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Hearing Protection for All Musicians - Three Trombone Example -- Music and Medicine on Monday

Submitted by hoffmanh on Sat, 01/06/2024 - 17:01

Return to: Music and Medicine on Monday at the University of Iowa - Schedule of Events

For detailed discussion - see: Music Making and Hearing Loss: Information for Musicians on Preventing or Managing Hearing Loss

protocol page initiated Feb 2024  Piper Wenzel BS, Henry Hoffman MD

Hearing Protection for All Musicians - Three Trombone Example (full length 29:57)

Acoustic Injury in Band (Traumatic Brain Injury in Football) (60 seconds)

3 Tips for Hearing Protection (60 seconds)

Definitions

Noise: unwanted and undesirable sound in the environment (Daniel 2007)

Noise Induced Hearing Loss = NIHL = hearing loss caused by exposure to excessive sound pressure levels - may be due to one-time exposure to very high noise levels or prolonged exposure to noise at moderate sound levels. Note concept of 'impulse noise'

Temporary Threshold Shift = TTS = (Dudarewicz 2023) Hearing loss from noise exposure that recovers over time - but, despite temporary recovery, may trigger progressive degeneration of auiditory fibers and premature aging of the auditory organ; a likely preamble to a permanent threshold shift 

Permanent Threshold Shift = PTS = permanent loss of sensitivity to sound; as per Hertanzo et al (2020) may result from loss of neuronal connections, outer hair cell loss and disruption of the integrity of the organ of Corti. 

Tinnitus   Tinnitus is the perception of sound in the absence of an external acoustic stimulus. The word tinnitus arises from Latin word 'tinnire" which means 'to ring'. (Chari and Limb 2018).  Hertzano (2020) affirmed that "all tinnitus are associated wtih some form of hearing loss" and tinnitus is "an early symptom of an underlying auditory injury before measurable audio metric changes.". There are many causes of tinnitus- among the most common are associated with sensorineural hearing loss  attributable to aging, prolonged noise exposure and head injury.

Impulsive Noise versus Steady State Noise.  Impulse Noise includes 'all forms of high-intensity short-duration sounds... may vary from tens of microseconds for small arms fire to several hundred milliseconds for a sonic boom... intensities of these impuslse may vary from less than 100 dB to in excess of 185 dB peak SPL" (sound pressure level) (Henderson 1986).   Assessments of NIHL occuring in factories and construction often emphasize continual background noise without factoring in impulse noise - the types of acoustic trauma that miliatary personnel are exposed to - with high intensity acoustic trauma termed "impulses" (Moore 2020). 

Decibel: a measure of the intensity of ambient sound (Muhonen 2023). Decibel (dB) is a 'relative unit of meaurement equal to one tenth of a bel (B);'  - named in honor of Alexander Graham Bell (Wikipedia contributors 2024)

NIOSH: National Institue for Occupational Safety and Health 

EPD "ear protection devices" as per NIOSH (preventing occupational noise): 5 C's of hearing protection - Comfort/Compatibility/Convenience/Communication/Cost

Two main types of EPD (Mohan 2022)  - 

 a. Passive Noise Control (earmuffs, disposable foam earplugs, ear canal plugs) physical barriers to sound

 b. Active Noise Control: active sound control devices electronically reduce unwanted noise instead of blocking noise - to modify sound - as per NIOSH ,<accessed 4 27 2024>  noise cancellation "can be added to headphones or earbuds which will cancel noise but should not be considered hearing protection unless labeled with an NRR".

Background

Estimated 1.3 billion people in the world have hearing loss due to noise exposure from occupational noiose exposure "responsible for 16% of disabling hearing loss in adults" (Chen 2020)

OSHA (Occupational Safety and Health Administration) requires employers to implement a hearing conservation program when noise exposure is at or above 85 decibels averaged over 8 working hours, or an 8-hour time-weighted average (TWA). They suggest that 'if you need to raise your voice to speak to someone 3 freet away, noice levels migh be over 85 decibels" <accessed 4-24-2024>

OSHA provides access to a sound meter application to measure workplace noise

Zhang et al (2022) reported that: "Relying on a single value (i.e., 85 dBA) as a recommended exposure limit does not appear to be sufficient to protect the hearing of workers exposed to complex noise."  They identified current standards are based on hearing loss due to continuous steady-state noise - which likely underestimate the damage caused by complex noise. These investigators identify that complex noise consists of regular or irregular impusive/impact components (impulsive noise) embedded in continuous Gaussian background noise. (Gaussian: "having the shape of a normal curve or normal distribution" <Merriam-Webster accessed April 27, 2024>) 

Mohan et al (2022) through a prospective study of dentists identified significant protection from use of EPD's and conclude that "dentists should mandatorily wear EPDs while working with instruments that emit high-frequency noise to prevent the TTS and subsequent development of ONIHL" (O-NIHL = occupational noise induced hearing loss). They further recommend use of high-fidelity earplugs (EPDs) with noise cancellation to allow for effective communication. 

