What are the symtoms, causes, and long-term effects of tendonitis? Is it common in musicians?

This question has been answered by CHRISTINE GUPTILL, PHD, OT, BMUS, Assistant Professor, Department of Occupational Therapy, University of Alberta.

Tendonitis is a rather catch-all, non-specific term that technically means ‘inflammation of the tendon’. It can often be used interchangeably with overuse syndrome; repetitive strain; and a variety of other terms used in the field of occupational health/medicine to describe work-related physical problems. Because it is non-specific, defining symptoms, causes, effects and effective treatment is a challenge. Experts agree that tendonitis usually presents as pain, particularly when pressure is applied that makes the tendon and the muscle it is attached to work harder. Two common forms of tendonitis include tennis and golfer’s elbow (lateral and medial epicondylitis). The generally accepted cause is lots of repetitive use of the sore muscle-tendon ‘unit’. Not surprisingly, it is rather common in musicians.

In terms of long-term effects, that sort of consistent overuse can cause other problems as the person tries to compensate for the pain by loading other parts of the body. This can range from a sore shoulder to back and hip pain, and the psychological impact of such a long term problem can be significant. It can also lead to tendinopathy, which results if tendonitis does not heal.

I really want an i-pod but my dad says its bad for my hearing.

Fathers are always right (I have three kids) but when it comes to ipods or other MP3 players, there is nothing wrong with them as long as you follow the 120/60 rule. There is actually a powerpoint presentation about ipods in the links section under “Marshall’s power point presentations”. The 120/60 rule says that it is safe to listen to your ipod for 120 minutes each day at 60% volume, and this will give you half of your daily dose of music exposure. If your favourite song comes on, turn up the volume, but remember to turn it back down to a more moderate level after. This will still allow you to mow the lawn.

What about hypersensitivity to noise as a result of exposure to loud music?

People who cannot tolerate even moderately loud sounds can be suffering from hyperacusis. It can be associated with an inner ear hearing loss. That is, not only are soft sounds too soft, but loud sounds are too loud. If there is a hearing loss, special hearing aids can be recommended that not only make soft sounds louder, but more importantly, loud sounds softer. For those with normal or near normal hearing, there is some controversy in the field. Some feel that earplugs can be useful. Others feel that earplugs are bad since they can exacerbate the reduced tolerance for loud sounds. Type in “hyperacusis” to any search engine for more information or contact the American Tinnitus Association (see link in the “Links” section of this website.

I am an electric guitarist playing in bands who now has Tinnitus. Do I have to stop playing now?

Tinnitus is a symptom of possible damage to the ear- in your cases, because of overexposure to loud music. However, the ear is very resillient and tinnitus typically recovers within a matter of 3 or 4 days (where a temporary hearing loss will typically resolve within 16-18 hours). If you frequently get a period of tinnitus after a loud set, if at all possible try not to play another gig for several days. And if definitely consider wearing musician earplugs. Even the ER-15 earplugs can extend the amount of time you spend around loud music by a factor of 32 times.

Could low-frequency hearing loss be caused by music?

NO. All music (and noise exposure) manifests itself in the higher frequency region (with the greatest hearing loss being near the top note on the piano keyboard- being between 3000 Hz and 6000 Hz). If someone has a low frequency hearing loss it is either related to the outer and middle ears (eg. wax, ear infecion, or a stiffening of the bones in the middle ear) or by an unusual condition of the inner ear. In both cases, you should seek out the medical opinion of an ear, nose, and thoat doctor (an otolaryngologist). Depending on where you live, you may require a referral from your family doctor.

Can headphones damage hearing?

Headphones are no more damaging than listening to music from a loudspeaker. One will always adjust the volume to a comfortable listening level, and the ear doesn’t know whether the music is coming from headphones or a loudspeaker. The potential danger is in “portable music” where headphones are used in conjuction with Walkman-like radios. Listening to music in a noisy environment can be damaging since one tends to turn up the volume over the background noise.

