Noise-Induced hearing loss among professional musicians

A Survey on Knowledge, Attitude & Practice of Yakshagana Mela Artists Towards Music-Induced Hearing Loss

Purpose

Yakshagana is a type of folk-art theatre portraying mythological and historical stories. It includes artists who play predominantly percussion instruments besides cymbals and harmonium. Professional musicians exposing themselves to deafening sounds are prone to develop noise-induced complications. [1] One such professional in the coastal districts of Karnataka state is a Yakshagana himmela (backstage) artist. There is no reported literature concerning these artists' hearing health and problems. Hence, the proposed study was aimed at developing, validating and assessing the Knowledge, Attitude and Practice (KAP )of Yakshagana Mela artists towards Music-Induced Hearing Loss (MIHL), a possible risk factor of their profession.

Method

This study was carried out on 139 yakshagana mela artists with a mean age of 41.63 years. It was conducted in two phases. In the first phase, an expert committee discussion was conducted to verify, modify and validate the questionnaire. The second phase included the administration of the developed questionnaire on the artists.

Results

The sum scores for each domain of KAP were computed. Scores above 80% were defined as good knowledge, practice, and a positive attitude. The findings of the study revealed that more than half of the participants demonstrated inadequate knowledge (63.3%) and negative attitude (63.7%), but a fair level of practice (65.4%).

Conclusion

From the outcome of the present study, it can be inferred that in spite of being in a profession with a high risk of MIHL, the participants considered hearing health as their least priority. The study illustrates the need for initiating hearing and conservation programs to improve awareness & combat music induced hearing loss in this population.

An acoustical environment survey of student music practice

Chronic exposure to loud sound leads to noise-induced hearing loss. This is especially common in collegiate-level musicians. Existing methods for estimating exposure typically do not consider genre- or instrument-specific variability in soundscape/spectral characteristics. We measured sound exposure levels (SELs) across instruments, bands, and genres at a university music school. We found (1) considerable variability in SELs across instruments and bands, (2) that Jazz musicians are consistently exposed to the highest sound levels, and (3) that spectral features of music differ between instrument type and genre, and based on room size. These findings highlight the need for tailored guidelines that moderate the implementation of hearing conservation initiatives for collegiate musicians.

Parameters influencing auditory fatigue among professionals working in the amplified music sector: noise exposure and individual factors

OBJECTIVE

Hearing disorders are common among music professionals, as they are frequently exposed to sound levels exceeding 100 dB(A). By assessing auditory fatigue, situations that are deleterious for hearing could be identified, allowing the deployment of preventive measures before permanent impairment occurs. However, little is known about the factors contributing to auditory fatigue. The objective is to determine the exposure parameters most influencing auditory fatigue during occupational exposure to amplified music.

DESIGN

Auditory fatigue was defined as variations of both pure tone auditory (ΔPTA) and efferent reflex thresholds (ΔER) during the workday. Noise exposure was monitored and information on the volunteers was gathered using a questionnaire.

STUDY SAMPLE

The population consisted of 43 adult volunteers exposed to amplified music (sound, light or stage technicians, security agents, barmen) and 24 unexposed administrative agents.

RESULTS

ΔPTA and ΔER were positively correlated with the energy of noise exposure and its stability over time, i.e a steady noise tends to create more auditory fatigue.

CONCLUSION

In addition to a global decrease of music levels and a systematic use of hearing protection, our results advocate for the provision of quiet periods within noise exposures as they reduce auditory fatigue accumulation and long-term risks for hearing.

Prevalence of hearing protection use and subjective auditory symptoms among Spanish classical orchestral musicians

INTRODUCTION

Sensorineural hearing loss caused by exposure to noise is one of the most frequent causes of deafness. Professional musicians have significant occupational exposure to high levels of noise. Use of hearing protection among musicians could substantially prevent hearing damage, though the rate of use is quite low.

METHODS AND MATERIAL

A questionnaire on the use of protective hearing devices, hearing care, and subjective judgments of hearing difficulties was completed by a group of classical musicians from Spain. We analysed the frequency of device use by instrument based on contingency tables analysed by χ² tests.

RESULTS

One hundred and ninety-four Spanish classical orchestral musicians voluntarily completed the questionnaire. The percentage of musicians who reported using hearing protection in our survey was very low and varied with the type of instrument played. However, we found a high prevalence of subjective auditory disorders within this group.

CONCLUSION

Few Spanish musicians use hearing protection. Training on hearing-loss prevention in this field and better protective devices could increase device use and improve the auditory health of this group.

