Evidence based research and what actually works

Marshall Chasin
August 2, 2011

Recently the Performing Arts Medicine Association (www.artsmed.org) and the National Association of Schools of Music (NASM) have collaborated on hearing health for the performing artists.  These documents have just been placed on the NASM web site for administrators, faculty and students.  This is an important step in the communication of evidence-based health care topics relevant to musicians from students to professionals.  Please go to:   https://nasm.arts-accredit.org/index.jsp?page=NASM-PAMA_0_Drafts.  Commentary of some of these articles are sought after in hopes of making this a premiere evidence-based resource for the prevention of hearing loss in musicians.

But, will some of these strategies and approaches work?   It is one thing to recommend musicians’ hearing protection and quite another to see a classical musician actually wearing it while the conductor scowls at them throughout a performance.  Part of this is educating the conductor and artistic directors, but part is also knowing what the musicians want.

Recently I was asked about three guiding principles that I would recommend for an idealized (ideal?) hearing loss prevention program for those in the performing arts. These are my three guiding principles or directives:

(1)    Liaise with musicians- a change will be no change if it not acceptable.

(2)    Less in more- many small changes will generally be more acceptable than one large change.

(3)    Verify, verify, verify- a change that cannot be verified and demonstrated to the musician will not be acceptable.

These are common sense, but sometimes in our rush to do what is right, we do what is wrong… and I am certainly guilty of this.  Ideally we would want the suggestion for a change to come from the musician and not from the hearing health care professional. This is actually a precept of the art of negotiation- if the “other side” can be slowly drawn in to your point of view and if they are the ones to articulate it, then the job is done.

Less is almost always more, except in mathematics and perhaps in weight gain.  A small change that results in a 3 dB reduction “only” may not seem like a lot but the potential damage is halved.  And several small changes generally are much more acceptable than a major one.  It’s OK to say that a musician doesn’t need to wear their earplugs every moment that they are exposed to loud music.  Ideally that would be great, but realistically we have to cool it.  As I tell some of my hearing aid staff, “something is better than nothing”.

And like real estate being all about location, location, location… working with musicians is all about verify, verify, verify.  Not only is it educational for the musician and may help them “buy in”, but it confirms that the change makes sense too.

We’re on the same team but sometimes progress needs to be made going forward with the hand break on.

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