How can I scare my band mates into using earplugs? They refuse to use them

This is a common problem. Prior to 1988 there were no earplugs that could successfully be used by musicians. Today’s earplugs (for example,the ER-15) not only treat all sounds equally but minimize the occlusion (echoey) effect in the ears. Your band mates’ concerns are outdated. They should contact their local audiologist for an assessment and information session. Your band mates concerns are based on old history and have no basis with today’s technology.

Are pitch perception problems caused by damage to the inner, middle or outer ear? Are they permanent?

Pitch perception problems can be caused by either a significant inner ear problem or a problem in more central structures of the brain. Indeed, perfect pitch is a brain phenomenon, and has little to do with the hearing mechanism. Once there are pitch perception problems, little can be done to help the situation. Prevention is mandatory.

What about hyperacusis?

Hyperacusis is an awful sounding word meaning an “abnormal sensitivity to loud sound”. People may complain that “medium sounds are OK but loud sounds that don’t bother most people, seem to bother me!” This is actually an early warning sign of hearing loss. That is, not only does sound have to be abit louder in order to hear, but also the tolerance to loud sounds is reduced. Most modern hearing aids are specially designed to not only amplify softer sounds but make louder sounds softer. Most people with hyperacusis have a hearing loss. On rare ocassions, some people with normal hearing have hyperacusis as well.

Can tinnitus (ringing in the ears) be treated with ginkgo biloba?

Health food stores frequently sell Gingko Biloba extract as a treatment for tinnitus. There is no scientific basis behind this. A recent study from England surveyed over 500 users of Gingki Biloba and found no significant tinnitus reduction benefit.

How did you figure out the dB output of musical instruments?

This is a commonly asked question. I use a specially designed sound level meter that can be placed in the ear canal or in the vicinity of the musician. Frequently stated are “peak” or maximum values. The “average” values may be quite different. Go to the “articles” section of this website for exact information for each instrument.

Are there any “open air” type in-ear monitors that would reduce “occlusion” effect?

This is an excellent question. Once an in-ear monitor is “open”- i.e., there is an air hole running through the monitor to your ear, there will be a significant loss of low-frequency sound energy as well as a loss of protection from intense low-frequency sounds in the environment. The advantage of course, would be to minimize the occlusion effect which causes one’s own voice to sound hollow and echoey. Other than creating an air hole, the major way of reducing the occulsion effect is to make the portion of the in-ear monitor that extends down the ear canal, as long as possible. This would also be useful for earplugs. When obtaining the in-ear monitors, or the musicians’ earplugs, ask that the person making the earmold impression, ensures that the bore will extend beyond the second bend in the earcanal.

I am a piano tuner. Can piano tuning lead to hearing loss and should I be wearing ear protection?

Indeed many piano tuners do suffer from hearing loss. Recall that it is not only the intensity of the sound that causes hearing loss, but also the duration. A piano tuner can spend many hours each day with various pianos and like most musically inclined people, tend to also visit night clubs and other loud venues. The total exposure can add up quickly. The ER-15 musicians’ earplug is the ear protection of choice. It will protect the piano tuner, while still allow them to hear the music.

Where can I find someone to make ER-25 or ER-15 earplugs?

You should contact your state and provincial association for audiologists or hearing aid dispensers. They can put you in touch with an audiologist or a hearing aid dispenser that specializes in musicians. They can also be found in the phone book under “Audiologist” or “Hearing Aid Dispenser”. They are not covered under any medical program and usually are about $185 a pair in Canada, and about $150 in the US.

I play tenor sax in a loud band and wear ER-25 earplugs. Is the internal sound of myself playing loud potentially damaging?

This is a common concern for sax and clarinet players- instruments where the top teeth touch the mouthpiece. Sound can be generated from the instrument, through the teeth and by way of bone conduction, go directly to the ear. There are no studies that I know of about the exact sound level, but indirect evidence suggests that the sound can be quite intense. One can minimize the potential effect by ensuring that the earplug does not “trap” the sound in the ear. This is called the occlusion effect. As a sax player, unless the band is VERY loud, you should not be wearing an ER-25. At most, the ER-15 would be sufficient. I’m a clarinet player and I use the vented/tuned earplugs. These use a small hole that would let the bone conducted sound out of my ear.

