Volume 17 - 2008
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Lessons From Music


Center Helps Prevent

Hearing Loss

Through

Awareness

By
Ellen Rossetti

Texas Center for Music and Medicine

The Texas Center for Music and Medicine, founded at UNT in 1999, is dedicated to studying, treating and preventing musicians' health problems. Researchers and clinicians within the UNT System, including faculty from the UNT College of Music, the UNT College of Arts and Sciences and the UNT Health Science Center at Fort Worth, conduct interdisciplinary research and provide clinical treatment to musicians in the North Texas region.

The Texas Center for Music and Medicine has conducted research on several issues important to musicians' health, including easing strain on small-handed pianists by using smaller keyboards, measuring mouthpiece pressure to reduce longterm negative effects for people who play wind instruments, and helping musicians deal with the mental and emotional pressures of the profession.

Kris Chesky

Photo by: Jonathan Reynolds

Kris Chesky, director of education and research at UNT's Texas Center for Music and Medicine, has made it a priority to educate musicians and others about the dangers of noise-induced hearing loss.

As a music professor at Western Illinois University in the mid-1990s, John Murphy continued his own education by taking an electronic music class to learn about digital recording. One day, his professor played tones of gradually increasing frequency, eventually causing the undergraduates around him to wince and cover their ears.

But Murphy didn't hear anything.

As it turned out, the saxophonist had a condition common to professional musicians — the 4k notch, meaning he had a dramatic drop in hearing sensitivity. Years of playing in jazz, rock and Latin bands and going to events with amplified music had taken a toll. The episode woke him up, he says, to the serious risk of noise-induced hearing loss in musicians.

"There is no tool more crucial for a musician than hearing," says Murphy, now a University of North Texas professor of music who uses musicians' earplugs whenever he plays or listens to loud music and encourages students to do the same. "If the training of musicians is degrading students' ability to hear well, then something has to change."


A Pervasive Problem

Kris Chesky has heard this story too often from people across the country. As director of education and research at the Texas Center for Music and Medicine at UNT, Chesky has made it his mission to educate people about the risk of noise-induced hearing loss in musicians, preparing them for longer careers and healthier lives.

Kris Chesky shows music students how to use earplugs during music practice

Photo by: Jonathan Reynolds

Kris Chesky, right, shows music students Trevor Neal and Eri Yoshimura how to use earplugs during music practice and performance. Chesky is surveying students who use musicians' earplugs to determine how they affect performance.

Musicians enclose themselves in tiny practice rooms, where they play for hours with the taps of snare drums banging off the walls, or they rehearse in ensembles where instruments blare into their ears. Chesky, who still plays trumpet professionally, knows how this dedication can backfire if caution isn't taken. He has noise-induced hearing loss himself.

About 28 million Americans have some form of hearing loss, and research by UNT and other organizations suggests 30 percent to 50 percent of musicians report hearing problems. To combat this, hearing-health education must begin in elementary school, Chesky says, and continue through college.

"This is about children in general — whether they work on a farm, ride motorcycles, mow lawns, play video games or listen to iPods," Chesky says. "Everything is loud these days, and kids are unaware of the related fundamental health issue."


Increasing Awareness

Facts About Noise-Induced
Hearing Lose

  • As many as 50 percent of musicians have problems with hearing loss.
  • Risk of injury is based on a combination of sound intensity and duration.
  • Listening to music, live or recorded, in performance or rehearsal, can result in significant exposure to high sound levels.
  • Hearing loss is cumulative: all sources (24/7) of elevated sound levels contribute.
  • Permanent noise-induced hearing loss is irreversible.
  • Temporary noise-induced hearing loss is reversible with adequate rest and recovery.

Last spring, UNT began distributing information to its students in instrumental ensembles, informing them of the possible danger of noise-induced hearing loss and advising them of resources to protect their hearing. Students are given tips such as reducing exposure time to sound levels above 85 decibels, wearing ear protection in noisy environments and resting their ears between exposures to loud sounds. Ensemble directors and teachers such as Murphy discuss noise-induced hearing loss and prevention methods with their students.

