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Hearing Health Resources

 

Living With Hearing Loss

I’m a sound technician. Losing my hearing was devastating

Dispelling the Inaccuracies of Hearing Loss in Sound of Metal 

Using Audiology To Extend a Musician’s Career

Audiologists and Hearing Tests

Audiologists

Musicians Hearing Solutions

Dr. Bruce Hubbard, CBT for Tinnitus

Hearing Health Foundation

Hearing Health Foundation Issue on Tinnitus

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In-Ear and Ear Plug Manufactures

 

Dispelling the Inaccuracies of Hearing Loss in Sound of Metal

 

Dispelling the inaccuracies of hearing loss in Sound of Metal. As an audiologist for the past 24 years with 13 of those years focused on the specialized hearing needs of musicians, sound engineers, and audiophiles, I couldn’t believe, even from the beginning of the movie, all of the inaccuracies of the portrayal of hearing loss, its causes, treatment, and rehabilitation.

Dispelling the Inaccuracies of Hearing Loss in Sound of Metal

It took me three tries to get through the Academy Award-nominated movie Sound of Metal. As an audiologist for the past 24 years with 13 of those years focused on the specialized hearing needs of musicians, sound engineers, and audiophiles.  I couldn’t believe, even from the beginning of the movie, all of the inaccuracies of the portrayal of hearing loss, its causes, treatment, and rehabilitation.

I understand that this is a movie, a dramatization of life and that Hollywood took artistic license with the occurrence of sudden hearing loss, but the portrayal is completely inaccurate. Some major steps in the process of sudden hearing loss and its diagnosis and intervention were left out and I would like to dispel that and clear up what happens in real life.

YOU WILL NOT HAVE PERMANENT TOTAL SUDDEN HEARING LOSS IN BOTH EARS BECAUSE YOU’RE A MUSICIAN.

On a bright note – I am thrilled about the awareness and attention the movie has given to the subject matter of hearing and hearing loss and am hoping to use that attention to shine a light on reality so that people can practice, play and listen to music safely and without fear.

Sudden Hearing Loss vs Loud Sound Exposure Hearing Loss

Sudden severe to profound bilateral (both ears) hearing loss is very rare and its cause is typically viral or because of an autoimmune disease.  Sudden hearing loss incidence is about 20 per 100,000 annually and bilateral sudden hearing loss is less than that (per the Clinical Practice Guidelines: Sudden Hearing Loss, published August 1, 2019, by the American Academy of Otolaryngology-Head and Neck Surgery.) Since the main character, Ruben, is a drummer and the name of the movie is Sound of Metal, I felt there was an underlying message that this type of hearing loss could occur as a result of his profession. It is true that hearing loss can happen from loud sound exposure. However, it is most typically gradual, affecting the higher frequencies from 2500Hz-6000Hz first.  This type of hearing loss is perceived as a loss of speech clarity or that hearing is muffled.  Usually, when someone has this type of mild hearing loss in the high frequencies, they may be unaware of it, but they will be if it further declines and becomes severe and by then it may be too late.

Some signs of a high-frequency hearing loss are difficulty hearing in noise, asking for more high frequencies or clarity in a mix, needing the television louder than others, and a general feeling of hearing but not understanding what is being said. That’s why it is crucial to be proactive and take necessary precautions to avoid having this happen. These steps include having an annual diagnostic hearing evaluation, monitoring loudness levels using NIOSH standards with a sound level meter, wearing hearing protection when you can’t control the volume, and getting the right in-ear monitors with a good fit coupled with the right mix so you don’t have to turn them up too loud while rehearsing and performing. The important thing to know is that it’s never too late to start!

Medical Intervention

Unfortunately, sudden hearing loss is possible, but typically it only affects one ear and needs to be treated medically immediately.  We hope that the perception of hearing loss in one ear is something as simple to fix as wax removal, however, do not assume that to be the case.  According to my colleague, Dr. Yu-Tung Wong, MD, Otologist out of Cedars Sinai Medical Center in Los Angeles, “Examining the ear may show impacted ear wax as the cause of hearing loss, especially in someone who wears earplugs or ear monitors. It may also show correctable physical damage to the eardrum.  In the event that the physical examination is normal, and the sudden hearing loss is identified in the first few weeks, most patients would be treated with oral steroids with or without intratympanic steroid injections, and sometimes hyperbaric oxygen therapy. Generally, one-third of patients will improve by themselves even without treatment, and one-third of patients will not improve despite all treatments. The remaining one-third of patients must have treatment to improve.  The hearing recovery is not always complete but may allow the patient to use hearing aids to amplify their residual hearing to a functional level.”  So, the take-home message is do not wait if this happens to you- call your Audiologist and Otologist or Otorhinolaryngologist, commonly known as Ear, Nose, and Throat doctor or “ENT” immediately.