Are there hearing aids for musicians?

Much work has been done in the last several years to define which is the best hearing aid for listening or playing music. There is a power point presentation(along with audio files) in the links section under “Marshall’s power point presentations” on this very issue. Many hearing aids clip or distort the louder inputs of music and once this is done, no fancy hearing aid circuitry can improve things, so… the solution is to use a hearing aid that doesn’t clip or distort the louder inputs of music, and these hearing aids, or hearing aid modifications are available.

Can a single, short duration sound cause permanent hearing damage? If so at what level?

This is called “acoustic trauma” and is quite rare. Unlike most types of hearing loss from loud noise or music which is gradual and happens over many years, a single intense blast can create a sudden permanent hearing loss at exactly the frequency of the insulting sound. A common example is a feedback squeal from a loud speaker- a permanent hearing loss can occur and will occur at exactly the frequency of the feedback squeal (eg. 1500 Hz). This example is not a typically frequency tested by an audiologist so care needs to be taken to assess as many frequencies as possible during testing in order to rule this out.

Are noise cancelling earbuds/headphones better for your hearing?

Portable or recreational music exposure such as those from ipods can be potentially damaging simply because people listen in noisy everyday environments. The tendency is to turn up the volume over the background noise, and this is where the danger lays. Using either noise cancelling headphones or “isolation” earphones that lessen the environmental noise means that you don’t need to turn up the volume as much. So, yes, these earphones can be very useful. BUT beware of not being as able to hear a car coming up behind you!

What is the Alexander Technique

This question has been answered by CHRISTINE GUPTILL, PHD, OT, BMUS, Assistant Professor, Department of Occupational Therapy, University of Alberta.

The Alexander Technique is an educational practice for recognizing and changing physical and mental habits. It is not healthcare, but rather what we call a ‘somatic’ technique – in other words, a way of recognizing, and working with, the body in what we do as musicians. Some research has indicated that musicians are relatively unaware of their bodies, particularly when we are ‘in the zone’. This lack of awareness can make us more susceptible to overuse and injury. Therefore, somatic techniques like Alexander, Feldenkrais, Body Mapping, Yoga, and other practices may be beneficial for musicians. Look for an Alexander Teacher who is certified through the Canadian Society of Teachers of the F.M. Alexander Technique.

I am a guitar player. What is the best way to sit?

This question has been answered by CHRISTINE GUPTILL, PHD, OT, BMUS, Assistant Professor, Department of Occupational Therapy, University of Alberta.

I’m a guitar player. What is the proper way to sit?
The short answer is that there is no entirely proper way to sit to play guitar – or any other instrument, for that matter. It all depends on your own anatomy and style preference. That being said, many of us (including me!) folk guitar players who sit to play place the guitar on the right knee, while it was designed to be placed on the left knee and held more vertically (assuming you play a standard, and not a left-handed, guitar). If you have shoulder pain while playing, and you play with the guitar on the right knee, it might be worth trying it on the left to see if that helps.

Your goal in analyzing your playing is to aim for ‘neutral’ posture. That means, not winging your right shoulder out too far; not twisting your left wrist too far clockwise (called supination); not hyperextending that left thumb against the back of the guitar neck. If you have trouble with these or any other discomfort while playing, there are a number of amazing resources on the web; and you should consult a professional to see what can be done to help.

What are some treatments for tendonitis?

This question has been answered by CHRISTINE GUPTILL, PHD, OT, BMUS, Assistant Professor, Department of Occupational Therapy, University of Alberta.

Treatment for tendonitis is varied, and good evidence exists for a number of approaches, including acupuncture; exercise, manipulation or mobilization by a therapist; splinting; ultrasound; and a few other fancy techniques such as short wave therapy and delivery of drugs via ultrasound or electric impulses. Good evidence also exists to show that laser therapy is not effective (so in other words, don’t have it done because it doesn’t help).