In addition, Chesky developed a course for undergraduate students of any major to learn about hearing and other occupational health issues. About 1,000 students have taken "Occupational Health: Lessons from Music" since it was first offered in 2006.

Chesky's research is being noticed by state and national organizations. The Texas Academy of Audiology is partnering with Chesky on a task force that will promote hearing conservation among school musicians in Texas.

"What Dr. Chesky did was bring awareness to the fact that noise from music is in fact potentially very dangerous to a person's hearing," says Ross J. Roeser, president of the Texas Academy of Audiology. "Efforts like his are bringing this to national attention."


Getting the Word Out

Tips For Short-Term Prevention of Hearing Loss

  • Listen to recorded music at moderate loudness levels.
  • Reduce exposure time to sound levels above 85 decibels.
  • Reduce repeated or cumulative exposure.
  • Protect yourself from exposure to hazardous sound environments.
  • Use ear protection in noisy environments.
  • Rest the ears between exposures to loud sounds.


Tips For Long-Term Prevention of Hearing Loss

  • Get a baseline comprehensive audiological evaluation.
  • Follow up with annual checkups.
  • Know the symptoms of noise-induced hearing loss:
  • Temporary threshold shifts
  • Ear discomfort after exposure to loud sounds
  • Ringing and buzzing in the ears
  • Difficulty hearing in noisy environments

UNT's hearing-loss education and prevention programs are based on recommendations outlined by the university's Health Promotion in Schools of Music project, funded by such organizations as the National Endowment for the Arts and the Grammy Foundation. The recommendations were sent to all college-level schools of music that are accredited by the National Association of Schools of Music — more than 600 programs nationwide.

Chesky hopes to establish a public school-based health education program that allows for the opportunity to learn about excessive exposure to noise starting in first grade. Lessons about hearing health would be as common as lessons about washing your hands, putting on sunscreen or wearing a helmet when riding a bicycle, he says. In addition, he has proposed that general music education teachers should teach at least one lesson per semester about hearing health.

"In the most severe forms, noise-induced hearing loss can end a musician's career," says Brian Fligor, director of diagnostic audiology for Children's Hospital Boston and instructor in otology and laryngology at Harvard Medical School. "And most tragically, it is preventable but also a slowly developing, subtle problem."

Musicians tend to accept noise-induced hearing loss as either inevitable or non-existent, says Fligor, who has worked with Chesky through his association with the National Hearing Conservation Association.

"Both attitudes are problematic as they perpetuate the problem," Fligor says. "Dr. Chesky's work should combat both problematic views by raising awareness and hopefully encouraging musicians to do something about it by taking steps toward prevention."


Earplugs and Intensity Levels

Many audiologists and musicians recommend hearing protectors to dilute the sound.

"To date, there's not one piece of research to document how musicians respond to earplugs," Chesky says. "Do they cause you to play louder, less sensitively, not as soft? What do they do to the ability to perform? How do they feel? Can musicians hear themselves better or worse? Can they hear the blending with other musicians around them, which is critical?"

To answer these questions, Chesky has a grant from Etymotic Research Inc. that is providing 600 pairs of musicians' earplugs. Students fill out surveys while using them under experimental conditions and after using them in routine activities.

But the first step to educating people about the potential risk associated with music in an educational setting is disclosure, Chesky says. In September 2007, he began tracking intensity levels in four UNT rehearsal venues for 10 hours a day. So far, he has collected data on more than 500 rehearsals of groups that include UNT's nine lab bands, the Symphony Orchestra, the Wind Symphony, Symphonic Band and Concert Band.


What Can Be Done

Chesky recommended in the January 2008 issue of the Music Educators Journal that all high school and college ensemble instructors across the nation know the intensity levels produced in their ensembles and disclose the information to their students.

If the average intensity is too high, what can directors do? Chesky says that high average levels are directly related to musical dynamics. Increasing the percentage of time spent playing music at soft to medium dynamic levels lowers the average intensity levels. And in the end, an ensemble with a greater range and balance of musical dynamics is a more musical group.

But for this to work, everyone needs to be educated and supportive — from music directors to music competition judges to audiences, he says.

"We want to encourage the whole community to think about this."



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