesota symphony, and her battle with hearing damage from loud amplified concerts.  ( hyperacusis: "an auditory injury caused by repeated exposure to high decibels or a single acoustic shock")  Her story in the Atlantic is truly harrowing, especially after years of awareness and prevention on her part, but it is a true cautionary tale to all musicians.

Let's look at the numbers.

dB (decibels) measure sound on a logarithmic scale, meaning that sound increases of 10 dB are actually an increase of the power of 10.  (If you don't remember this portion of your high school mathematics curriculum, you are not alone).  

Decibels in Environment and Music (adapted from hear

*80-90 dB marks the beginning of the danger zone of sound

125 dB causes immediate pain

60-70 dB is a normal conversation 

95 dB is a subway train

107 db- power mower

60-70 db- normal piano practice

75-85 dB- chamber music concert

92-95 dB- piano extremes

84-103 dB- violin range

84-92 dB- cello

85-111 dB- flute

95-112 dB- piccolo (imagine when they're doubled and at maximum volume in Shostakovich or Tchaikovksy…)

85-114 dB- trombone

Chart from

Chart from

106 dB- timpani/bass drum rolls

130 + dB- high end of trumpet

So what does this all mean?  Well these are individual instrument readings, which means that if you are in the thick of an orchestra, small ensemble, new music ensemble, or band, the combined sounds can be more intense on a logarithmic scale.  Loud shows with amplification can exceed volume beyond a typical classical concert as well, especially if you're playing onstage or close to speakers.  Hearing loss can be short term or long term, and can take a few different forms.  Many of us have had tinnitus (ringing in the ears), after sitting in an orchestra danger zone, which might go away after a few days or even hours.   There is also sustained progressive hearing loss due to consistent exposure to high volume sounds.   What makes this all even scarier is that when musicians are tested for hearing loss, especially in an orchestra, the numbers are relatively high.   If you look up statistics for hearing loss in the symphony, the numbers range from 35% to 70%, depending on the questions asked, the year, the age of musician, etc.  Even if it's on the low end of 35%, that's actually a rather high percentage for folks who need to make their living this way!  The simple answer is to start using earplugs for musicians ASAP, and if nothing else, use foam earplugs.  Most ensembles provide earplugs for free as part of the OSHA requirements, but it is definitely worth it to invest in a nicer set that doesn't block out all frequencies equally.  Many of my colleagues use Etymotics, either as custom made earplugs or just the generic $12 ones.  Both are an improvement upon foam earplugs.  Many earplugs come with different filters/levels of sound diminishing, depending on what you need.  Custom earplugs will often have the option to adjust to where you sit, what you play, and what clarity you need.

Most professional orchestras will at least have these cheap foam earplugs, in order to comply with OSHA (occupational safety and hazard administration).

Most professional orchestras will at least have these cheap foam earplugs, in order to comply with OSHA (occupational safety and hazard administration).

Some of the more dangerous zones in the orchestra:

Piccolo hot seat- second violins right next to the piccolo

Percussion explosion- brass players, bassoonists, and clarinetists often get a double dose of loud percussion and brass in momentous forte sections

Trombone Zone- Cellists, bassists, and violists in front 

This is what a custom set of earplugs might look like, running approximately $200. They aim to diminish the total volume of sound rather than muffle or distort pitch and speech.

This is what a custom set of earplugs might look like, running approximately $200. They aim to diminish the total volume of sound rather than muffle or distort pitch and speech.