At the end of the day, something will need to change in how you do the aggravating activity(ies) in order to change the inflammation cycle. So, be prepared to have a look at posture, technique, practice routines, how you carry your instrument, other exercise you might do, and stress in your life as a musician.

You have discussed the effects of smoking, but could you address the effects of second hand smoke on vocalists?

Second hand smoke can be as damaging as smoking directly. In fact, second hand smoke is more carcenogic than direct smoke! That is, there is a greater chance of contracting cancer from second hand smoke. Second hand smoke is cooler than direct smoke from a cigarette, so the toxins have not been burned off as efficiently as direct smoke. Also, second hand smoke tends to be more irritating than direct smoke! There is a greater chance of irritation to the vocal chords, with an associated sore throat, and possible long-term problems.

Are there any institutions in Canada dedicated to helping only musicians’ injuries?

Actually the Musicians Clinics of Canada was set-up initially to handle injuries in musicians, and the clinics have seen over 6000 musicians for injuries since its inception in the 1980’s. The Musicians’ Clinics has seen patients from all over Canada and the United States. To see Dr. Chong, a medical referral is necessary and there is reciprocal billing through medicare with all Canadian provinces, except Quebec. For more information, see the “Who We Are” section.

What do you know about Carpal Tunnel syndrome in classical violinists

Carpal Tunnel syndrome by definition is an entrapment of the median nerve at the wrist. The median nerve can also be entraped at the elbow, shoulder, and neck. When one plays the violin, it is common that the nerves can become irritated or damaged by abnormal alignment, breathing and coordination while playing at all of the above locations- for example, by the scalene and pectoralis muscles. One needs to seek out a proper ergonomic diagnosis in order to map out an effective therapy program. A significant portion of our classical violinists suffer from Carpal Tunnel syndrome.

Why does smoking lower the pitch of a person’s voice?

Smoking doesn’t always lower the pitch of a person’s voice. The smoke can however, cause irritation to the vocal chords which can increase its mass. The more massive something is, the lower its resonant frequency. Increased blood supply (edema) to the vocal chords can also have a pitch lowering effect, since the increased volume of blood increases its mass. This can temporarily occur with colds and throat infections.

I’m a drummer. What about drummer injuries?

We see alot of posture and alignment problems in drummers who tend to play slumped over in the “turtle” position- sitting too low, with their cymbals mounted too high, and slamming away as loud as they can. Now I’m not advocating that everybody go back to a softer style of drumming, but you can accomplish alot with a little pressure. Athletes like Mark McGuire and Tiger Woods are actually exerting very little grip pressure- no more than you’d use to squeeze a tube of toothpaste!

I play guitar. Any suggestions to prevent injuries?

Most pop guitarists are self-taught; they tend to pick up their licks from listening to CDs and mimicking Eric Clapton and Jeff Beck. Unfortunately they often learn those licks sitting around on a couch, which causes lots of bad posture and alignment problems. This is how injuries occur. Also, an electric guitar is heavy and if its strapped across a shoulder for hours at a time, it’s going to cause nerve compression and blood vessel compression in the neck and shoulder.

I am a singer. Do you have any suggestions to help reduce my vocal strain and sore throat after a session?

I have three suggestions- “water”, “water”, and “water”. The muscles in the throat are so delicate, they are like onion skins. So, the whole issue of keeping them moist is the first thing. The second is how hard you use these delicate structures. Breathing patterns , alignment and straining are all big issues. Many singers tend to jut their head and jaw forward and to push for intensity and volume. But those things can be counterproductive to long-term performance.

What about smoking?

Smoking is obviously a no-no. Anybody working in a bar is getting way more smoke than their personal limit of second hand smoke, to begin with. Smoking tends to dry out your vocal chords and limits your singing range. Other than Rod Stewart, I can’t think of any other successful singer who can sing with damaged vocal chords.

