Music to Their Ears Working in an unregulated industry that deals in noise, musicians stand to benefit from audiologists’ support to preserve their hearing and to bolster their performance. Features
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Features  |   May 01, 2016
Music to Their Ears
Author Notes
  • Haley Blum is a writer/editor for The ASHA Leader. hblum@asha.org
    Haley Blum is a writer/editor for The ASHA Leader. hblum@asha.org×
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Hearing & Speech Perception / Acoustics / Hearing Disorders / Features
Features   |   May 01, 2016
Music to Their Ears
The ASHA Leader, May 2016, Vol. 21, 50-56. doi:10.1044/leader.FTR2.21052016.50
The ASHA Leader, May 2016, Vol. 21, 50-56. doi:10.1044/leader.FTR2.21052016.50
Musicians: Good at creating irresistible earworms, making your soul come alive with one chord, capturing in song emotions you couldn’t otherwise express.
Not always good at taking care of their ears.
Although some are more proactive than others, “musicians [often] are not excellent at protecting their hearing because they don’t want to sacrifice their performance, which is of course their number-one concern,” says Amber Powner, a clinical audiologist based in Santa Rosa, California, who specializes in musicians, hearing loss prevention and vestibular issues.
Housed in an unregulated industry based on art and performance, musicians lack any form of standardized hearing protection and care. Audiologists can do much to reach out to and help the hearing health of this niche in the community, and at the same time gain a new set of patients, advises Powner.
It starts with what you already know—what every audiology student learns in school about noise and acoustics, says Toronto-based Marshall Chasin, a clinical and research audiologist known for his work with musicians over the past 35 years. Chasin insists that audiologists shouldn’t be intimidated by the specific needs of musicians.
“You don’t have to be a musician, or indeed know anything about music, to work with musicians. … I can play [clarinet] a little bit, but I’m not all that great,” Chasin says with a laugh. “And I’m not naturally a musician. But solving the problems of musicians, that’s right down the very center line of Audiology 101.”
By adding musician-specific knowledge and marketing ideas to your basic audiology skills, Chasin says, you can retune your client list.

“If a patient comes in and wants to talk about hearing protection, very rarely do they not already have symptoms of noise-induced hearing loss.”

Why musicians neglect hearing health
Musicians—whether they’re selling out arenas, marching in the high-school band or singing in the church choir—have one job: to perform. Add that to the invincibility younger musicians sometimes feel toward their hearing, and it can be a recipe for little to no action.
Powner says she comes across the same sentiment again and again while looking at consumer attitudes toward hearing loss: “I don’t really care about protecting my hearing unless I’m noticing a difference.”
“Especially in the music world, if we are dealing with musicians who are playing professionally, and that is their entire livelihood,” she says, “their [concern is] about … protecting their performance as opposed to what it actually does to them physically.”
But Chasin, who serves as the auditory research director of the Musicians’ Clinics of Canada, says he’s seen a huge increase over the past 25 years in the number of musicians who seek out hearing protection, largely because of successful educational ventures by schools, organizations like Hearing Education Awareness for Rockers (HEAR), and famous musicians, such as Pete Townshend of The Who, who are outspoken about their own hearing issues.
After musician earplugs (with flat attenuation to reduce sound levels evenly to maintain original quality) became available in 1988, “very few wanted them. It was not macho, not cool to wear earplugs,” Chasin says. But now, as older musicians have gone through the often-devastating effects of hearing loss, they are “talking very honestly about their own experience, whether it’s tinnitus or whether it’s the fact that music sounds distorted, and saying, ‘Hey guys, you know, it’s cool now to wear earplugs. It’s stupid if you don’t.’”
Wearing musician earplugs or in-ear monitors is now “standard procedure” for young, popular bands, says Joseph Montano, associate professor of audiology in clinical otolaryngology and director of hearing and speech at Weill Cornell Medical College. He is also ASHA vice president for standards and ethics in audiology and serves on the board at HEAR.
While musician earplugs simply reduce noise exposure, in-ear monitors deliver aural feedback to band members so they can clearly hear themselves play. Audiologists can work with their musician clients to find the appropriate settings, Montano says.
“Musicians who are older—what’s interesting about that generation, especially in rock ’n’ roll, is that they’ve never used [in-ear] monitors, and so they’ve just been in a situation where it has affected their hearing. Younger musicians are more attuned to hearing loss. The in-ear monitors are really helping them to listen to their own music, and we’re able to limit the amount of output.”
But although its brashness can make rock ’n’ roll seem like the type of music that’s bound to give people hearing loss, it’s not so simple. Or, at least, not so genre-oriented.
“It’s the loudness of the music,” says Montano. “If you listen to Mozart loud, it can cause hearing loss. … We see many people from the Philharmonic, many people who are in classical orchestras, who have hearing loss because it’s loud.”
And, as audiologists well know, with long exposures to loud music come hearing impairments. Tinnitus, followed by hypersensitivity and pitch distortion, is the most common complaint Powner hears from patients. “If a patient comes in and wants to talk about hearing protection, very rarely do they not already have symptoms of noise-induced hearing loss,” she says. “If they have a flat, moderate-to-severe hearing loss, typically they’re looking for amplification that will allow them to play adequately while wearing hearing aids, and the others are interested in tinnitus mediation.”
Hearing loss can negatively affect any of her patients’ lives, but Powner—who has conductive hearing loss herself in one ear—points out that the prospect of tinnitus and hearing loss can be doubly devastating for musicians, who often rely on their hearing as part of their livelihoods.
“They’re a much more emotional bunch of people,” she says. “They typically are going to describe their hearing loss—as opposed to your traditional patient who will say things like, ‘I really want to hear my grandchildren’ or ‘I really want to participate in conversations’—as centered around, ‘This is my life, and this is what I really want do, and I’m afraid my career is over.’
“I’ve heard that sentence more often than I care to admit,” she says. “But I’m happy to say that most of the musicians that I work with have found that not to be the reality. That’s really the goal we’re pushing for: giving them their passion back, but allowing them to do it in a safe way.”

