Laitinen and Torben Poulsen . 2008 . Questionnaire

Musicians in symphony orchestras are exposed to harmful sound levels. Although research shows that industrial workers have a higher propensity to noise-induced hearing loss, musicians can also develop a hearing loss from noise exposure. Furthermore, musicians can suffer from tinnitus, hyperacusis, and distortion, among other hearing disorders, which can affect their work more severely than a hearing loss. This study investigated the use of hearing protectors, the prevalence of self-reported hearing disorders among musicians, and the importance of these hearing disorders to the musicians. The musicians at three Danish symphony orchestras were asked to complete a questionnaire on the topic. Results showed that Danish musicians are aware of the dangers of loud music, yet they rarely use hearing protectors and not always correctly; however, musicians with hearing disorders use hearing protectors more frequently. In addition, the musicians questioned suffered from different hearing disorders. Education is needed to change musicians’ opinion of hearing conservation and hearing protectors. The education must be directed to both the musicians and the administration of the symphony orchestras. Sumario Los músicos de las orquestas sinfónicas están expuestos a niveles dañinos de sonido. Aunque las investigaciones muestran que los obreros industriales tienen una mayor propensión para la sordera inducida por el ruido, los músicos también pueden desarrollar una hipoacusia producto de la exposición al ruido. Más aún, los músicos pueden sufrir de acúfenos, hiperacusia y distorsión, entre otros trastornos auditivos, los cuáles pueden afectar su trabajo más severamente que una pérdida auditiva. Este estudio investiga el uso de protectores auditivos, la prevalencia de la hipoacusia auto-reportada entre los músicos, y la importancia de estos trastornos auditivos para ellos. Se les pidió a los músicos de tres orquestas sinfónicas danesas que completaran un cuestionario sobre el tema. Los resultados mostraron que los músicos daneses están concientes de los peligros de la música fuerte, aunque ellos raramente utilizaban protección auditiva, y no siempre en forma correcta; sin embargo, los músicos con trastornos auditivos utilizan más frecuentemente los protectores auditivos. Además, los músicos interrogados sufrı́an diferentes trastornos. Se requiere educación para cambiar la opinión de los músicos sobre la conservación de la audición y los protectores auditivos. La educación debe estar dirigida tanto a los músicos como a los administradores de las orquestas sinfónicas. Researchers have studied the sound exposure of classical musicians for more than 40 years, and they still do not agree if the measured peak sound levels in symphony orchestras are as harmful as industrial noise of the same energy (Kähäri, 2002; Kähäri et al, 2003; Behar et al, 2006). The European Union (EU) directive on noise at the workplace was adopted in 2003 and was implemented in the member states in the following years (EU, 2003). Because of the special problems in the music and entertainment sector, the EU directive allowed a transition period for the implementation, and the directive must be in effect by February 2008. Unlike the sound from industrial work, the sound in the music and entertainment sector is produced by the employee, and it is therefore not relevant to ask for noise reduction of the sound source. Hearing protectors are seldom the optimal solution for musicians; however, it may be one of the means to fulfil the EU directive. The aims of the present investigation were to examine the use of hearing protectors in various Danish symphony orchestras, to investigate musicians’ self-reported hearing disorders and to obtain information about musicians’ experience of the sound levels in their working environment. Note that the term ‘hearing disorder’ is used for the various self-reported hearing problems musicians indicate in the questionnaire. No objective measurements (e.g. of hearing loss) are made in the present investigation. With regard to hearing loss, musicians’ audiograms do not always show hearing loss consistent with their noise exposure (Obeling & Poulsen, 1999). In addition, researchers consistently search for a method for early detection of a possible hearing loss (Reuter & Hammershøi, 2007). Obeling and Poulsen (1999) studied 57 Danish musicians. This included an audiological evaluation, an interview about their work, and sound level measurements in the orchestra. When audiograms were agecorrected in accordance with ISO 7029 (ISO-7029 1984), they were consistent with the typical hearing loss for the age. The audiograms were also compared to the ISO 1999 prediction for occupational noise (ISO-1999 1990), which showed no hearing loss. The authors concluded that musicians cannot be expected to acquire pronounced hearing loss from playing in a symphony orchestra; however, the authors note that limited data was used in the study. Other studies have assessed hearing thresholds of ISSN 1499-2027 print/ISSN 1708-8186 online DOI: 10.1080/14992020801886770 # 2008 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society Received: April 4, 2007 Accepted: December 26, 2007 Heli Laitinen Engineering Office, Heikki Helimäki Ltd, Temppelikatu 6 B, 00100 Helsinki, Finland. E-mail: [email protected] D o w n l o a d e d B y : [ I n t e r n a t i o n a l S o c i e t y o f A u d i o l o g y ] A t : 0 9 : 3 7 7 A p r i l 2 0 1 0 musicians as well (Axelsson & Lindgren, 1981; Karlsson et al, 1983; Johnson et al, 1985; Ostri et al, 1989; Royster et al, 1991; Schmidt et al, 1994; Kähäri et al, 2001; Kähäri et al, 2003). For a review, see Sataloff et al (2006). Noise at the workplace is usually measured as the A-weighted equivalent continuous sound level, LAeq, for definitions see ISO1999, 1990. The LAeq is the level (in dB(A) re. 20 mPa) of a steady sound which, over the same interval of time as the fluctuating sound of interest, has the same mean square sound pressure. The daily noise exposure level (LEX,8h) is the time-weighted average of the noise exposure levels for a nominal eight-hour working day as defined by international standard ISO-1999, 1990, point 3.6. It covers all noises present at work, including impulsive noise (EU 2003). The actionand limit levels in the EU directive relate to an eight-hour working day. As musicians seldom play continuously for eight hours, this should be taken into account when orchestra sound levels are evaluated. A LAeq of 83 dB for four hours corresponds to a LEX,8h of 80 dB. Several studies have investigated musicians’ exposure to sound (Jansson & Karlsson, 1983; Royster et al, 1991; Laitinen et al, 2003b; Frölich, 2005). In some parts of the orchestra, the levels are below the EU action level, LEX,8h 80 dB, but in other parts of the orchestra, the levels are too high. For the conductor, the LAeq level is 88 dB with a 65-person symphony orchestra, 91 dB for a mixed choir (114 persons), and 96 dB for a jazz orchestra (Harding & Owens, 2003). Levels in the orchestra pit were below the risk criterion, LEX,8h 80 dB (Lee et al, 2005). One literature review illustrated that the average sound level was 80 to 100 dB(A) for symphony orchestra musicians and 90 to 105 dB(A) for jazz musicians (Peters et al, 2005). With regard to other health effects the working environment of a musician is quite different from the industrial workplace; therefore, a hearing conservation program must be adapted to this special situation. Aspects other than sound exposure and hearing loss must be considered including auditory disorders (e.g. tinnitus, distortion, and hyperacusis), attitudes, and use of hearing protectors. Furthermore, occupational effects like ergonomics, stress, and stress related problems must be taken into account. Sometimes these problems are related. One of the aims of this study was to investigate not only the prevalence of selfreported hearing disorders among musicians, but also the importance of these hearing disorders to the musicians. The use of hearing protectors may seem awkward in an orchestra situation. Under usual working conditions, hearing protectors should be the last resort in hearing conservation; however, to a musician, they are often the only functional option. Hoffman et al (2006) investigated the use of hearing protectors among percussionists. Better hearing thresholds were found among those that used hearing protection (foam plugs); however, Rudel et al (2006) found that only 1.5% of the musicians in their study accepted and used hearing protection. Laitinen (2005) found that 6% of the musicians reviewed in their investigation always used hearing protection. In a Spanish investigation (González & Armendáriz, 2001) 20% of musicians found hearing protectors acceptable. Cederstam (2006) found no difference between musicians and non-musicians in their views on using hearing protection when listening to loud music. One study assessed hearing protection amongst a Swedish and an American pop-concert audience. Results showed that women use more hearing protection than men and that Swedish men use more hearing protection than American men (Widén, 2006; Widén et al, 2006). Based on interviews among 500 English musicians, Reid (2001) found that 65% of the woodwinds and 55% of the strings used earplugs. To summarize preferred recommendations, Chasin (1996) developed a table of recommended hearing protectors for different instruments. The present investigation examined the use of hearing protectors in symphony orchestras, how they are used, the difficulties that musicians experience, the usage rate, and how the usage rate might be improved. These are all important issues as the EU directive on noise at the workplace (EU, 2003) included musicians. In the present investigation, the musicians are asked about the occlusion effect in particular. The occlusion effect is well known in connection with hearing aids (Schweitzer & Smith, 1992; Ballachanda, 1995); however, there is only one article found that assessed the occlusion effect among musicians (Oberdanner et al, 2002). With regards to other means of protection, the sound level in an orchestra can be reduced to some extent by increasing the acoustic absorption in the room; however, the sound source (the instrument) is close to the musician, and thus, the protection from absorption is limited. The musicians need to hear each other as well as the other instrument groups; therefore, much absorption around the podium is not desirable. In a concert hall, the acoustics of the hall is a major part of the audience’s experience, and a change of the absorption in the hall will almost