Are there any hearing aids that are either designed for music or particularly well adapted to music listening?

If you go to the Articles section of this website there are some articles that tackle the question of hearing aids and music. In short, this is not a programming or software issue- the ultimate settings for a music program are not all that different than a speech in quiet program. The difference is in the hard ware of the hearing aid. Only certain hearing aids can handle the higher levels of music without distortion. This is a question that should be addressed to your local audiologist.

You had said earlier that TTS is not necessarily temporary. Can you clarify what you meant?

Research prior to 2006 indicated that TTS, or temporary threshold shift, was indeed just that… temporary. However, these earlier studies used puretone beeps (like a hearing test). And the acuity for these beeps do indeed return to the pre-exposure level after 16-18 hours. More recent research, mostly by Dr. Sharon Kujawa and Dr. Charlie Liberman at Harvard show that while the puretone thresholds or acuity does recover, there can be permanent nerve damage. This is the basis of the new Temporary Hearing Loss Test app that we have developed (available for both the iphone and the Android).

I’m a rock singer and I use custom molded In Ear Monitors. Should I be worried about the occlusion effect ?

Most ear monitors (custom made loudspeakers that fit in the ear) are made with a long bore, or portion that goes deep in to the ear canal. This long bore, will serve to minimize the occlusion (or echoey) effect. If your ear monitors give you this echoey sound, there are three things that can be done: (1) set the input to the ear monitors to have LESS bass sound, (2) have the hearing health care professional that made it for you, drill a small hole called a vent, or (3) send the ear monitors back to the manufacturer with a new ear mold impression and have them make the bore as long as possible. All three of these things will serve to minimize the “echoey” sensation that you might get.

Which are more damaging: low or high frequencies?

Actually this is an important question. A few research studies concluded that some frequencies are “sligthly” more damaging than others, but in reality, all frequencies are equally damaging. The reason we have our worst hearing in the 3000-6000 Hz region (around the top note of the piano keyboard) has more to do with the way our ear is made up, rather than the sound(s) that cause the hearing loss. For this reason, a flute and a bass player would have similar hearing losses. For more information see the FAQ near the top on “factors affecting hearing loss”.

So what is Tinnitus Retraining Therapy (TRT)?

Tinnitus is actually created in the brain- not the ear. The hearing loss (from too much loud music) causes the nerve endings in the ear to become damaged. The brain cells that receive the impulses from these nerve endings say “where is the sound??” These cells become “lonely” and start to generate their own sound. TRT is a method that involves counselling and the use of a noise generator (or masker). The cells in the brain say “Oh! Here is the sound” and gradually (after a year or so) stop producing their own noise. The tinnitus dies away (or at least becomes less bothersome and noticeable). Many audiologists offer this type of tinnitus therapy. You should consult your local audiologist for more information. Also, click on the “links” section of this website and click on the link for the American Academy of Audiology Tinnitus Position Paper. It is an excellent overview of everything we currently know about tinnitus. Also, click on the link to the American Tinnitus Association for more information.

So what are the factors affecting hearing loss?

The two main factors are how intense the music or noise is, and how long one has been exposed to it. We know from research that prolonged exposure to 85 decibels (dB) or greater, over time will cause a permanent hearing loss. A level of 85 dB is not particularly loud- a dial tone on a telephone is about that! Even though it is not loud, it is intense enough to be damaging. But, it also depends on how long you are exposed to it. Research has found that the maximum exposure each week should be less than 85 dB for 40 hours. This is identical to 88 dB for only 20 hours. That is, for each increase of 3 decibels, you can only be exposed for half as long. Saying it differently, for every 3 decibel increase, your exposure doubles. Other less significant factors are your liking of the music, general health, and hereditary factors.

Let me get this straight. If I like my music, it is less damaging to my hearing?!