Sound of Metal did not address medical intervention of sudden hearing loss at all. In fact, Ruben was told by the seemingly cold audiologist in the beginning that “sorry there is nothing we can do for you”. That statement couldn’t be further from the truth as there is a lot that could have been done. While they do not sound like normal hearing, cochlear implants are truly amazing, but they would not have been the first stop on Ruben’s journey of aural rehabilitation.

After his first hearing test, Ruben should have been treated by a medical doctor, preferably an otologist, and further hearing tests would have been done to check for possible recovery.  This process could take at least a month to come to a conclusion. Had his hearing loss not improved, he would have then been told his next option which would be hearing aids, which are WONDERFUL these days! Additionally, he could have also gotten custom in-ear monitors tuned to his hearing test results to use while performing.  I do that when appropriate for my clients and JH Audio is the only in-ear monitor company that will help me accommodate for hearing loss. I have found it to be a tremendous help so that my clients don’t have to compensate by turning up the volume on their monitors too loud and their engineers don’t have to compensate for it in the mix, therefore, reducing the risk of further hearing damage due to loud sound exposure.

The fact is, that no one is even considered a candidate for a Cochlear implant until they first try hearing aids and show no benefit. Cochlear implants are typically done one ear at a time, not both ears at the same time. The good news is most insurance companies and even Medicare actually cover the cost of cochlear implants so no need to short sell the Airstream, Ruben!

Lastly, you would never have outright left Ruben, who has been through such a traumatic event with people, first of all, he doesn’t know, and second, he doesn’t speak their language. To me, it would be equivalent to being shipped off to a foreign country where no one spoke English after a trauma.  You just would never do that in real life, plus he never expressed a desire to be part of the Deaf community. It was, however, great to see the Deaf community represented and its realistic portrayal, but again it just wouldn’t be the next step for Ruben in real life. A more appropriate route would have been surrounded by friends and family supporting him through all the steps of medical intervention.

Positive Notes

Some positive notes – the sound design team did a great job letting us all hear what it is like to have severe hearing loss. We actually all have gotten to experience what hearing loss is like in real life the past year during the pandemic while wearing a low-pass filter called a face mask!  I’m hoping this experience raises awareness and empathy for what it’s like to not hear clearly and also how important visual cues are to hearing.  Hopefully when all is said and done with the pandemic people will have a newfound awareness and understanding of hearing loss.

Regarding Sound of Metal, I hope it doesn’t scare people to quit playing instruments or make them TOO paranoid. Instead, I hope by following a good hearing conservation program which includes getting your hearing tested annually, wearing good earplugs (best would be custom fit and I prefer Sensaphonics who uses Etymotic Research filters), wearing in-ear monitors at a safe level, and monitoring loudness in general that everyone can continue their careers for a long time with good hearing health!

JULIE GLICK, Au.D., F-AAA

Dr. Glick was first introduced to custom in-ear monitors and musicians earplugs twenty years ago when she started her career in private practice in Beverly Hills, California, and is thrilled to have come full circle after spending time gaining a myriad of experiences in Chicago and New York City. Musicians Hearing Health

Her passion for music and commitment to the field of audiology led her to recognize that the optimization of the live performances of musicians and hearing conservation was a niche she wanted to be involved in from the very beginning. Over the past twenty years, Julie has spent invaluable time with monitor/sound engineers and has been backstage and in rehearsal studios with musicians of all genres.  She has also worked as an audiologist for two years at Sensaphonics Hearing Conservation in Chicago. Through all of these experiences, she has gained great insight and appreciation for all the technical details that go into live musical performances and how important hearing and hearing conservation is to not only musicians but to the fans as well. Dr. Glick’s knowledge and technical expertise in sound, hearing, and hearing conservation make her a valuable asset to the music community.

