Deterioration in hearing sensitivity and tinnitus
The present study was a preliminary effort to document subjective reports of hearing deterioration and tinnitus in musicians, their awareness and use of EPDs and measurement of temporary thresh old shifts following a practice session. In the study, 8.8% of musicians who reported hearing deterioration and tinnitus in left ear had more than eight years of experience. The present finding indicates a positive relationship between the years of experience as a professional musician and its detrimental effects on the hearing system. Similar findings have been reported by Dana et al.6 in which a positive correlation has been found between the extent of exposure to amplified music and hearing thresholds at 3-6 kHz. Greater the years of experience as a professional pop/rock/jazz musician, poorer the hearing thresholds due to exposure to amplified music. In addition to the years of experience, hours of music exposure per week has been found to have greater effect in predicting hearing loss in both ears. Ralli et al.7 reported significant differences between subjects with respect to gender, auditory threshold and tinnitus laterality. Subjects who were employed in jobs with a high risk of noise exposure were mostly males and reported poorer hearing threshold mostly in the left ear; tinnitus was mostly bilateral, followed by left-sided, and described as buzzing or high-pitched
In the present study, 38.2% of all the musicians reported of tinnitus and all of them had been a musician for more than eight years. No difficulty in music perception was reported, as it was intermittent. One of the subjects reported the occurrence of tinnitus after every show, which usually disappears after some hours. This shows that the longer they have been musician, the more likely they are to have tinnitus. In the control group, tinnitus was reported in 5.8% of them and none of them reported any other symptoms of auditory dysfunction. In a study done by Pouryaghoub et al.,8 among musicians with a minimum of 5 years of experience, 50% of participants reported experiencing tinnitus after a performance and 28% had ear pain during the performance. In total, 56% of the subjects had experienced one of these symptoms during or after the performance. A higher risk of NIHL was observed in musicians who had experienced acute symptoms of exposure to loud noise (tinnitus or ear pain). This finding highlights the importance of preventive measures in individuals with similar experiences
Studies done in western population have shown that that 39% of all the musicians suffer from tinnitus2 and most often localized to the left ear. 24% of professional orchestra musicians reported of tinnitus for at least 5 minutes in duration and half of them reported experiencing constant tinnitus.9 Findings by Kahari et al.10 and Gribbins2 have reported tinnitus in 45% and 39% of musicians respectively.2 In the current study, musicians reported tinnitus in the left ear. Khalfa et al.11 have proposed an explanation regarding the higher susceptibility of left ear to auditory damage in the peripheral hearing mechanism due to noise exposure. This finding could be attributed to the fact that Outer Hair Cell (OHC) motility in middle frequencies of left ear when compared to right ear are strongly attenuated by nerve fibers within the efferent nerve system. When the left ear OHCs are less functional, fibers within the Medial Olivary Complex (MOC) compensate, and may become more functional, especially in mid-range frequencies. This phenomenon increases with human development and affects middle frequencies of the left ear only, resulting in the left ear being more susceptible to auditory dysfunction and tinnitus.
Study reported by Birgit Mazurek12 did not find any statistically significant differences in the hearing loss between the left and the right sides but found that left-sided tinnitus more distressing than the right-sided one, which could be attributed to neuroanatomic differences between the left and right parts of the auditory system.
Risk factors for auditory dysfunction includes the type of music played, type of instruments, position in the orchestra or on stage, years of career experience and playing in acoustically unsuitable venues.Musicians located near percussion instruments (e.g., drums) and brass instruments (e.g., trumpet, trombone), as well as those located near amplifiers, tend to have higher exposures.
In the present study, 70% of musicians were not aware of EPDs and the remaining participants never used them as they did not know where to purchase the EPDs from and its importance in hearing conservation. Similar findings have been reported in college music students where 74% of them were aware of noise and its effect on hearing but none of them reported wearing EPDs all the time. Only 22% of them reported use of ear protection devices when exposed to potentially harmful sound levels.9 Similar results were found in other studies in which 95% reported no use of EPDs while performing in concerts, 85% never used EPDs during rehearsals, and 64% never used EPDs in other environments, such as when attending rock concerts and using lawn mowers.13 Only 20% of musicians found hearing protectors acceptable. It is also found that musicians do not wear hearing protection continuously, and many use hearing protection in one ear only. It is reported to be time consuming to get used to hearing protection for most of the musicians. These findings suggest that awareness regarding EPDs were reported to be significantly better in the Western population, when compared to the present group in Indian scenario. The importance of using these devices could be brought into practice only by educating this population about the hazardous effects of noise exposure. The acceptance of hearing protectors and the change in attitude towards hearing conservation among musicians should be of prime importance in the process of creating awareness. Hence more education is needed for the acceptance of hearing protectors and to change the attitudes towards hearing conservation among musicians.7 Hoffman et al., 200614 investigated the use of hearing protectors among percussionists. Better hearing thresholds were found among those who had used hearing protection (foam plugs).
Although most of the subjects seemed aware of the risk, only few had taken preventive measures against hearing loss.15 O’Brien et al.16 evaluated 367 orchestra musicians and found that only 64% of the participants had occasionally used Ear Protective Devices during their performance. In a study reported by Luszczynska et al.17 14% of the participants had experienced using personal protective devices when exposed to loud noise and about 30% were aware of the potential risks and intended to use personal protective devices in the future.
This clearly shows that when the awareness of the individual is better, there is a greater chance for using some form of EPD. Hence the present study highlights the importance of educating musicians regarding exposure to loud music and its detrimental effects on the hearing system.