Well, sort of… technically, its not so much that liking the music is good for us- its if we don’t like the music, it is worse. We’re not sure exactly why that happens, but there are two theories. One is that when you are under stress, certain hormones are released in your inner ear that makes it more susceptible to hearing loss. A second theory is related to the fact that there are a series of feedback loops from the brain back to the inner ear. These feedback signals can change the susceptibility of the inner ear to damage. If the music is pleasureable, the feedback from the part of the brain corresponding to hearing, reduces the susceptibility.

Are there any other differences between classical musicians and rock musicians besides the obvious?

You mean, beyond the long hair? Although this next issue is highly variable, many classical musicians don’t like their music as much as rock musicians do. It is this liking of the music that is partially responsible for the difference in susceptibility between rock and classical musicians. Research has shown (see some of the articles in the “Articles” section of this website) that if you like the music, it is actually less damaging than if you don’t like it. Classical or orchestra musicians may play the same piece of music countless times, and become bored with it. In addition, an orchestra musician has their music selected for them by a conductor or artistic director. They may not like the selected pieces. In contrast, a rock musician tends to play their own music- music that they love. This research has been replicated many different ways, always with similar results. So, go ahead and enjoy your music (in moderation).

I understand that rock music can be damaging to my hearing, but I can’t believe that Mozart or Beethoven can be bad for me.

Believe it or not, but Classical music- or specifically playing classical music- can be more damaging than rock music. Research has shown that about 37% of rock musicians have a hearing loss, and about 52% of classical musicians suffer from this problem. The main difference is that classical musicians rehearse, perform, and teach more hours each week than typical rock musicians. And classical musicians tend to be clustered closer together than rock musicians. So even though the peak sound levels in a rock band may be higher than in an orchestra, the total weekly doseage of a classical musician is greater.

So what can be done if I do have tinnitus that won’t go away?

Don’t panic- this is rather uncommon, but it does occur on occasion. There is almost always a hearing loss associated with the tinnitus. Using a small hearing aid (and there are some that fit invisibly into the ear canal) not only will help you hear better, but will tend to mask or block out the tinnitus in the majority of people. Being overly concerned about it is another problem. The last thing someone should do is become stressed as this may make the tinnitus more noticeable. There are therapy programs that serve to retrain the brain to ignore tinnitus and these can be very successful. Contact your local audiologist or doctor if this becomes a problem.

What else can happen as my hearing gets worse?

In some sense, hearing loss is the least of your worries. After all, it is very gradual, and only affects the very high pitched sounds… so you may not notice it for years to come. But, with hearing loss comes two other things that can be very annoying- or if you are a musician, can be career ending. They are pitch perception problems and permanent tinnitus. Pitch perception problems, as the name suggests, means that a person with a significant hearing loss may hear one note as another (and have limited understanding for speech). And can you imagine having a constant hum or whistle in your head day and night? This is what many people report with permanent tinnitus. So,… prevention of hearing loss is where its at.

If my tinnitus goes away after 16 hours, is it safe to go to another concert after?

The short answer is “yes” and “no”. It is true that the ear recovers after about 16 hours and can take on new challenges of loud music, but TTS is a warning signal of being exposed to too much music. If you go to a rock concert on Friday night, don’t mow your lawn until Sunday (or better yet, get someone else to do it!) However, once you have a music related (or noise related) hearing loss, it is permanent, so do whatever it takes to prevent it. Certainly moderation is one idea. Enjoy that loud song, but when its over, turn down the volume a bit to give your ears a rest.

Well, … thank you for that, but what is TTS?

What a good question! TTS stands for Temporary Threshold Shift. This is a fancy way of saying temporary hearing loss. After a loud concert, or a day in the factory, your hearing is temporarily reduced. After about 16 hours to 18 hours, this resolves and your hearing should return to the level it was before (hopefully normal). When the hearing is reduced, there is frequently tinnitus, which is especially noticed in quiet places such as when you are trying to sleep. The tinnitus and hearing loss (sometimes felt as a numbness in your ears) should completely resolve after 16 hours. BUT, it turns out that TTS may not be just a benign characteristic of too much noise or music. Recent research indicates that while the hearing loss (as measured with puretone beeps) returns to normal, that there can be permanent neural damage… see other TTS questions below…

I went to a concert last night and my ears are still ringing. Will this stop?

