Hearing loss prevention is just that – hearing loss prevention.
What can be done today to ensure that 30 years from now you will still be able to hear, at least relatively well? We can tell a musician that they should turn down the volume, but they won’t listen to us – they are just not good listeners. Actually, it’s not just musicians; nobody likes to be talked at. Musicians are very good listeners but perhaps the things we want to tell a performing artist are not as well packaged. If you tell a musician (or a 14 year old kid) to turn down the music, a certain unnamed middle-of-the-hand finger will pop up, and quite frankly, I don’t blame them.
I just returned from a regional conference of the Performing Arts Medicine Association (PAMA) at the Cleveland Clinic in Cleveland, Ohio. (There are Cleveland Clinics in cities other than Cleveland, so I wasn’t being redundant in saying “in Cleveland”.) PAMA is an organization that typically has its annual meetings in Aspen, Colorado every July, but over the last several years has also had regional meetings in Cuba, Toronto, Cleveland, and some southern USA locations. In 2016, for the first time away from Aspen, the main annual conference will be in New York City (July 5-8, 2016) in conjunction with the Weill-Cornell Medical Center.
The focus of PAMA is injury prevention. This can be related to reducing hip strain due to unnatural turn-out for dancers, minimizing shoulder fatigue for violinists, or hearing loss prevention for all of those in the performing arts. In some sense, the issue of hearing loss isn’t just a sideline or something that will happen when a musician retires, but an overarching issue for all of those in the performing arts. Whether one is sitting in an orchestral pit with a 4-stringed noise generator by their left ear or a dance teacher who is spending 25 hours a day in the very loud dance studio, the issue of hearing loss is ubiquitous, but also invisible. Life for a hearing health care educator would be so much easier if blood gushed from the ears every time that the sound level was too high!
The most recent meeting of PAMA in Cleveland was well attended and had amazing content. Interestingly very few audiologists were in attendance other than a handful of audiology students. The audience was comprised of musicians, music educators, chiropractors, occupational and physiotherapists, and physicians of every stripe. Neurologists sat next to orthopedic surgeons, and otolaryngologists sat next to epidemiologists. Like many excellent conferences, one tends to learn almost as much from the person one sits next to, rather than just from the slate of speakers. I would like to hope that future PAMA meetings would attract more audiologists to their conferences.
Elements of my talk have changed dramatically over the last 30 years. This is also true of the talks given by my audiology colleagues at hearing loss prevention meetings around the world. In the 1980s I would try to talk about hearing loss and how evil noise and music was. Now, I have flipped my perspective and it’s more a matter of risk management – there is nothing wrong with going to a rock concert on Friday night, just don’t mow your lawn on Saturday. If your favorite song comes on, turn up the volume and enjoy it, then turn down the volume to a more reasonable level after. Enjoy your MP3 player; just keep the volume below 8/10 and restrict your listening to 90 minutes a day or less. Moderation and common sense.
Delusion, smoke and mirrors, have also entered into my educational sessions. Every musician knows that rock and roll needs to be loud – but it doesn’t have to be intense. After all, the physical measure of intensity (or, more correctly, sound level) is what contributes to hearing loss, and not whether a musician considers something to be subjectively “loud”. Much time is spent trying to tease out these two different, but related, concepts. One strategy is to turn up the bass of the sound (or alternatively provide some subwoofer range amplification) – this deludes the musician into thinking that something is loud (but is actually at a lower sound pressure level). If you tell a musician something that they will not ever do, it won’t be done (see picture of young musician below). But if we can use delusion and smoke and mirrors (and some education as well) to fool the musician into thinking that they are playing at a desired level but it’s actually at a lower sound level than what they think, then we have done a good day’s work.
And there are other things that can be done to assist in minimizing the potential for future hearing loss; stress reduction, use of anti-oxidants, intermittent exposure, hearing protection – the list goes on. These are things that the field of audiology is beginning to learn from the people sitting next to us at PAMA conferences. How stress affects long-term hearing loss has more to do with biochemistry and physiology than mere acoustics. Learning from our colleagues in other fields can bring great benefits to our attempts at hearing loss prevention.