As musicians we recognize that hearing is vital to our livelihoods. Yet, the very nature of our work may cause temporary or even permanent hearing loss. Studies abound about excessive and sometimes unhealthy sound levels in the workplace. Sound shields, musician specific earplugs, and even language in our collective bargaining agreements have helped to reduce the occurrence of noise induced hearing loss (NIHL) in our workplace.
We know that sound is measured in units called decibels (dB). On the decibel scale, an increase of 10 means that a sound is 10 times more intense or powerful. To our ears, each additional increase of 10 dB sounds twice as loud. A 20 dB sound seems twice as loud as a 10 dB sound, 30 dB seems twice as loud as 20 dB, and so on. The humming of a refrigerator is 45 dB, normal conversation is approximately 60 dB, and the noise from heavy city traffic can reach 85 dB. Sources of noise that can cause NIHL include motorcycles, firecrackers, and small firearms, all emitting sounds from 120 to 150 dB. Long or repeated exposure to sounds at or above 85 dB may also cause hearing loss. Sound levels onstage and in the pit often exceed 95 dB for extended periods of time. Although being aware of decibel levels is an important factor in protecting one’s hearing, distance from the source of the sound and duration of exposure to the sound are equally important. A good rule of thumb is to avoid noises that are “too loud” and “too close” or that last “too long.”
With my experience serving on orchestra committees and having attended various ICSOM presentations on musicians’ hearing issues, I thought I had this area pretty well covered. Recently, I unintentionally discovered another hearing disorder that I had never previously heard of.
On March 15, during an orchestral rehearsal, I encountered sudden hearing loss (SHL). Out of the blue, with no rhyme or reason, my right ear began to feel very full and under great pressure. I was unable to hear out of the ear and knew that something was very, very wrong. We had just finished reading a brand new piece, which I was excited to play because there was a piccolo trumpet solo in my part. After trying to play just a few more notes, I knew I needed medical attention.
Fortunately, my otolaryngologist (ear, nose, and throat doctor, or ENT) saw me within the hour. After a battery of hearing tests and a thorough examination by the ENT (including using different sized tuning forks), it was confirmed that I indeed had suffered sudden hearing loss. I was instructed to begin a regimen of 60mg of prednisone daily as soon as possible for the next 7 to 10 days. I still did not comprehend how serious the situation was. My ENT then told me that even though we were starting the corticosteroid treatment immediately, there was only a fifty-fifty chance that some or all of my hearing might return. His words hit me like a ton of bricks.
As I drove home it dawned on me that my life might well be different going forward. Would I be able to return to work? How would I earn a living if not with my symphony job? More importantly, would I ever be able to clearly hear the voices of my wife and our two young children again?
After I started on the medication, I sat in front of the computer and studied every Internet resource I could find. I then phoned a friend to musicians everywhere, Janet Horvath, author of Playing (Less) Hurt. Janet was in NYC getting ready to speak at a seminar. She took time out of her busy schedule to talk with me. I will forever be grateful to Janet for her calming influence and expert advice.
Through my research I found that my occupation was likely not a contributing factor to this condition. Interestingly, the exact cause of SHL is never found in most cases. Possible causes range from recent viral infections and immune system disorders to tiny blood vessel ruptures or even strokes.
Fortunately, within a couple of days my tinnitus began to subside. After five days some of my mid-range hearing returned. I saw another ENT for a second opinion and was heartened by restoration across several frequencies. Another hearing test was conducted nine days after the event, and it showed that most of my hearing had returned to normal as compared with a hearing test from two years earlier.
There are different types of SHL. According to a guideline on SHL published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, prompt and accurate diagnosis is important, and it’s crucial to distinguish sensorineural (nerve or inner ear) hearing loss from conductive (mechanical) hearing loss. Prompt recognition and management of sudden sensorineural hearing loss (SSNHL) may improve hearing recovery and patient quality of life. SSNHL affects between 5 and 20 per 100,000 population, with about 4,000 new cases in the U.S. every year. SSNHL is usually defined as a greater than 30 dB hearing reduction over at least three contiguous audiometric frequencies, occurring over 72 hours or less. SSNHL affects men and women equally, and the median age for its onset is between 40 and 54.
SHL can affect people very differently. SHL is usually unilateral (that is, it affects only one ear), and it is often accompanied by tinnitus, vertigo, or both. The hearing loss may vary from mild to severe and may involve different parts of the hearing frequency range. SHL may be temporary or permanent. About one third of people with SHL awaken in the morning with a hearing loss.
Sudden hearing loss is a medical emergency. One’s best chance for recovery is to seek medical attention immediately. Corticosteroids are the primary agents used to treat SSNHL. Between 40% and 60% of those with SSNHL will recover to functional hearing levels. Those that recover 50% of their hearing in the first 2 weeks following the onset of SSNHL have a better prognosis than those who do not recover at that rate. Recurrence of SSNHL is rare but possible.
As I write this column it has now been six weeks since the event took place. My hearing has pretty much returned to previous levels. I realize how truly fortunate I am to have recovered. Many who experience sudden hearing loss either lose their hearing permanently or recover less than 100% of their prior hearing ability.
For every patient who recovers at least some hearing after SHL there is another who is not as fortunate. Since mid-March I have encountered other ICSOM musicians affected by SHL. No doubt there are more across the AFM. Additional research needs to be done. Is there something about what we do as musicians or the environment in which we work that may contribute to a greater rate of SHL? We know that seeking medical treatment immediately dramatically increases full or partial hearing restoration. What else can we do to assist those who suffer sudden hearing loss permanently?
My first program back at work included Dvořák’s New World Symphony. Like many orchestral musicians, I first performed this piece in high school over thirty years ago. Yet, on that weekend, I couldn’t have been happier to perform it again. (I may have even had a tear or two in my eyes.) Realizing how close I came to losing it all reminded me just how much I enjoy being a musician. I have rediscovered the magic of beautiful music, the emotional interaction between musicians and audience that only happens during live performances, and the joy that comes with creating beautiful art one phrase at a time. When the pressures and stresses of being in an orchestra or committee responsibilities begin to overwhelm me, I hope to remember what happened to me. I hope to remember just how lucky I am to be in an ICSOM orchestra doing what I have loved to do ever since I first picked up a trumpet as a young boy.