Health education in conservatoires: what should it consist of? Findings from workshops with experts (Part II)

Although health education programmes have been implemented in higher music education (HME) and their evaluations published in peer-reviewed journals, guidelines as to what ought to be included in these programmes are still missing. This study aimed to document expert discussions on the content of an ideal health education curriculum for HME students in the UK, integrating critical thinking. Four interdisciplinary workshops were conducted, where 67 experts in relevant fields took part, and were asked to discuss four lists of topics and concepts created based on literature reviews (cognitive biases, logical fallacies, critical appraisal tools and health topics). Only the list on health topics is relevant here. Notes taken by the participants and ourselves were thematically analysed. Four themes were identified, two of which are reported in this paper: (i) The health education curriculum and (ii) A settings-based approach to health. Part I of this project (published elsewhere) is focussed on the critical thinking content of health education for conservatoire students. The present paper focusses on the ideal health education curriculum and its implications for the wider context of health promotion.

A Smartphone-Based Assessment of Hearing Impairment among Students of a Medical College, Delhi, India- A Cross-Sectional Study

Introduction

The burden of hearing impairment in India is substantially high, largely preventable, and avoidable. The present study aimed to estimate the prevalence of hearing impairment using a smartphone-based tool among medical students and to study the factors associated, including personal audio device usage in a medical college hospital in Delhi, India.

Material and Methods

We conducted a cross-sectional study among undergraduate medical students. The study participants were enrolled via. Stratified random sampling. We assessed hearing impairment via-HearWHO application with scores ranging from a minimum of 0 to a maximum of 100 with categorization into i) above 75 ii) 50-75 iii) below 50. A p-value less than 0.05 was considered statistically significant.

Results

A total of 96 study participants were included, with the mean age of study participants as 20.3±1.4 years. On assessment with HearWHO, 36 (37.5%) were in the category of score above 75, 51 (53.1%) in score category 50-75, and 9 (9.4%) in score below 50. The overall mean score of the hearing assessment was 68.9±13.4 (Range: 12 to 94). Among the earphone device users, 27.1% do not comply with volume alerts on user devices.

Conclusion

Among the study population, 9.4% of the study participants were likely to be having hearing loss and 53.1% should be screened regularly for hearing impairment. Addressing hearing loss remains crucial among the young population, especially the medical professionals, which is feasible and imperative in the current scenario.

Preferred music-listening level in musicians and non-musicians

The purpose of this study was to establish whether preferred music-listening level differed between musicians and non-musicians, and whether preferred music-listening level was related to music genre preference and lifetime noise exposure. Seventeen musicians (mean age = 29.06 years, SD = 4.74; female n = 9) and 17 non-musicians (mean age = 28.94 years, SD = 4.63; female n = 9) with clinically normal hearing were recruited to listen to six music samples from different genres and one sample of environmental sounds. Participants adjusted the listening level [dB(A)] until the music was loud and enjoyable. This was repeated three times and an average was taken. Lifetime noise exposure was estimated using the Noise Exposure Structured Interview. Preferred music-listening levels of musicians were significantly higher than non-musicians. The preferred music-listening level differed with genre preference, with the participants' favorite tracks being played at 11 dB higher level than the least favorite tracks. There was also a positive correlation between lifetime noise exposure and preferred music-listening level. Musicians prefer to listen to music at higher level than non-musicians and thus may be more susceptible to noise induced hearing loss than non-musicians. As such, musicians in particular would benefit from simple changes in lifestyle and listening habits, including increased awareness of the risks of higher listening levels, as well as the use of hearing protection.

The comprehensive audiological evaluation in young violinists: the medial olivocochlear system, high frequency thresholds, and the auditory figure ground test

PURPOSE

The aim of this study was to examine whether the medial olivocochlear hearing system functions, the high frequency hearing thresholds and speech discrimination in noise performance can guide us in assessing the risk of hearing loss among violinists. It is aimed to investigate possible hearing damage that is not reflected in pure tone hearing thresholds in violinists.

METHODS

The participants (n = 50) who have normal hearing and the ages of 18-30 were included in this study in two groups: violinists and controls who are unrelated to music. High frequency audiometer, auditory figure ground test (AFG) for speech discrimination in noise performance, Distortion Product Otoacoustic Emission (DPOAE) and contralateral suppression on DPOAE for medial olivocochlear system function tests were applied to all participants as well as routine audiological tests.

RESULTS

The high frequency hearing thresholds were obtained higher in violinists compared to the controls. In violinists, the AFG test scores and the suppression amount at 1 kHz were lower than the controls. In addition, DPOAE responses at 4-6 kHz were obtained lower in violinists (p < 0.05).

CONCLUSION

The reason for high frequency hearing loss, decreased DPOAE response amplitudes, and poor medial olivocochlear function in violinists can be explained by the long-term exposure to high-level noise caused by the violin, one of the closest musical instruments. Routine and comprehensive audiological follow-up is crucial for musicians.

Surrounded by Sound: The Impact of Tinnitus on Musicians

AIM

To investigate the impact of tinnitus on professional musicians in the UK.

BACKGROUND

Tinnitus is the experience of sound when an external source is absent, primarily associated with the ageing process, hearing loss, and noise exposure. Amongst populations exposed to industrial noise, noise exposure and noise-induced hearing loss (NIHL) have been found to be the factors most associated with tinnitus. The risk of NIHL amongst professional musicians is greater than that amongst the general population, meaning they may be at increased risk of tinnitus.