Dr. Glick received her Bachelor of Arts degree in Speech and Hearing Science from The Ohio State University, Master of Science in Communicative Disorders from California State University, Northridge, and Doctor of Audiology from the Pennsylvania College of Optometry, School of Audiology. Dr. Glick is a licensed Audiologist and Hearing Instrument Dispenser in the states of California and New York and a Fellow of the American Academy of Audiology.

Healthy Ears Are Happy Ears

 

As we grow older, hearing loss is something we will all have to deal with in one way or another.   Human hearing deteriorates at different rates and severity for each of us.  As members of the audio community, it is extremely important for us to keep our ears in tip-top condition for as long as possible.  Here are a couple of tips to help your ears stay young and healthy.

Regular Ear Exams

Audio professionals should get their hearing checked at least once a year.  Hearing tests can be done with your physician during your annual physical, or by making an appointment with an audiologist.  If you are an avid industry convention attendee, chances are that there might be an audiology group providing free hearing screenings.  This has been the case over the years with AES, NAMM, USITT, and even LDI to name a few.  If circumstances prevent you from getting a hearing test in person, here are a few online options:

No Smoking

In 2019, Reuters News reported that smokers were 60% more likely to develop high-frequency hearing loss as compared to non-smokers.  Studies show that nicotine and cigarette smoke interfere with the neurotransmitters responsible for delivering sound information to the brain, irritate the Eustachian tube and lining of the middle ear, and can even cause tinnitus.  If you’re having a hard time quitting smoking, your physician can help map out a plan that works for you.  There are also many free resources designed to assist with quitting smoking.  Some of these are:

Ditch the Cotton Swabs

I have to admit that this one is hard for me.  I hate the feeling of anything in my ears, including water, so I definitely gravitate toward the Q-Tips right after a shower, but this is probably the worst way to clean your ears.  In fact, cotton swabs can make matters worse by pushing ear wax deeper into the ear, and they can even damage the eardrum.  Physicians and audiologists suggest towel drying the parts of the ear you can reach, and then cleaning out ear wax with an at-home irrigation kit or over-the-counter ear drops to lubricate and soften ear wax to prevent it from hardening and plugging up the ear canal.  If your ear becomes plugged with wax, and one of these methods is not doing the trick, your doctor can provide in-office irrigation.  BTW, there is no science behind the effectiveness of ear candles, and actually, some studies have shown that ear candles can cause an increase in wax due to candle wax deposits.  So, if you’re thinking that this will be a fun and natural solution for cleaning your ears, think again and stick with science.

Keep Them Covered

We all know that we need to be wearing earplugs or earmuffs at concerts, but loud music is not the only thing that will damage your ears.  If you have to yell over a noise to be heard, it’s too loud for your naked ears.  Construction sites, home power tools, electric yard tools, and even areas with high human population (farmer’s markets, shopping malls, airports) all produce consistent high noise levels.  For more information on choosing the right hearing protection for you, check out one of these links!:

The National Institute for Occupational Safety and Health (NIOSH)

Hearing Protection for Musicians

SELECTING AND VALIDATING HEARING PROTECTION DEVICES PDF

These are just a few of the many things we can do to protect our ears.  Remember, as audio professionals, our ears are our greatest asset, and we need to always remember to be our own advocate in protecting them.  If you’re at a restaurant or bar that has loud music playing, it’s ok to ask an employee or manager to turn it down.  We also have complete control over the electronics and tools we buy for our personal use.  Most have a noise rating listed, and this can help inform what kind of device you want to have around your precious little moneymakers.  We can’t stop the inevitable, but we can, and should, prolong it.  Long live the ears.

Audiologists and Hearing Tests

Hearing tests aren’t a common topic of conversation between audio professionals. But why? You’d think in an industry where our careers depend on hearing (and we do educate about hearing loss) we may want to get our ears checked periodically. A lot of us probably don’t do it because we think our hearing is fine. And tests are basic – most audiologists only test up to 8kHz which is fairly limited for audio engineers. But how many of us don’t get tested cause we’re scared? What if we actually have a hearing problem? Is it better to just not know?

I went to see Dr. Julie Glick of Musician’s Hearing Solutions after a couple of weeks of tinnitus and muffling in one ear that wasn’t going away (my first hearing test in 20 years). Her specialty is musicians and audio industry professionals and what caught my attention about her practice is that she does hearing tests up to 20kHz.

