Musicians, our medical colleagues, and the dose…

I just returned from the Performing Arts Medical Association ( conference in Snowmass, Colorado, and I was the only audiologist there.   Of the hundred or so people, there were physiotherapists, occupational therapists, orthopedic surgeons, rehab. medicine/physiatry specialists, family doctors, and quite a few musicians and musician educators.  The conference underscored our duty to educate our colleagues in different fields about what we do, and what our training is.  There was a case report about a drummer with strained wrists and elbows.  Occupational therapists, physiotherapists, physicians of every type, and drumming instructors, were involved in trying to get to the “diagnosis”.  I had actually seen many drummers in this situation over the years and have published on this issue in the distant past.  The problem was that this drummer had read in Modern Drummer (a magazine for drummers) that he should be wearing hearing protection.  After using his father’s industrial strength foam earplugs he started to notice wrist strain.  It’s pretty obvious that the foam earplugs removed so much of his cymbal and rim shot sounds that he started hitting harder.  The wrist issue is a hearing/monitoring issue.  And it’s something that I have written about in the distant past.  (I believe that my article was entitled “the wrist sings the blues”).   When the drummer is fit with the proper form of hearing protection- not as much to lose the monitoring ability, but enough to still hear his music at a safe level (e.g. the ER-25)- the wrist and arm problems cease.   I am always amazed how our audiology training is half theory, half practical, and half common sense.  The high point of the conference for me was the delightful task of having to remind our colleagues in other, seemingly unrelated fields, what an audiologist is.  The beer at 10,000 feet was also pretty good.

And not to forget the educational component… our jobs in the realm of hearing loss prevention would be so much easier if when we damaged our hearing, blood would gush from our ears.  It would be messy, but the immediacy would drive home the hearing loss prevention point.  Alas, hearing loss is not so messy.  I still feel that the best way to educate the musician (and our colleagues who are also involved in the care and treatment of musicians) is to underscore the difference between loudness and intensity.  Rock and roll needs to be loud.  That is perfectly true and that should never change.  But, rock and roll does not need to be intense.  Improved monitoring (with increased bass response, increase vibro-tactile response, and in ear monitors) all serve to delude the musician into thinking that something is sufficiently loud, but not overly intense.  Reminding some of our colleagues that a toilet flushing (with your head in the bowl) is 85 dBA can humorously drive home the point that a potentially damaging level is not necessarily loud.

And let’s not forget the dose… after all, its the dose that we are concerned about and not the spot intensity.  We should encourage musicians to wear hearing protection.  If they only want to wear it during practice and rehearsals, (and not during a performance) I see nothing wrong with that, as long as the cumulative dose does not exceed 100%.  The treating of musicians with respect is something that is sometimes forgotten.



About Marshall Chasin

Marshall Chasin, AuD, is a clinical and research audiologist who has a special interest in the prevention of hearing loss for musicians, as well as the treatment of those who have hearing loss. I have other special interests such as clarinet and karate, but those may come out in the blog over time.