Management

Three P' (see videos above for detail): 

  • Pay Attention (noisy world, be aware of acoustic trauma)

  • Protect Hearing (strategies to decrease acoustic injury offered in video discussion)

  • Plan Ahead (e.g. carrying EPD - Ear Protection Devices to concerts/athletic events and more)

jazz band on risers with permission from U of Iowa School of Music

 

References

Dudarewicz A, Pawlaczyk-Łuszczyńska M, Zaborowski K, Pontoppidan NH, Wolniakowska A, Bramsløw L, Christensen JH, Katrakazas P, Brdaric D, Samardžić S, Śliwińska-Kowalska M. The adaptation of noise-induced temporary hearing threshold shift predictive models for modelling the public health policy. Int J Occup Med Environ Health. 2023 Mar 2;36(1):125-138. doi: 10.13075/ijomeh.1896.01681. Epub 2023 Jan 20. PMID: 36661863; PMCID: PMC10464745.

Quaranta A, Portalatini P, Henderson D. Temporary and permanent threshold shift: an overview. Scand Audiol Suppl. 1998;48:75-86. PMID: 9505300.

Sallustio V, Portalatini P, Soleo L, Cassano F, Pesola G, Lasorsa G, Quaranta N, Salonna I. Auditory dysfunction in occupational noise exposed workers. Scand Audiol Suppl. 1998;48:95-110. PMID: 9505302.

Bizup B, Brutsaert S, Cunningham CL, Thathiah A, Tzounopoulos T. Cochlear zinc signaling dysregulation is associated with noise-induced hearing loss, and zinc chelation enhances cochlear recovery. Proc Natl Acad Sci U S A. 2024 Feb 20;121(8):e2310561121. doi: 10.1073/pnas.2310561121. Epub 2024 Feb 14. PMID: 38354264; PMCID: PMC10895357.

Macrae JH. An investigation of temporary threshold shift caused by hearing aid use. J Speech Hear Res. 1994 Feb;37(1):227-37. doi: 10.1044/jshr.3701.227. PMID: 8170126.

Ching TY, Johnson EE, Seeto M, Macrae JH. Hearing-aid safety: a comparison of estimated threshold shifts for gains recommended by NAL-NL2 and DSL m[i/o] prescriptions for children. Int J Audiol. 2013 Dec;52 Suppl 2(0 2):S39-45. doi: 10.3109/14992027.2013.847976. PMID: 24350693; PMCID: PMC3876025.

Chen KH, Su SB, Chen KT. An overview of occupational noise-induced hearing loss among workers: epidemiology, pathogenesis, and preventive measures. Environ Health Prev Med. 2020 Oct 31;25(1):65. doi: 10.1186/s12199-020-00906-0. PMID: 33129267; PMCID: PMC7603754.

     Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–96.

Occupational Safety and Health Administration "Occupational Noise Exposure" Occupational Noise Exposure - Overview | Occupational Safety and Health Administration (osha.gov) <accessed 4-26-2024>

Zhang M, Gao X, Murphy WJ, Kardous CA, Sun X, Hu W, Gong W, Li J, Qiu W. Estimation of Occupational Noise-Induced Hearing Loss Using Kurtosis-Adjusted Noise Exposure Levels. Ear Hear. 2022 Nov-Dec 01;43(6):1881-1892. doi: 10.1097/AUD.0000000000001223. Epub 2022 Apr 21. PMID: 35442928; PMCID: PMC9585092.

Merriam-Webster.com Dictionary, s.v. “Gaussian,” accessed April 27, 2024, https://www.merriam-webster.com/dictionary/Gaussian.

Mohan KM, Chopra A, Guddattu V, Singh S, Upasana K. Should Dentists Mandatorily Wear Ear Protection Device to Prevent Occupational Noise-induced Hearing Loss? A Randomized Case-Control Study. J Int Soc Prev Community Dent. 2022 Oct 31;12(5):513-523. doi: 10.4103/jispcd.JISPCD_28_22. PMID: 36532321; PMCID: PMC9753927.

Daniel E. Noise and hearing loss: A review. J Sch Health 2007;77:225-31.

Spomer J, Estrich CG, Halpin D, Lipman RD, Araujo MWB. Clinician perceptions of 4 hearing protection devices. JDR Clin Trans Res 2017;2:363-9.

NIOSH - The National Institute for Occupational Safety and Health. Noise and Hearing Loss Prevention: Personal Protective Equipment (PPE) [Internet]. 2018. Available from: https://www. cdc.gov/niosh/topics/noise/reducenoiseexposure/adminppe. html. 

Hertzano R, Lipford EL, Depireux D. Noise: Acoustic Trauma to the Inner Ear. Otolaryngol Clin North Am. 2020 Aug;53(4):531-542. doi: 10.1016/j.otc.2020.03.008. Epub 2020 Apr 30. PMID: 32362563.

Chari DA, Limb CJ. Tinnitus. Med Clin North Am. 2018 Nov;102(6):1081-1093. doi: 10.1016/j.mcna.2018.06.014. PMID: 30342610.

Moore BCJ. Diagnosis and quantification of military noise-induced hearing loss. J Acoust Soc Am. 2020 Aug;148(2):884. doi: 10.1121/10.0001789. PMID: 32873002.

Henderson D, Hamernik RP. Impulse noise: critical review. J Acoust Soc Am. 1986 Aug;80(2):569-84. doi: 10.1121/1.394052. PMID: 3745686.

Muhonen EG, Abouzari M, Yang Y, Zeng FG, Djalilian HR. Audiometric Validation of a Smart Watch Decibel Meter. JAMA Otolaryngol Head Neck Surg. 2023 May 1;149(5):466-467. doi: 10.1001/jamaoto.2023.0035. PMID: 36892831; PMCID: PMC9999267.

Wikipedia contributors, "Decibel," Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/w/index.php?title=Decibel&oldid=1219098941 (accessed April 29, 2024).