The hearing test process

Before she could conduct a hearing test, Dr. Glick had to clean my ears. She used a lighted “curette,” which looks like a clear crochet needle that lights up to see in the ear canal. The process was far from pleasant but necessary if you have bad wax buildup. The results were immediately noticeable. The muffling completely went away and while the tinnitus was still there, it was less noticeable against the noise floor of the room, which I couldn’t hear well before.

The hearing test was performed in an isolated booth in her office. The test itself is very simple: press a button when you hear a long beep. Each beep starts out at a noticeable level then drops a few dB until you can’t hear it anymore. Then, the beep changes to a different frequency. Dr. Glick does all the testing by computer so the button pushing is registered within the software to help correlate the results.

She also did a Tympanometry test, which checks how well the eardrum moves. A small probe is put in the ear and then the ears are given a puff of air. It’s easy and painless.

Test Results

We were immediately able to look at the results: My hearing was within normal range – but what is considered “normal” includes some loss. It’s sort of like acoustically tuning a room where a room could be called “flat” but its frequency response isn’t truly flat.

But there was a surprise when we looked at the Audiogram results: there was a noticeable difference between my ears. My right ear, the one I was concerned about, performed better than my left ear at high frequencies (8-12k). I knew immediately why: I played the violin for 15 years. I had a loud, high-frequency instrument inches away from my left ear for hours every day. I’ve probably had that discrepancy throughout my audio career.

Here’s a generic example of an audiogram to see what one looks like:

Sample Audiogram up to 8kHz

What do the results mean?

I asked Dr. Glick to help explain how any hearing loss (even if it’s considered within the “normal” range) would affect the work of an audio engineer or mixer. Frequencies like 12-16k are crucial for tasks like de-essing and noise reduction. I assumed a hearing curve is like an EQ curve (or a room curve) – that you have to compensate even when you’re mixing at nominal levels. But, that is actually incorrect.

The scale used to measure loudness outside the ear is dB SPL but hearing is on a scale of dB HL, or Hearing Level. The dB HL scale is based on the SPL scale but with a curve applied. The way Dr. Neil Bausman explains dB HL, “Our ears do not hear equally well at all frequencies. If our ears heard all frequencies of sound equally well, then we wouldn’t need the HL scale.” (His article is great for more detail!)

What the audiogram is showing is the level (HL) where the frequency completely disappears for you. This makes sense based on how a hearing test occurs because there is a threshold where a tone is played and you won’t hear it. So, if you’re mixing at a nominal level (like a reference level of 85 dB SPL) your hearing will always be “flat” – unless you have severe hearing damage at some frequencies. With normal to moderate hearing loss, it’s only when you drop to low-level mixing where you might not hear some of those frequencies. But, it doesn’t make sense to do detail EQ or de-essing work at a low level. It’s something to be aware of but doesn’t necessarily need to change how you work.

This video explains audiograms well:

Hearing Health – Hearing Test

What to expect from your hearing test

After seeing several recent articles and social media posts promoting good ear health, I realised that I was long overdue for a hearing test so promptly booked myself in with an audiologist to get a check-up at my local Specsavers hearing centre. The NHS covers hearing tests here in the UK, and so they are funded and available to all who require them. Whilst I am eternally grateful we have this service, I found the process of the test rather unpleasant, baffling in its design, and felt it left me with more questions to research myself than it had answered.

The Hearing Test

The exam started with a series of questions regarding medical history, hearing concerns, work, and lifestyle. I told the audiologist my concerns and was met with a weird scoff and strained line of subsequent questions when I answered my profession, making it an uncomfortable start. Maybe she was having a bad day, or had found musicians and engineers to make difficult patients? I can only wonder. Next, a photograph was taken inside each of my ears, which is called an otoscopy, and then the photos were brought up onto a computer screen to show the ear canal. Once those were out the way with no problems, the headphones went on in the soundproof booth, and the hearing test started.