METHODS

Seventy-four professional musicians completed an online survey involving closed and open-ended questions, and completed the Tinnitus fuctional Index (TFI) questionnaire. Descriptive statistics and thematic analysis of open-ended qualitative responses were used to analyse the data.

RESULTS

Three themes were generated from the analysis of the responses to the open-ended questions. These themes were: (1) the impact of tinnitus on the lives of professional musicians, (2) professional musician experience of tinnitus services, support, and hearing health and safety, and (3) the support professional musicians want. The mean global TFI score for professional musicians was 39.05, interpreted as tinnitus being a moderate problem. Comparisons with general population data revealed lower TFI scores for the TFI subscales of 'sense of control' and 'intrusiveness' for professional musicians and higher for auditory difficulties associated with tinnitus amongst professional musicians.

CONCLUSION

Tinnitus can negatively impact on professional musicians' lives. There is a need for bespoke self-help groups, awareness raising, and education to prevent tinnitus and promote hearing health among musicians.

Patterns of noise exposure and prevalence of hearing loss amongst Cape Town Minstrel Carnival musicians

Background

Cape Town Minstrel Carnival is one of the oldest and most authentic indigenous New Year’s customs in South Africa. Musicians who perform at this carnival are exposed to excessively loud music and therefore at a risk of acquiring noise-induced hearing loss (NIHL).

Objectives

This study aimed to determine patterns of exposure to loud music and prevalence of hearing loss amongst Cape Town Minstrel Carnival musicians.

Method

A descriptive, observational exploratory survey design was used and 43 participants (21 males and 22 females; mean age, 21 ± 9 years) took part in this study. Sound level measurements were conducted to assess musicians’ sound exposure during rehearsals and performances. All participants underwent the following audiological test battery at least 2 h before music exposure: Case history, otoscopic examination, tympanometry, pure tone audiometry and distortion products otoacoustic emission (DPOAE).

Results

Average noise levels recorded were 86 dBA during rehearsals and 98.7 dBA at performances and average durations of exposure were 240 and 10 min at rehearsals and performances, respectively. One out of 43 (1/43) participants presented with sensorineural hearing loss. Audiometric results of the remaining participants were normal and did not show a pattern suggestive of NIHL. A high proportion of participants (21/43) reported experiencing tinnitus.

Conclusion

Despite being exposed to high levels of noise, there was a low prevalence of hearing loss amongst these musicians. However, a high proportion of them reported tinnitus, which could be an indication that they were at a high risk of NIHL from the music that they played.

Loud Music and Leisure Noise Is a Common Cause of Chronic Hearing Loss, Tinnitus and Hyperacusis

High sound levels capable of permanently damaging the ear are experienced not only in factories and war zones but in concert halls, nightclubs, sports stadiums, and many other leisure environments. This review summarizes evidence that loud music and other forms of "leisure noise" are common causes of noise-induced hearing loss, tinnitus, and hyperacusis, even if audiometric thresholds initially remain within clinically normal limits. Given the huge global burden of preventable noise-induced hearing loss, noise limits should be adopted in a much broader range of settings, and education to promote hearing conservation should be a higher public health priority.

Acute Recreational Noise-Induced Cochlear Synaptic Dysfunction in Humans With Normal Hearing: A Prospective Cohort Study

Objectives

The objective of the study was to identify the acute high-intensity recreational noise-induced effects on auditory function, especially the cochlear synaptopathy-related audiological metrics, in humans with normal hearing.

Methods

This prospective cohort study enrolled 32 young adults (14 males and 18 females); the mean age was 24.1 ± 2.4 years (ranging from 20 to 29). All participants with normal hearing (audiometric thresholds ≤25 dB HL at frequencies of 0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz for both ears) had already decided to participate in the outdoor music festival. Participants were asked to measure the noise exposure dose and complete auditory examinations, including the air-conduction pure-tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), contralateral suppression (CS) on transient evoked otoacoustic emission (TEOAE), auditory brainstem response (ABR) test and Mandarin Hearing in Noise Test (MHINT), at baseline and 1 day and 14 days after music festival noise exposure.

Results

The mean time of attending the music festival was 7.34 ± 0.63 h (ranging from 6.4 to 9.5), the mean time-weighted average (TWA) of noise exposure dose was 93.2 ± 2.39 dB(A) (ranging from 87.9 to 97.7). At neither 1 day nor 14 days post exposure, there were no statistically significant effects on PTA thresholds, DPOAE amplitudes, CS on TEOAEs, or MHINT signal-to-noise ratios (SNRs) of acute outdoor music festival noise exposure, regardless of sex. While the ABR wave I amplitudes significantly decreased at 1 day after exposure and recovered at 14 days after exposure, the exposed/unexposed ABR wave I amplitude ratio was significantly correlated with MHINT SNR change at 1 day after exposure, although it was not correlated with the noise exposure dose.