It is not usually the fault of these instrumentalists that their instruments are loud, or that composers ask them to play fortissimo and beyond (wagner, strauss...), and it is often your job to seek out shields or earplugs in those situations, and hope that the conductor will manage volumes when appropriate.  In addition, it's important to be clear with management about the importance of shells for protection.  Some of the orchestras I've played with did not provide protection, and while I often have my earplugs in my case, many others don't.  If you are a sub or extra musician, always bring your own plugs.  It can be stressful to tell personnel managers about the sound situation, especially if it's a high profile concert or conductor.  Your long term hearing is more valuable than your ability to play fast passages in a Wagner overture, Mahler symphony, contemporary piece, or Pops show.  If you can't hear yourself over the cacophony, chances are, your stand partner can't either, nor can the section leader or concertmaster.   (Not to say that preparation is optional, but sometimes folks are afraid to use earplugs lest they play wrongly or out of tune). Prepare well and also experiment with knowing your own volume with and without earplugs so that you can start to be more comfortable using them.  Many of my colleagues have found most success by using one earplug and leaving the other ear open directly next to the instrument, although there's certainly a case for mixing it up to prevent long term asymmetry.

If you are a youth orchestra coach/leader/teacher, check out the situation in your class or ensemble.  Many teenagers are not apt to worry about hearing loss, and your assistance could make a big difference.  Also, avoid always use in-ear headphones, which are more damaging long term to your hearing depending on the frequency and volume of music/sound listened to.

One last excellent point that my friend trombonist Chris Wolf pointed out to me, is that many musicians deal with something called the occlusion effect when earplugs are in, meaning that the sounds are perceived as booming, and difficult to perceive in context.  Many of my friends who don't use earplugs say that they can't hear their section or intonation well, but just can hear their breath (especially wind players).  It seems as though hearing specialists have addressed this issue in the context of hearing aids, but I wonder if it's something that audiologists are looking at for musicians, especially those who play wind instruments.  If any of you have any experience with resolving this issue or know of a brand of earplug that addresses this,  let me know!


Ototoxicity: When Drugs Affect Your Hearing


A few weeks ago, the topic of ototoxicity popped up on in an email list about musician health.  I had never heard of it before, and thought I should do some research.  First off though, what is otoxicity?  The prefix OTO refers to structures of the ear, and toxicity meaning poison, so total meaning poisonous to the ear and its structures.  Many different pharmaceuticals can cause ototoxicity, which can be anything from temporary hearing loss to permanent damage to the vestibular system.  Here are the categories of damage:

1. Cochlear system: short or long term hearing loss, tinnitus, hearing distortion, hyperacusis, and more

2. Vestibular system: Vertigo, equilibrium disorders, dizziness, and more

3. Nervous system: with damage to the ears, damage to the nervous system and message processing can follow

4.  Ear structure damage: middle or outer ear damage, infections, etc.



What drugs are ototoxic?  Depending on the article, I've seen estimates from 200-800 different drugs as being ototoxic.  Some of the more common ones are chemotherapy drugs (cisplatin), certain beta-blockers, antibiotics, antidepressants, aspirin, and diuretics.  Not all drugs within these classes are ototoxic, but some are.  If you're on any kind of prescription medicine, check with your physician about ototoxic side effects and whether there are other alternatives with non hearing related consequences.  In addition, one's absorption of the drug impacts the side affects, as well as any genetic propensity for hearing loss, kidney damage, or exposure to loud sounds.  Frequency and dose are also factors.  As always, talk with a physician if you believe your medication to be impacting the structures of your ear negatively.

Here are some more resources: 

Drug Induced Otoxocity from Merck

Pharmacological Drugs Inducing Ototoxicity: An updated guide This is a very thorough and scientific article examining this issue from the European Review for Medical and Pharmacological Sciences.

Ototoxicity- the Hidden Menace by Neil Bauman.  Although this is an older article, it shares some of the narratives of ototoxicity and many of the specific drugs impacting the ears.


Summer Festival (and general life) Survival Guide

Last month, I wrote up a brief informational sheet about self-care and overuse injuries for a summer festival.  While most of you regular readers will be familiar with these concepts, I thought I'd give you the option to read the highlights of the article, and also have the pdf download.  (huzzah!)  

PDF to Download! 


Did you know?