Pure tone audiometry (PTA) is a test that measures the hearing threshold. Pure tones are played in each ear, and the responses are measured – in this case, by pushing a button each time I could hear a sound. The test starts with one ear: a frequency is played loudly, and then the same frequency is played slightly softer, again and softer again several times. This is then repeated in the same ear with the next tone. PTA measures audibility thresholds and has a “normal” average range but does not identify all hearing loss, and therefore some question its accuracy. The average levels refer to the average of hearing threshold levels of the tones used in the test, which are typically 500, 1000, 2000 and 4000 Hz. Headphones are changed during the test from being on the ear as you would normally wear them, to a different set which is placed slightly behind the ear onto the bone of the skull. The process is repeated on the other ear, with the click response being the only interaction from the patient to the audiologist during the test.

Questions arising from the test

The strange thing to me about this method is the lack of the element of surprise – the interval time between the diminishing volume tones was quite rhythmic and predictable, creating absurd existential doubt over the tones reality versus expectation. I had gone in with no real memory of my last hearing test and had thought it would be more similar to an eye exam in the way that new pictures and letters are introduced to the eyes for the first time with no way of cheating your way through, and there’s a continuous back and forth interaction with the optometrist. The lack of interaction meant that there was no opportunity to discuss whether there was a different experience in each ear or anything else that might have cropped up during the test. It seemed quite odd not to have any dialogue, and the decision not to randomise the tones in frequency, volume, and ear was the thing that surprised me, rightly or wrongly.

I was brought out of the booth and greeted with fine results, but unfortunately, it was not the cause to celebrate you’d imagine; I was told that my concerns raised back at the very beginning of the test were either:

  1.  not real and were in my head, or
  2.  due to a brain problem.

The audiologist explained to me that her role only studies the signals as far as the ear and that the signals to the brain from the ear are the jurisdiction of another doctor. The test was over, and I wondered how older or more confused patients might be dealt with at this point.

What to do if you are facing hearing loss

Hearing impairment is defined by the World Health Organization (WHO) as a hearing loss with thresholds higher than 25db in one or both ears. Loss at this level at one or more of the previously mentioned frequencies in the PTA test can guide an audiologist to the specific diagnosis and treatment.

If you’re curious to get tested but are unable to arrange an exam in person, there are various online sources with recreations of PTA tests you can do to discover if you are in the “normal” range or have any areas of concern you’d like to understand better. As with most things, though, prevention is better than the cure and looking after your hearing should be a priority. While I’m not working with stadium rock levels of loudness every night, safety measures are so crucial for those working in potentially damaging environments.

Moulded earplugs and IEMs are a big but worthy investment for both prevention and treatment to stop further damage occurring. Whilst I’m not affiliated with any companies myself, I have peers who collaborate with businesses who provide IEMs and earplugs to them in the way of sponsorship deals, which can be a great and mutually beneficial way to help with the cost of necessary ear protection.

Since my hearing test, I’ve been pleasantly surprised in my research to find there are rolling schemes in the UK such as the Musicians’ Hearing Health Scheme which provides access to specialist hearing assessment and bespoke hearing protection, partnership with Help Musicians UK and Musicians Hearing Services. These tests are with musician-specialist audiologists and include regular check-ups and bespoke hearing protection, all at a massively subsidised rate, making hearing health and treatment both accessible and affordable.

Final thoughts

In the last few weeks, I’ve learned that PTA is possibly not the most suitable or in-depth method for testing musicians’ hearing, although it gives a good benchmark to pinpoint severe hearing loss. I’ll definitely be visiting a musician-specialist for my next appointment, for the bedside manner as well as the knowledge. In matters of health, I do sometimes worry that complacency is encouraged, and if possible, my advice would be to visit a specialist and get a second opinion if something feels ‘off.’ There are experts, sponsorships, and schemes actively working to help look after musicians and engineers, and I for one am comforted knowing they’re out there taking musicians’ health seriously.

To find out more about getting specialised hearing assistance in the UK, including tests and ear protection visit:

Musician’s Union

In the United States visit

MusicCares

Musician’s Hearing Solutions

Hearing Health Seminar

SoundGirls Presents Hearing Health with Musicians Hearing Solutions

Join SoundGirls for an evening learning about hearing health, live sound, noise-induced loss and how to prevent it.  Learn about IEMS and ear plugs and how to use them properly. Dr. Julie Glick of Musicians Hearing Solutions will have demos of different IEMS available; JH Audio, Ultimate Ears, Sensaphonics and Noble Audio. Plus we will have plenty of time to meet and network with other SoundGirls members. Musicians Hearing Solutions will be offering attendees a discount on products and services. (details TBD)

Register Here

JULIE GLICK, Au.D., F-AAA

Dr. Glick was first introduced to custom in-ear monitors and musicians earplugs twenty years ago when she started her career in a private practice in Beverly Hills, California and is thrilled to have come full circle after spending time gaining a myriad of experiences in Chicago and New York City.