Conclusion

In young adults with normal hearing, we found the self-compared decrement of ABR wave I amplitudes at 1 day post acute recreational noise exposure at high intensity, which also contributes to the change in speech perceptual ability in noisy backgrounds. This study indicated that auditory electrophysiological metric changes might be a more sensitive and efficient indicator of noise-induced cochlear synaptic dysfunction in humans. More attention should be paid to the recreational noise-induced cochlear synaptopathy and auditory perceptual disorder.

Association of occupational noise exposure, bilateral hearing loss with hypertension among Chinese workers

OBJECTIVE

To evaluate the relationship of occupational noise, bilateral hearing loss with blood pressure and hypertension among a Chinese population.

METHODS

We included 15 422 individuals from a cross-sectional survey of the key occupational diseases in 2017 in Wuhan, Hubei Province, China. Occupational noise exposure was evaluated through workplace noise level and/or the job titles. Hearing loss was defined as a pure-tone average of 25 dB or higher at speech frequency (0.5, 1, 2 kHz) or high frequency (3, 4, 6 kHz) in both ears. Hypertension was defined as blood pressure at least 140/90 mmHg or self-reported current use of antihypertensive medication.

RESULTS

Compared with participants without occupational noise exposure, the prevalence of hypertension was significantly higher for noise exposure duration of 5 to less than 10 years [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.27] and at least 10 years (OR = 1.17, 95% CI = 1.09-1.30). In the sex-specific analysis, the association was significantly pronounced in male (OR = 1.18, 95% CI = 1.06-1.32 for duration of 5 to <10 years; OR = 1.25, 95% CI = 1.12-1.38 for duration ≥10 years), but not in female (OR = 1.01, 95% CI = 0.80-1.11 for duration of 5 to <10 years; OR = 1.06, 95% CI = 0.90-1.20 for duration ≥10 years). In the subsample analyses, bilateral hearing loss was associated with a higher prevalence of hypertension, no matter for speech frequency hearing loss (OR = 1.12, 95% CI = 1.02-1.30 for mild; OR = 1.35, 95% CI = 1.20-1.50 for severe) or for high-frequency hearing loss (OR = 1.24, 95% CI = 1.03-1.50 for mild; OR = 2.40, 95% CI = 1.80-3.17 for severe). The sex-subgroup analysis of hearing loss with hypertension was similar as occupational noise and hypertension.

CONCLUSION

Our study has suggested occupational noise exposure is a potential risk factor for hypertension.

Assessment of noise level and risk of hearing loss among taiko musicians

Introduction:

taiko music is performed with specific drums, which produce loud and low-tone sounds that can potentially lead to hearing risk.

Objectives:

To assess sound pressure levels and hearing safety of musicians who play in taiko groups.

Methods:

Using a decibel meter, noise exposure was measured in two different groups (group 1 and group 2), which are divided into categories: (group 1 = five categories - junior, free, general a, general b, and master, and group 2 = two categories - adult and child). The calculation of the daily noise dose was based on the Brazilian Occupational Hygiene Standard 01, which establishes the following classification: acceptable dose (between 0 and 50%), above the action level (50 to 80%), uncertain dose level (80 to 100%), and above the acceptable level (more than 100%).

Results:

In group 1 categories, the daily noise doses obtained were: junior = 88%; general B = 423%; master = 218%; general A = 370%, and free = 150%. In the adult and children categories of group 2, the results were 127 and 17%, respectively.

Conclusions:

taiko musicians are exposed to daily noise doses above the safe level, except for the junior categories in group 1, and the children, in group 2 - which showed daily noise doses at an uncertain dose level, and at an acceptable level, respectively.

Musicians' Hearing Handicap Index: A New Questionnaire to Assess the Impact of Hearing Impairment in Musicians and Other Music Professionals

Purpose We aimed to develop and validate the Musicians' Hearing Handicap Index (MHHI), a new self-evaluation tool for quantifying occupation-related auditory difficulties in music professionals. Although pure-tone audiometry is often considered the "gold standard" and is usually employed as the main instrument for hearing assessment, it cannot fully describe the impact of hearing dysfunction. The MHHI is an attempt to complement the hearing impairment assessment toolbox and is based on a unique approach to quantify the effects of hearing-related symptoms or hearing loss on the performance of musicians and other music industry professionals. Method An initial set of 143 questionnaire items was successively refined through a series of critical appraisals, modifications, and suggestions. This yielded an intermediate questionnaire consisting of 43 items, which was administered to 204 musicians and sound engineers. After exploratory factor analysis, the final form of the MHHI questionnaire was obtained, consisting of 29 items. The questionnaire's test-retest reliability, internal consistency, discriminating power, content validity, criterion validity, and aspects of construct validity and inherent conceptual structure were assessed. Results Exploratory factor analysis revealed a combination of four common factors for the 29 validated questionnaire items. They were named "impact on social and working lives," "difficulties in performance and sound perception," "communication difficulties," and "emotional distress." The MHHI was shown to be a valid and reliable instrument to assess musicians' and sound engineers' occupational difficulties due to hearing impairment and related symptoms. Conclusion The ability of the MHHI to discriminate between groups of music professionals with different auditory symptoms or pure-tone audiometry thresholds suggests that auditory symptoms might influence a professional's performance to an extent that cannot be assessed by a pure-tone audiogram.