The ringing is called tinnitus. Actually, tinnitus refers to any noises that are heard in the head, that don’t come from the outside. Tinnitus comes in two flavours- objective and subjective. Objective tinnitus is tinnitus that can be heard by other people. This is very rare, and is usually related to blood vessel problems in the ear. Subjective tinnitus is much more common and refers to the type of tinnitus that only the person can hear. But, to answer your question. You are probably suffering from TTS from the concert.

What about smoking?

Smoking is obviously a no-no. Anybody working in a bar is getting way more smoke than their personal limit of second hand smoke, to begin with. Smoking tends to dry out your vocal chords and limits your singing range. Other than Rod Stewart, I can’t think of any other successful singer who can sing with damaged vocal chords.

Can this be helped by diet and lifestyle?

Diet is obviously critical to maintaining optimal health. Drinking plenty of fluids and eating healthy (vegetarian) meals can do alot to extend your musical career, especially if you are on the road. Many 24 hour supermarkets stock easy to prepare frozen foods that can be heated up in the nightclub’s microwave. Try to keep caffeine and alcohol to an acceptable minimum- having two beers and not four. (And of course no beer if you are under age!)

What are some causes of music related injuries?

Most music-related health problems come from the interaction between the musician and their instrument or the musician and the environment. Too much force, too many repetitions, and too much force or volume can all result in injury. Musicians tend to be stuck in one position and repetitive strain injuries can occur. Faulty technique can also contribute to problems.

Can my hearing loss be treated with medicine or surgery?

Only hearing losses that are from the middle ear (where kids get ear infections) or from the outer ear (such as wax occlusion) can be treated. Rarely can a hearing loss be treated if it is from the inner ear. The inner ear is actually in the brain, so inner ear surgery is brain surgery! Having said all this, researchers are working on a “vacination” that can be given to reverse inner ear hearing loss- as more information becomes available, look in the “What’s New” section of this website.

What are some other causes of permanent hearing loss?

Other than hearing loss associated with aging (called presbycusis), the single greatest cause is working around noise. The ear does not know the difference between loud noise and loud music. To the ear, noise and music are just vibrations in the air. Rarely, a person may suffer a permanent hearing loss from a virus or even a brain tumor. These usually have a sudden onset and may be accompanied by dizziness. Hearing loss from noise or music tends to be gradual in nature with no dizziness. If one experiences dizziness or a sudden hearing loss, one should contact their doctor.

I listen to my MP3 player at about half volume. Is this level OK?

Well, lets find out. We know that MP3 players generate about 85 decibels at about 1/3 volume control. Many yield about 95 decibels at half volume. Let’s do some math- 85 dB for 40 hours, is the same as 88 dB for 20 hours, which is the same as 91 dB for 10 hours, and this is the same as 94 dB for 5 hours each week. Therefore you can listen to your Walkman safely at one half volume for about 5 hours each week. If your favourite song comes on, turn up the volume and enjoy, but be sure to turn it back down after. There is an interesting case study in the “articles” section of this site by Brian Fligor. Take a look at it!

I have tried earplugs but they sound hollow. Also, I can’t really hear the high end. Are there better earplugs?

Because of the laws of physics, earplugs lessen (attenuate) the sound energy for the higher pitches more than the lower bass notes. Typically earplugs will cause a hollow sound without much high end. About a decade ago, a company named Etymotic Research came out with a “flat” earplug- one that lessens the sound energy for the high pitched notes as much as for the low bass notes. These use a small acoustic amplifier that puts back many of the high pitched sounds. Musicians and music listeners then can hear their music unaffected, except that its at a non-damaging level. These earplugs come in several amounts of protection- 9 decibels of protection (ER-9),15 decibels of protection (ER-15) and 25 decibels of protection (ER-25). Different musicians use different earplug.