A musicians’ hearing assessment is not a musicians’ assessment

For years I referred to what I do with a musician to be a “musician’s HEARING assessment”.  Recently I have seen the error in my ways and now call it a “musician’s assessment”.  This may seem trivial, but it is a better reflection of what I can offer to musicians.

The word “hearing” denotes that I am interested in hearing, and, while this is true, this is far from the entire picture.  Much of what is discussed has to do with strategies to improve room acoustics, tinnitus counseling, education about psycho-physics; latest results in neurobiology and neuropathology; and the politics of advocacy.

It seems that I am doing much more counseling now than I did in the past.  The topics appear to be divided between counseling young people and counseling those over 40.  The “young people” counseling is based on allaying their fears that they may be unable to continue their musical careers because they already have tinnitus and are uncertain what the future will hold.  The “over 40” counseling is much more complex, so thank goodness I work closely with a physician/musician who has remarkable counseling skills.  The “over 40” issue typically is “my parents wanted me to be a lawyer or dentist and I agreed to do it, but I really want to play music”.

I know that I was one of those “parents” with my son who is passionate about music.  I “encouraged” him to go into computer science, but after two years he came to me and said that he wanted to go to the Berklee School of Music in Boston.  I happily agreed.  After all, I didn’t want him to turn 40 and look back and say “I should have done this or that”.  He is now a wonderful composer for films and video games and enjoying every minute of his chosen work.

Part of my “over 40” counseling involves providing information.  For example, I can tell people about Internet-based evening courses from the Berklee School of Music that explain the latest in harmony and counterpoint.  There are also a number of computer-based “composition” programs ranging from “Protools” and “LogicPro” to “Garage Band” and any number of freeware programs that can assist people in music composition.  And it’s amazing how many community orchestras and bands are looking for woodwind players and violinsts.  Being over 40 is  no longer a reason to nurse regrets about not having done something when you were 20.  Do it now! It’s never too late to learn to play a musical instrument!

Counseling those under 40 and who are concerned about what their future might look like as a professional or semi-professional musician is right down audiology’s alley.  In my 30 years working with musicians, I have never told someone to stop playing their music.  There is always some technical innovation (hearing protection, personal amplified mixer with an array of microphones, personal monitoring, and even specially designed hearing aids) that is waiting in the wings to help out our clients.

Counseling those under 40 includes providing information based on sound knowledge of psycho-acoustics and room acoustics.  For example, having a large temporary threshold shift (TTS) after a gig does not necessarily mean that that that person is any more or any less susceptible than those without TTS  to permanent hearing loss (PTS) in the future.  TTS is simply not a predictor of long-term hearing loss.  The same can be said of tinnitus.  Although we know far less about tinnitus than TTS, it would be erroneous to say that a person who has significant tinnitus after a gig has done himself permanent damage.  We don’t yet know as much about the clinical ramifications of tinnitus as I would like.  Telling our young clients that the tinnitus they experienced after their last gig is a harbinger of things to come is possibly erroneous and potentially damaging to their planned career in music.

After about 30 or 40 minutes, we finally get down to the “hearing” side of things.  Regardless of what audiometry tells us, most musicians I see can benefit from hearing protection.  This may mean using baffles or other environmental strategies or it may involve the use of personal hearing protection in the form of musicians’ earplugs–either custom-made or non-cust0m earplugs.  To convey how well accepted personal hearing protection has become, note that since 1988 when the first commercially available custom-made musicians’ earplugs became available (the Etymotic ER-15), over 1 million pairs have been made, and over 2 million non-custom ETY earplugs (available since 1992) have been sold.  And these numbers don’t include the other brands of musicians’ earplugs in the marketplace.

Our responsibility does not stop when the client leaves our office.  Much of what I do (alas, unpaid) is advocacy for the musician.  It is amazing how often I need to write letters and even meet with people who set policy to encourage them to ensure that a school room is as acoustically optimal as is possible for the school band teacher.

Hearing loss prevention remains the primary concern of hearing health care professionals when working with musicians, but musicians and those who want to be musicians have a very complex set of needs- many of which can be met by the expertise that audiologists and other hearing health care professionals bring to the table.