An overview of occupational noise-induced hearing loss among workers: epidemiology, pathogenesis, and preventive measures

Occupational noise-induced hearing loss (ONIHL) is the most prevalent occupational disease in the world. The goal of this study was to review the epidemiology, pathogenesis, and preventive measures of ONIHL among workers and provide evidence for the implementation of control measures. Literature studies were identified from the MEDLINE, PubMed, Embase, Web of Science, and Google Scholar using the search terms “noise-induced hearing loss” “prevalence”, “pathogenesis”, and “preventive measures”. The articles reviewed in this report were limited from 2000 to 2020. Articles that were not published in the English language, manuscripts without an abstract, and opinion articles were excluded. After a preliminary screening, all of the articles were reviewed and synthesized to provide an overview of the current status of ONIHL among workers. The mechanism of ONIHL among workers is a complex interaction between environmental and host factors (both genetic and acquired factors). The outcomes of noise exposure are different among individual subjects. Clinical trials are currently underway to evaluate the treatment effect of antioxidants on ONIHL. Noise exposure may contribute to temporary or permanent threshold shifts; however, even temporary threshold shifts may predispose an individual to eventual permanent hearing loss. Noise prevention programs are an important preventive measure in reducing the morbidity of ONIHL among workers.

The hearing health of live-music sound engineers

Most studies of hearing loss prevention in the music industry focus on the risk of hearing injury to musicians. However, live-music sound engineers (LMSE) may also be at risk of hearing injury due to their work-related sound exposure. We studied 27 LMSE, all of whom underwent otologic examination, including audiometry, distortion product otoacoustic emissions, speech discrimination and uncomfortable loudness levels, and completed a questionnaire investigating their history of sound exposure and use of hearing protectors. Hearing thresholds were significantly poorer than normative data across several frequencies, and a substantial proportion reported constant tinnitus (30%) and reduced sound tolerance (41%). Use of hearing protection was relatively low, with many reporting interference with their job when using it. Our results suggest that LMSE are at risk of hearing injury due to their work-related sound exposure.

Hearing Difficulties and Tinnitus in Construction, Agricultural, Music, and Finance Industries: Contributions of Demographic, Health, and Lifestyle Factors

High levels of occupational noise exposure increase the risk of hearing difficulties and tinnitus. However, differences in demographic, health, and lifestyle factors could also contribute to high levels of hearing difficulties and tinnitus in some industries. Data from a subsample (n = 22,936) of the U.K. Biobank were analyzed to determine to what extent differences in levels of hearing difficulties and tinnitus in high-risk industries (construction, agricultural, and music) compared with low-risk industries (finance) could be attributable to demographic, health, and lifestyle factors, rather than occupational noise exposure. Hearing difficulties were identified using a digits-in-noise speech recognition test. Tinnitus was identified based on self-report. Logistic regression analyses showed that occupational noise exposure partially accounted for higher levels of hearing difficulties in the agricultural industry compared with finance, and occupational noise exposure, older age, low socioeconomic status, and non-White ethnic background partially accounted for higher levels of hearing difficulties in the construction industry. However, the factors assessed in the model did not fully account for the increased likelihood of hearing difficulties in high-risk industries, suggesting that there are additional unknown factors which impact on hearing or that there was insufficient measurement of factors included in the model. The levels of tinnitus were greatest for music and construction industries compared with finance, and these differences were accounted for by occupational and music noise exposure, as well as older age. These findings emphasize the need to promote hearing conservation in occupational and music settings, with a particular focus on high-risk demographic subgroups.

Audiological findings in professionals exposed to music and their relation with tinnitus

Professional musicians are at high risk of developing tinnitus due to their over-exposure to music at both occupational and recreational level. This is a 5-year long prospective case series study performed in the Musicians/Performing Arts Medicine Clinic of the 1st Otorhinolaryngology Department of the National and Kapodistrian University of Athens. A total of 274 professional musicians underwent thorough medical history, history of music exposure, assessment of the impact their hearing status has on their professional life (Musicians Hearing Handicap Index), behavioral (Pure Tone Audiometry, standard and extended high frequency) and objective audiometric tests (TEOAE and DPOAE). Standard pure tone audiometry thresholds were correlated with the presence of tinnitus only at high frequencies. Musicians with tinnitus had a clinical and significant higher MHHI score and the incidence of tinnitus was significantly higher in participants suffering from musculoskeletal disease and those with abnormal PTA. Participants' hours of practice were similar in those with tinnitus and those without. The tinnitus group (and in order of descending effect size) had significantly worse thresholds in high frequency audiometry (≥3000Hz) as well as lower signal to noise ratios in DPOAE at almost all frequencies and in TEOAE at high frequencies (2.8 and 4kHz). A subgroup analysis of the musicians with normal PTA, showed that those with tinnitus showed elevated thresholds in the extended high frequency. In conclusion, tinnitus occurrence in musicians with normal audiogram is potentially correlated with high frequency hearing loss and impaired otoacoustic emissions and these two examinations should be considered in this group.

