LUGA PODESTA, MD, & HELENA ESPINOZA, PA-C

Musicians, particularly drummers, are at risk for losing their hearing as a result of playing without proper ear protection. Sixty percent of Rock And Rock Hall Of Fame inductees are hearing impaired. Hearing damage can present a temporary or permanent ringing in the ears, called “tinnitus,” or a short- or long-term loss of the ability to hear clearly called “noise-induced hearing loss.” Noise-induced hearing loss is caused by chronic exposure to sound levels that exceed 85—90dB, particularly in the frequency range around 4,000Hz, causing sensorineural impaired hearing.

Playing drums or listening to loud amplified music without ear protection usually exposes you to 100—115dB. The risk of developing hearing loss depends on the length of time of exposure without ear protection, the proximity to speakers, listening to loud music through earphones, previous hearing damage, and your physical condition. It takes only 15 minutes of noise exposure of 100—115dB without ear protection before you may begin to damage your hearing.

Often, this problem goes unnoticed for long periods of time because speech frequencies, which are 500—4,000Hz, are initially unaffected. Therefore, you may not experience difficulty with hearing during a normal conversation. At first, there is a temporary threshold shift, in which there is a reversible elevation in the threshold for sound perception. Over time, if sound levels above 90dB persist, this threshold shift will become permanent.

The drummer who may be developing hearing loss may experience a sensation of ear fullness or pressure. Also, if you think you have grown used to loud noise, it has probably damaged your ears. At this point, it is vital to protect what remaining hearing you have because there is no treatment, no medicine, no surgery, not even a hearing aid that can correct your hearing once it is damaged by noise.

If you suspect that you are developing noise-induced hearing loss, ringing in your ears, difficulty hearing in the presence of background noise, conversation sounds mumbled, the need to turn the volume of your TV or MP3 player up, or hearing a telephone better with one ear than the other, it is important to see your physician for a physical exam, a screening for hearing loss, and several hearing tests. The American Academy of Otolaryngology has developed a simple one-page test that the musician can self-administer to determine if a hearing evaluation by an otolaryngologist (ear, nose, and throat physician) is necessary. To find this test, visit nsslha.org/public/hearing/disorders/Self-Test.htm.

Ear protection to avoid exposure to continued noise exposure is the only way to prevent noise-induced hearing loss. Earplugs are small inserts that fit into the outer ear canal. To be effective, they must totally block the ear canal with an airtight seal, snugly fitting to the circumference of the canal. Properly fitted earplugs or muffs reduce noise 15 to 30dB. They are available in a variety of shapes and sizes to fit individual ear canals and can be custom made. Simple foam earplugs are available at very low cost at most music stores. Custom made earplugs can be obtained from audiologists.

An improperly fitted, dirty, or worn-out earplug can irritate the ear canal and may not seal properly. Ordinary cotton balls or tissue paper wads pressed into the ear canals are very poor protectors and may only reduce noise by only 7dB. Better earplugs and muffs are approximately equal in sound reduction, although earplugs are better for low frequency noise like music produced by drummers or bass players. In-ear personal monitoring systems (Fig. 3) provide quality stereo sound, eliminating external background noise. These devices allow the musician to hear exactly what the instrument produces; however, if the in-ear monitor volume is too loud, these too can be harmful to the ear.

We know that the more we practice, the better we will play, but keep in mind that it is impossible to be a successful musician if you cannot hear the music.