-Musicians often live with a certain amount of expected pain.  Not to paint a depressing picture for you, but a 1998 Survey of Symphony and Opera musicians by ICSOM (International Conference of Symphony and Opera Musicians) revealed that 76% of musicians during the course of their career had at least one medical condition compromising performance.  As musicians, we tend to underestimate the sheer mechanical repetition needed in order to perform in our jobs-many traditional symphonic works are thousands of measures long, requiring hundreds of notes per minute.  (Remember this post on statistics?)

-Overuse is a blanket term for muscle, tendon, ligament, bone, and joint issues which are induced through repetitive motion beyond typical limits.  Tendonitis is most common, which is an inflammation of the connective tissue that connects muscle to bone.


-Move more! Exercising can't undo 6-8 hours of sitting, so add more movement to your day.  Walk more often, take the stairs, carry things- don't take the easy route unless you need to. Your body molds itself like silly putty to the shapes that you put it in-choose wisely (and move diversely)!

- Do simple mobility and stretching every day.  Stretching may not seem like the coolest thing to do at breaks or between rehearsals, but movement can make a big difference in maintaining healthy tissues.  In addition, try to warm up before serious practicing or rehearsals to increase blood flow.  Also keep in mind that when you can't control the amount of rehearsals you have in a given day, self-care should be a priority, not an add-on!

-Use your ischial tuberosities (your sitting bones!).  This Katy Bowman video is my personal favorite for explaining how to sit better, as opposed to sitting on your sacrum.  Poor alignment in sitting (especially if you rehearse more than 6 hours a day) can lead to many other musculoskeletal issues, including back pain and neck pain.

-Get a massage or try self-massage.   If you have residual knots, adhesions, or tight spots in your upper back, consider a serious deep tissue massage, myofascial release, or rolfing session.  Restriction in the trapezius and upper back can affect your whole upper body (shoulders, neck, forearms, etc.).  A good session can restore normal range of motion and increase blood flow as well as remove adhesions in the soft tissue.  Rolling on balls (YTU®, lacrosse, pinky) can also be incredibly helpful as well!

-Sleep more than 6 hours a night. Sleep is when your body takes on cellular repair, renewal, detoxing (!!), and provides rest for your vital internal organs.  When you don't sleep enough, you’re hungrier, more vulnerable to illness, less focused, increasing your odds for injury and disease, and preventing your cells from repairing adequately, which is important when you're playing often.  Sleep often gets sacrificed in the summer for revelry, which is great, until your forearm muscles feel like you've been doing crossfit "musician-style," and your body runs on a combination of all-day caffeine and nocturnal alcohol.

-Drink lots of water. Your body is 60% water, which is essential for cellular operation.  If you're in hot, humid weather, you need to drink more, and if you're moving and exercising in the heat, even more.  Keep in mind that soda, caffeine, and alcohol can contribute to dehydration, and that water helps in the cellular regeneration process.

dB Danger Zone chart!

dB Danger Zone chart!

-Protect your ears in ensembles.  Sounds above 140 decibels cause immediate damage to your auditory sensory receptors, and normal conversational levels are 60-70 dB.  Flutes and piccolo are between 111 to 145 dB, trumpets can reach up to 140dB, and a full orchestra can be between 120-150 dB.  We all know that hearing loss can be permanent, so wear earplugs if you're in the line of fire and ask for a sound shield.  I love the Etymotics brand, but even cheap foam ones can prevent damage.  Your hearing is not only the basis of your musical career, but a primary mode of our verbal communication

    Overall, pay attention to your body, your tissues, and your pain signals.  Pain is your body's way of telling you that something is not working in your movement patterns, habits, or duration of activity.  Shooting pains, numbness, and tingling are warnings of bigger potential issues, and you should stop playing immediately and see a medical professional if these are occurring.  No festival rehearsal schedule is worth long-term tissue damage, nor is a competition, a recital, or any other concert engagement.

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