Performing Arts Medicine

Performing artists are a unique subset of athletes. With the highly repetitive nature of performance training, emphasis on proper technique, ergonomics, and preventive cross-training is vital, as many injuries are due to overuse or poor technique. There are novel medical concerns in performers, including ENT problems, mental health concerns and substance use risks. While music is central to performances, it is also a treatment modality to address cognitive, sensory, and motor dysfunctions in certain neurological conditions. Due to this wide array of issues, it is imperative to understand the specific needs and risks of performers to provide optimal medical care.

Socio-economic disparity in the global burden of occupational noise-induced hearing loss: an analysis for 2017 and the trend since 1990

OBJECTIVES

To evaluate socio-economic disparity in the global burden of occupational noise-induced hearing loss (ONIHL) using disability-adjusted life-years (DALYs).

METHODS

The numbers of DALYs due to ONIHL, age-standardised DALY rates and national human development index (HDI) data from 1990 to 2017 were collected. The relationship between the age-standardised DALY rates and the 2017 HDI was analysed. A concentration index (CI) and a relative index of inequality (RII) were calculated to evaluate the trend in socio-economic disparity in the burden of ONIHL for the period 1990-2017.

RESULTS

From 1990 to 2017, the global DALYs due to ONIHL increased from 3.3 to 6.0 million, with the highest growth occurring in low-income countries (110.7%). Age-standardised DALY rates due to ONIHL were negatively associated with the HDI (β = -0.733, p<0.001), and these rates were significantly higher in countries with a lower HDI. From 1990 to 2017, the trend in between-country inequality was flat with little fluctuation, the CIs stayed near -0.17, and the RIIs remained near 0.35.

CONCLUSIONS

Over the past few decades, low-income countries have experienced the most rapid growth in DALYs worldwide. A widening socio-economic disparity has persisted in the global burden of ONIHL, with a higher burden in lower socio-economic countries. These data suggest that more prevention programmes and healthcare services should be provided for developing countries.

Inflammatory and immunological changes caused by noise exposure: A systematic review

Today, due to the growth of industries and spread of the use of various instruments and devices that produce high noise levels, it is necessary to pay more attention to the effects of exposure to noise on organs and tissues in the body. The importance of the immune system in fighting external and pathogenic factors has raised the need to consider external factors (such as harmful physical factors) and make efforts to avoid producing them. In this systematic review, 811 potentially relevant studies were found in Google Scholar, PubMed, and Web of Science databases, of which 32 different English-written articles were included in the study. The method of searching and systematically reviewing articles was based on the assessment tool of the multiple systematic reviews (AMSTAR) method. The results of this study suggested that noise could affect the function of the immune system and its components by affecting other systems and organs of the body, including the central nervous system, auditory system, circulatory system, and endocrine gland. Moreover, it can be hypothesized that noise affects immune system by producing the NADPH oxidase (Nox) and reactive oxygen species (ROS).

Audiological and electrophysiological assessment of professional orchestral musicians

ABSTRACT Purpose: to verify whether the frequent musical exposure can impair peripheral and central auditory pathway responses in professional orchestral musicians. Methods: 45 male individuals from 19 to 40 years old participated in the study. They were divided into two groups: one comprising 30 orchestral musicians who played strings or wind instruments, and another with 15 nonmusicians. The two groups were submitted to both conventional and high-frequency pure-tone audiometry, transient-evoked otoacoustic emissions, and frequency-following response. The results were subjected to descriptive and inferential statistical analysis, using the one-way ANOVA unmatched samples parametric test, with a 5% significance level. Results: no significant differences were observed between the hearing thresholds in both conventional and high-frequency audiometry and frequency-following response. However, there were statistically significant differences between transient-evoked otoacoustic emission responses, with lower responses to musicians in comparison to the nonmusician group. Conclusion: the results suggest that frequent musical exposure experienced by orchestral musicians can impair the cochlear hair cells’ function. Therefore, audiological monitoring is important to detect subclinical impairments.