“To a certain extent, we can use technology to delude the musician.

Amp up the hearing protection
It’s also important for audiologists to show their musician patients how they can maintain their relationship with music, Montano says. “We have to allow them to hear speech, but we also have to allow them to get good perception of music, because that’s part of their life.”
That’s where counseling comes in. Devices may be the tools, but Montano emphasizes the key role counseling plays in working with musicians—helping them adjust to the fact that they have hearing loss and showing them how to preserve the hearing they still have.
And when it comes to hearing preservation, of course it’s all about how you use the tools. In-ear monitors, a common choice for musicians, especially for those in established acts, have the capacity to be used as hearing protection—but only if they’re programmed for safe volumes. Otherwise, if they have too many drivers (the cone- or horn-shaped parts of speakers that shake back and forth to create sound) or if they’re turned up too loud, they can do more harm than good, Powner says, so teaching patients how to use them correctly is crucial.
“If [a musician is] playing in a loud environment with an electrified band, as long as they’re amplified, I do recommend in-ear monitors with a heavy bit of counseling,” she says. “There are a number of in-ear monitors that are out these days that actually have up to 12 drivers, which is a prevention audiologist’s nightmare, because all those drivers do is make things louder—it doesn’t help the overall sound quality.”
In-ear monitors have another selling point: They’re an attractive option for artists who are looking to “clean up” their stage setup and downsize the amount of equipment they have to lug, Powner says. The pocket-size in-ear monitors can take the place of the large “wedge” floor monitors that sit at the front of the stage, pointed at the musicians so they can hear their instruments. The wedges make the stage incredibly loud; in-ear monitors can save bands from the cacophony they produce.
When making ear impressions for custom in-ear monitors and earplugs, audiologists should consider what instrument the person plays and whether they sing, Chasin says. Having the person open their mouth slightly can help make sure the product seals the ear sufficiently without causing any irritation or pain. He also advises thinking about how far into the canal to go—contrary to requests from in-ear monitor manufacturers, monitors don’t necessarily need to go deep into the ear to achieve the desired sound quality.
Low-frequency vibrators—also known as “bass shakers” or “butt kickers”—are another tool audiologists can suggest to their musician patients who play with percussionists to help reduce overall sound during performances. The small, often hockey-puck-shaped speakers are placed on the board where the drummer sits, physically shaking to intensify the feedback. When the drummer hits, it feels loud.

“Having a good relationship with musicians is crucial to encouraging them to wear hearing protection and getting them to understand what they’re protecting and why they’re protecting it.”

“That allows them to play at a more reasonable level, so the person next to them doesn’t have to overplay to compensate,” Chasin says, adding that bass players can also use shakers to the same effect. “To a certain extent, we can use technology to delude the musician.” Drummers also can play behind large plexiglass shields to protect other band members from exposure.
But for musicians just starting to contemplate hearing protection, Powner says musician earplugs are a good place to start.
“It gives them an idea of what it’s like to wear hearing protection while they play and it gets them into a good habit, instead of having them immediately put a custom-fit earplug in their ear, or even custom in-ear monitors,” she says. “Many of them come in and they haven’t had any experience putting anything in their ears while they’re playing, and starting with a full-shell monitor is a really big change for them. So it’s counseling, counseling, counseling.”
Chasin suggests also tweaking environmental factors, such as moving or elevating an amplifier if it is bothersome to a band member, to provide musicians with less exposure.
And don’t forget to arm your patients with protection for other situations beyond when they’re playing on stage. “Musicians not only play music, but they go see their friends [perform]—they listen to music in lots of different venues, so maintaining the use of hearing protection is really important,” Montano says. “Always talk about that.”

