Hearing conservation and noise management practices in professional orchestras

Identifying barriers and facilitators of hearing protection use in early-career musicians: a basis for designing interventions to promote uptake and sustained use

OBJECTIVE

The current study aimed to: i) determine the patterns of hearing protection device (HPD) use in early-career musicians, ii) identify barriers to and facilitators of HPD use, and iii) use the Behaviour Change Wheel (BCW) to develop an intervention to increase uptake and sustained use of HPDs.

DESIGN

A mixed-methods approach using questionnaires and semi-structured interviews.

STUDY SAMPLE

Eighty early-career musicians (age range = 18-26 years; women n = 39), across all categories of musical instrument.

RESULTS

42.5% percent of participants reported using HPDs at least once a week, 35% less than once a week, and 22.5% reported never using HPDs for music-related activities. Six barriers and four facilitators of HPD use were identified. Barriers include the impact of HPDs on listening to music and performing, and a lack of concern about noise exposure. Barriers/facilitators were mapped onto the Theoretical Domains Framework. Following the systematic process of the BCW, our proposed intervention strategies are based on 'Environmental Restructuring', such as providing prompts to increase awareness of noisy settings, and 'Persuasion/Modelling', such as providing credible role models.

CONCLUSIONS

For the first time, the present study demonstrates the use of the BCW for designing interventions in the context of hearing conservation.

Description and evaluation of a hearing conservation program in use in a professional symphony orchestra

Professional orchestral musicians risk permanent hearing loss while playing their instruments. Protecting the hearing of these musicians in the workplace is critical to their ongoing ability to play their instruments, but typical workplace hearing conservation measures can have very damaging effects on the product (music) and the musicians' abilities to hear one another sufficiently. To enable effective intervention, orchestras as employers must encourage engagement with hearing protection programs and implement controls while preserving the integrity of the music. To achieve this, typical approaches used in other industries must be redesigned to suit this unique workplace. In response to these challenges, the Queensland Symphony Orchestra (Brisbane, Australia) introduced a comprehensive hearing conservation strategy in 2005 based upon best practice at the time. This strategy-which has been regularly refined-continues to be implemented on a daily basis. This investigation aimed to assess the successes, difficulties, and practical viability of the program. To achieve this a process evaluation was carried out, incorporating archival analyses, player and management focus groups, and an interview with the program's administrator. Results show the program has successfully become integrated into the orchestra's and the musicians' daily operations and significantly contributes to managing the risk of hearing loss in this population. While there is room for improvement in the orchestra's approach-particularly regarding usable personal protective devices and improved education and training, results are encouraging. This study provides a basis for those wishing to implement or evaluate similar paradigms.

Sound Practice-improving occupational health and safety for professional orchestral musicians in Australia

The Sound Practice Project is a 5-year study involving baseline evaluation, development, and implementation of musician-specific work health and safety initiatives. A cross-sectional population physical and psychological survey and physical assessment were conducted at the same time, with an auditory health assessment conducted later. The results were used to guide the development of a series of targeted interventions, encompassing physical, psychological, and auditory health components. This paper provides an overview of the project but focuses on the health findings arising from the cross-sectional survey. Three hundred and seventy-seven musicians from the eight professional symphony orchestras in Australia took part in the cross-sectional study (about 70% of eligible musicians). Eighty-four percent (84%) of musicians reported past performance-related musculoskeletal disorder (PRMD) episodes; 50% were suffering a current PRMD. Of the 63% who returned hearing surveys, 43% believed they had hearing loss, and 64% used earplugs at least intermittently. Noise exposure was found to be high in private practice, although awareness of risk and earplug use in this environment was lower than in orchestral settings. Improved strategic approaches, acoustic screens and recently developed active earplugs were found to provide effective new options for hearing protection. With respect to psychosocial screening, female musicians reported significantly more trait anxiety, music performance anxiety, social anxiety, and other forms of anxiety and depression than male musicians. The youngest musicians were significantly more anxious compared with the oldest musicians. Thirty-three percent (33%) of musicians may meet criteria for a diagnosis of social phobia; 32% returned a positive depression screen and 22% for post-traumatic stress disorder (PTSD). PRMDs and trigger point discomfort levels were strongly associated with increasing severity of psychological issues such as depression and music performance anxiety.

A clinical trial of active hearing protection for orchestral musicians

Orchestral musicians-an at-risk group for noise-induced hearing loss-have consistently reported great difficulty using hearing protection while performing or rehearsing, even when using earplugs specifically designed for musicians. A recent innovation in this field has been electronic earplugs that claim to deliver very high quality sound and only attenuate when sound levels become excessive. This study investigated these claims, aiming to determine whether professional orchestral musicians were able to use these devices and whether they were preferred to existing earplugs. Initially clinical and laboratory testing was carried out on the devices, indicating some spectral alteration of processed sound occurred, however claims of attenuation properties were validated. Following this, 26 orchestral musicians used the devices during rehearsals and performances for at least four weeks, providing feedback throughout this period. While musicians preferred the devices to previous earplugs, they identified issues including difficulty with orchestral balance, perception of dynamics and quality of sound provided by the devices. Results indicate these earplugs are a very positive step towards a usable hearing conservation tool for orchestral musicians to use in conjunction with other risk mitigation measures.

Sound exposure of professional orchestral musicians during solitary practice

It is broadly acknowledged that professional orchestral musicians risk noise-induced hearing pathologies due to sound exposure in rehearsal and performance. While much has been published regarding orchestral sound levels, little is known of the sound exposure these musicians experience during solitary practice, despite the many hours they spend engaged in this activity. This study aimed to determine sound exposure during solitary practice of 35 professional orchestral musicians, representing players of most orchestral instruments. To allow cross-comparison, participants were assessed playing similar repertoire in a controlled environment, recording simultaneously at each ear to determine sound exposure levels. Sound levels were recorded between 60 and 107 dB L(Aeq), with peak levels between 101 and 130 dB L(C,peak). For average reported practice durations (2.1 h per day, five days a week) 53% would exceed accepted permissible daily noise exposure in solitary practice, in addition to sound exposure during orchestral rehearsals and performances. Significant inter-aural differences were noted in violin, viola, flute/piccolo, horn, trombone, and tuba. Only 40% used hearing protection at any time while practicing. These findings indicate orchestral musicians at risk of noise-induced hearing loss in ensemble face significant additional risks during solitary practice. Data presented will enable more effective and targeted management strategies for this population.