Her passion for music and commitment to the field of audiology led her to recognize that the optimization of the live performances of musicians and hearing conservation was a niche she wanted to be involved in from the very beginning. Over the past twenty years,

Julie has spent invaluable time with monitor/sound engineers and has been backstage and in rehearsal studios with musicians of all genres.  She has also worked as an audiologist for two years at Sensaphonics Hearing Conservation in Chicago. Through all of these experiences, she has gained great insight and appreciation for all the technical details that go into live musical performances and how important hearing and hearing conservation is to not only musicians but to the fans as well. Dr. Glick’s knowledge and technical expertise of sound, hearing and hearing conservation make her a valuable asset to the music community.

Dr. Glick received her Bachelor of Arts degree in Speech and Hearing Science from The Ohio State University, Master of Science in Communicative Disorders from California State University, Northridge and Doctor of Audiology from the Pennsylvania College of Optometry, School of Audiology. Dr. Glick is a licensed Audiologist and Hearing Instrument Dispenser in the states of California and New York and a Fellow of the American Academy of Audiology.

 

N.Y. – SoundGirls Presents Hearing Health with Musicians Hearing Solutions

Join SoundGirls for an evening learning about hearing health, live sound, noise induced loss and how to prevent it.  Learn about IEMS and ear plugs and how to use them properly. Dr. Julie Glick and Dr. Elvera Bader of Musicians Hearing Solutions will have demos of different IEMS available; Shure, Sennheiser, Ultimate Ears, JH Audio, Sensaphonics and Noble Audio. Plus we will have plenty of time to meet and network with other SoundGirls members. SoundGirls Executive Director Karrie Keyes will be on hand to meet members.

JULIE GLICK, Au.D., F-AAA

Dr. Glick was first introduced to custom in-ear monitors and musicians earplugs nineteen years ago when she started her career in a private practice in Beverly Hills, California. Her passion for music and commitment to the field of audiology led her to recognize that the optimization of the live performances of musicians and hearing conservation was a niche she wanted to be involved in from the very beginning. Over the past nineteen years, Julie has spent invaluable time with monitor / sound engineers and has been backstage and in rehearsal studios with musicians of all genres.  She has also worked as an audiologist for two years at Sensaphonics Hearing Conservation in Chicago. Through all of these experiences, she has gained great insight and appreciation for all the technical details that go into live musical performances and how important hearing and hearing conservation is to not only musicians but to the fans as well. Dr. Glick’s knowledge and technical expertise of sound, hearing and hearing conservation make her a valuable asset to the music community.

Dr. Glick received her Bachelor of Arts degree in Speech and Hearing Science from The Ohio State University, Master of Science in Communicative Disorders from California State University, Northridge and Doctor of Audiology from the Pennsylvania College of Optometry, School of Audiology. Dr. Glick is a licensed Audiologist and Hearing Instrument Dispenser in the state of New York and a Fellow of the American Academy of Audiology.

ELVERA BADER, Au.D., F-AAA

Dr. Elvera Bader’s professional experience in audiology at the leading practices in New York City combined with her background in dance and love for music made her a perfect fit as part of the team at Musicians Hearing Solutions™.  Elvera’s background includes extensive audiological evaluations, hearing conservation, tinnitus treatment and rehabilitation.  

Elvera received her Bachelor of Arts in Communication Sciences and Disorders from City University of Brooklyn College, where she graduated magna cum laude and was elected into the Phi Beta Kappa Society. She went on to complete her Doctorate of Audiology through the City University of New York Graduate Center and co-authored a study titled “College Music Faculty Views about Hearing Protection and Hearing Conservation Training”.

Dr. Bader is a licensed Audiologist and Hearing Instrument Dispenser in the state of New York and is a fellow of the American Academy of Audiology. She is also a licensed Audiologist in the state of New Jersey.

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