“I’m not naturally a musician. But solving the problems of musicians, that’s right down the very center line of Audiology 101.”

Becoming a musician’s ally
Musicians who come to you for services are obviously already making some effort, but you can still take extra steps to educate and motivate them about hearing health care.
Powner, for example, gives musicians a dosimeter to gauge loudness for themselves. A patient who played in several jazz bands, which are incredibly loud because of all the brass, took the instrument to practices and performances.
Although he was already motivated to wear hearing protection because he had tinnitus, the patient came back with the dosimeter showing that “one single hour-and-a-half session was 460 percent of his noise dose,” Powner says. “He’s like, ‘Wow, I can’t wait to take this back and show my bandmates.’ This was an incredibly good motivator for him, and he ended up actually moving forward with amplification to assist his tinnitus when he wasn’t playing music as a result of that.”
And it’s not just band members who can benefit from a visit to the audiologist. HEAR’s educational outreach extends not only to musicians themselves but to roadies, managers, bartenders, club security guards—anyone who’s in any environment in which loud music is played, Montano says.
If possible, actually stepping into those environments can help you gather information that will better allow you to counsel musician patients: where they stand on stage relative to speakers and other bandmates, what type of instrument and music they play, what their typical venue sounds like.
For Chasin, it’s a bit of forensic science mixed with audiology. “You see a person with the left ear being a little bit worse than the right ear, and they may be a drummer, with the high hat [to their left]. They may be a violinist, with their instrument to their left ear. Or it could be because they sit downwind of a flute player to their left-hand side. Or it could be that they are a DJ and they only wear the earphone on one ear, with some protection, and the other ear is not protected and open to the environment,” he says.
Part of Powner’s strategy is watching her musician clients perform. “It gives me a better idea of what they’re up against,” she says. If she can’t make a performance, she has them draw a diagram of their stage setup. If possible, she also encourages them to bring in their instruments, which helps foster the patient-clinician relationship.
“Having a good relationship with those musicians is crucial to encouraging them to wear hearing protection and getting them to understand what they’re protecting and why they’re protecting it,” Powner says. When you acknowledge that their hobby or career is important, they’re less likely to take your advice as a “slap on the hand.”
One way Montano builds relationships with patients, especially “macho” musicians who may not feel comfortable expressing problems with hearing, is through a more subtle, comfort-creating approach: He hangs his old LPs all around his office. “So somebody comes in and they say, ‘Ah, I love this. Oh, there’s Tom Waits.’ With musicians, that’s an immediate bond.”
Hearing education awareness for rockers to Receive 2016 ‘Annie’

ASHA will present the 2016 Annie Glenn Award to Hearing Education Awareness for Rockers (HEAR), an organization dedicated to “the prevention of hearing loss and tinnitus among musicians, other music professionals, and all music fans (especially teens and young adults) through education and grass-roots advocacy.”

The “Annie” is named for Annie Glenn, wife of Sen. John Glenn. She is known nationwide for her advocacy for people with communication disorders, and the award recognizes efforts to broaden awareness of communication issues and those who exemplify Mrs. Glenn’s distinction, courage and quiet charisma.

HEAR has helped identify well-known rockers to advocate for safe-hearing practices among their peers and fans. Pat Benatar is the spokesperson for a national initiative to educate baby boomers about the importance of hearing health awareness, prevention and treatment, and other musicians have appeared in public service announcements: Green Day, George Clinton, Perry Farrell of Jane’s Addiction, Herbie Hancock, Pete Townshend of The Who, Lars Ulrich of Metallica, Ray Charles and others.

Musician Marketing 101: How to Amplify Your Offerings

Tapping in to the musician niche in your community is a matter of pointed marketing. Audiologists Marshall Chasin and Amber Powner share their tips:

First, get over your fear: Even if you’re not a musician yourself. “The musician population is not as unique as people think it is,” Chasin says.

Hit your community: Chasin suggests writing a column for a local newspaper or blog, offering to speak in a high school’s health classes, visiting a local college or university’s music department, or starting a word-of-mouth effort at your place of worship.

Talk to your referring physicians: “Let them know that there are options, and that most of these people who are going to see them for tinnitus are really desperate,” Powner says.

Prepare a brochure or booklet: Chasin offers patients easy-to-understand written material, like his 90-page book “Hear the Music,” which he says patients often pass on to friends.

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May 2016
Volume 21, Issue 5