Risk of noise-induced hearing loss due to recreational sound: Review and recommendations

This review was conducted to address three questions related to recreational sound exposure: (1) what criteria are used to determine noise exposure limits, (2) are there differences in the risk of hearing loss from occupational noise versus recreational sound, and (3) what is an appropriate exposure limit for recreational sound? For the first question, most standards specify an 8-h occupational noise exposure limit (L_EX) of 85 dBA. This limit assumes that some workers exposed at the limit will develop hearing loss. To eliminate the risk of hearing loss, a 24-h equivalent continuous level (L_EQ24h) limit of 70 dBA is appropriate. For the second question, there is some evidence that the effects of occupational noise on hearing may be worse than energetically equivalent recreational sound. Limits developed for noise are nevertheless applicable to recreational sound, and use of existing statistical models to predict hearing loss from recreational sound is appropriate, with the caveat that these models are limited to durations ≤40 years. For the third question, a recreational sound limit of 80 dBA L_EX, equivalent to a 75 dBA L_EQ24h, will virtually eliminate the risk of recreationally induced hearing loss in adults. Lower limits may be warranted for vulnerable or susceptible individuals.

The Influence of Occupational Noise Exposure on Cardiovascular and Hearing Conditions among Industrial Workers

This study was conducted to estimate the current prevalence of hypertension, cardiovascular condition and hearing difficulty of workers exposure to occupational noise, and to analyze any associations between these abnormal signs and occupational noise exposure. The subjects included 5205 noise-exposed workers. Workers with high noise exposure were more likely to have a higher threshold value than low exposure ones (P < 0.05). Subjects in the high exposure group had a significantly higher risk of hypertension and hearing loss than the ones in low exposure group. Between the ages of 30 and 45, high-level occupational noise exposure led to a significantly raising risk of both hypertension (Adjusted OR = 1.59, 95% CI, 1.19-2.11) and hearing loss (Adjusted OR = 1.28, 95% CI, 1.03-1.60) when comparing to low-level noise exposure. In male workers, the prevalence of hearing difficulty in high exposure group was approximately 1.2 times worse than in low group (P = 0.006). In addition, exposure to high noise level demonstrated a significant association with hypertension and hearing loss when the duration time to occupational noise was longer than 10 years. Hypertension and hearing difficulty is more prevalent in the noise-exposed group (higher than 85 dB[A]). Steps to reduce workplace noise levels and to improve workplace-based health are thus urgently needed.

Prevalence of Noise-Induced Hearing Loss in Middle and High School Band Members: A Preliminary Study

OBJECTIVE

This study was aimed at determining the risk of developing noise-induced hearing loss (NIHL) in middle school band (MSB) and high school band (HSB) members.

METHOD

Between-group comparison of hearing thresholds. Eleven MSB members and 6 MSNB controls, 20 HSB members and 5 HSNB controls.

RESULTS

Sixty-four percent of school-age band members presented with 15 dB HL or greater notch at 4,000 or 6,000 Hz in at least one ear. The high school students were slightly more likely to present with a notch.

CONCLUSIONS

Results indicate that participation in band even as early as middle school increases the risk of developing NIHL, and that the longer the participation the higher the risk. Steps to insure hearing preservation in school-age band members are recommended.

University student musician noise-dosage study measuring both ensemble and full-day noise exposure

A risk factor shared by all musicians is a potential for noise-induced hearing loss. A study was conducted to explore what factors determine noise dosage during musical events experienced by college student musicians. First, noise exposure during specific activities was explored, including during ensemble rehearsal and personal practice. Next, full-day noise exposure was investigated by measuring levels experienced by student musicians during a typical daily routine. Factors such as instrument played, type of activity, location within ensemble, and room environment were related to noise dosage. Disparities in results using different standards to calculate noise dosage were also explored. Risk of noise overexposure was found to be greater in some instrument classes, such as wind instruments, than in others, such as string instruments, and can yield vastly different results depending on the metric used for noise dosage calculation.

Validation of clinical techniques for verification of uniform attenuation earplugs

OBJECTIVE

Uniform attenuation earplugs (UAE) theoretically provide near even attenuation across frequencies when built to a manufacturer's specifications. Unfortunately, there is no current research available confirming if custom-molded uniform attenuation earplugs (UAE) are made to specifications nor is there guidance available on clinical methods of measuring attenuation of uniform attenuation earplug (UAE) devices. The goal of this study was to evaluate different procedures for UAE verification and to determine the most accurate clinically accessible verification protocol.

DESIGN

Attenuation was measured using probe microphone techniques, as well as real-ear attenuation at threshold (REAT) measurements under circumaural earphones, soundfield speakers and supra-aural earphones. Comparisons were made to a reference system created in the laboratory.

STUDY SAMPLE

Seventeen adult participants, totaling 30 ears.

RESULTS

The results of this study demonstrate that the REAT measured in the soundfield using a narrowband noise stimulus with masking in the contralateral ear is currently the most accurate and widely available method of verifying UAEs.

CONCLUSIONS

Factoring in clinical efficiency, the authors of this study recommend verifying attenuation levels using a soundfield REAT procedure as best clinical practice. In addition, the data suggests that REAT measurements under circumaural earphones are an acceptable second choice method.

Hearing Loss, Tinnitus, Hyperacusis, and Diplacusis in Professional Musicians: A Systematic Review

Professional musicians (PMs) are at high risk of developing hearing loss (HL) and other audiological symptoms such as tinnitus, hyperacusis, and diplacusis. The aim of this systematic review is to (A) assess the risk of developing HL and audiological symptoms in PMs and (B) evaluate if different music genres (Pop/Rock Music—PR; Classical Music—CL) expose PMs to different levels of risk of developing such conditions. Forty-one articles including 4618 PMs were included in the study. HL was found in 38.6% PMs; prevalence was significantly higher among PR (63.5%) than CL (32.8%) PMs; HL mainly affected the high frequencies in the 3000-6000 Hz range and was symmetric in 68% PR PMs and in 44.5% CL PMs. Tinnitus was the most common audiological symptom, followed by hyperacusis and diplacusis. Tinnitus was almost equally distributed between PR and CL PMs; diplacusis was more common in CL than in PR PMs, while prevalence of hyperacusis was higher among PR PMs. Our review showed that PR musicians have a higher risk of developing HL compared to CL PMs; exposure to sounds of high frequency and intensity and absence of ear protection may justify these results. Difference in HL symmetry could be explained by the type of instruments used and consequent single-sided exposure.

Effects of Including Information about Hidden Hearing Loss in an Adopt-A-Band Program on College Band Members' Attitudes toward Healthy Hearing Behaviors

Young musicians may be at risk for developing cochlear synaptopathy (CS), or hidden hearing loss (HHL), that could lead to permanent music-induced hearing loss (MIHL). Patients with CS often complain of tinnitus and/or difficulty understanding speech in noisy situations, even though traditional audiometric testing indicates normal hearing. The aim of this article was to determine the effects of including information about HHL on an Adopt-A-Band program involving college band members' concern about and self-efficacy toward the prevention of MIHL. We conducted a single-blinded, randomized clinical trial. Forty-eight band members participated in this study. Band members were randomly assigned to two Adopt-A-Band presentations, one with and one without information on HHL. Including information about HHL had no effect on these band members' concerns about and self-efficacy toward the prevention of MIHL. However, the Adopt-A-Band program resulted in significantly increased concern for MIHL by 39.5% ( p  < 0.0001, 95% confidence interval [CI]: 25-54.2), self-efficacy in its prevention by 79.1% ( p  < 0.0001, 95% CI: 66.9-91.2), and plans to use musicians' earplugs while playing by 67.4% ( p  < 0.0001, 95% CI: 53.4-81.45). Although inclusion of information about HHL did not have a significant effect, the Adopt-A-Band program, in general, significantly increased the immediate intent of these students to practice healthy hearing behaviors. Future research is needed to determine the long-term effects of using the Adopt-A-Band program with university marching bands' use of healthy hearing behaviors.

Awareness of musicians on ear protection and tinnitus: A preliminary study

Music induced hearing loss (MIHL) is linked to chronic, extended exposure, and progress at a rate proportionate to exposure conditions. The aim was to document hearing deterioration; awareness of ear protection devices (EPDs); presence of tinnitus, measurement of temporary threshold shift. Thirty-four musicians filled a questionnaire regarding: years of experience, instrument/splayed, hours of music exposure per week with/without amplification, through earphones and speakers, use of EPDs and tinnitus. Hearing screening in five subjects was done before and after one hour and ten minutes of practice session. Among the participants, 8.8% reported hearing deterioration subjectively and 38.2% reported unilateral intermittent tinnitus, 79.4% lacked awareness about EPDs and 21.6 % were aware but never used them. Mean for temporary threshold shift at 500 Hz and 1 KHz was 5dB HL and 10dBHL at 2 KHz. Musicians are at risk for hearing problems, but the awareness on auditory damage is limited, hence conservative measures must be taken for their well being.

Work-Related Noise Exposure in a Cohort of Patients with Chronic Tinnitus: Analysis of Demographic and Audiological Characteristics

Work-related noise exposure is one of the major factors contributing to the development of adult-onset hearing loss and tinnitus. The aim of this study was to analyze, in patients with chronic tinnitus and long-term occupational noise exposure, (A) characteristics of hearing loss, tinnitus, comorbidities, demographic characteristics and a history of work-related noise exposure and (B) differences among individuals employed in occupations with high and low risk of developing work-related noise-induced hearing loss (NIHL). One hundred thirty six patients with chronic tinnitus and at least a 10 year-long working history were divided into two groups based on the risk of their profession to induce NIHL. Individuals employed in jobs at high risk for NIHL were mostly males and exhibited a poorer hearing threshold, more evident in the left ear. Tinnitus was mostly bilateral; the next largest presentation was left-sided; patients described their tinnitus as buzzing or high-pitched. Correlation between age, length of tinnitus and worse hearing was found. Patients with a higher degree of hearing impairment were mostly males and were more likely to have a family history of hearing loss and at least one cardiovascular comorbidity. Our study shows some differences in individuals with tinnitus and a history of a profession associated with increased exposure to NIHL compared to those without such a history.