Hearing Loss and the Singer

Hearing Loss and the Singer


We live in a noisy world, and the sound is omnipresent, incessant, and increasing. Constant noise, loud music, and meaningless loud chatter compete for our attention. Apart from how this devalues the informational and aesthetic value of what we hear (How can you ever again appreciate Vivaldi if you are forced to endlessly listen to it through a telephone receiver while being put on hold by your HMO?), constant sound can damage our hearing and our health.

Our ears are at their most sensitive best when listening to soft and moderate levels of sound, such as might be found in nature. Loud noise, especially when sudden and unexpected, not only damages our ears, but also evokes an alarm response which stresses our bodies. While this discussion can go in many different directions (including the effect of elevated stress hormones on the heart), I would like instead to focus on our ears and how to preserve them in today’s noisy world.

As mentioned above, our cochleas were designed to perceive soft sounds and are maximally responsive around 1,000 cycles per second (or Hertz), which is around B-flat below high C. At this frequency, we can distinguish smaller gradations of sound increase than at any other frequency. Perhaps not coincidentally, this frequency of 1,000 Hz happens also to be smack in the middle of our speech range. So one might argue that we have evolved to listen most effectively to conversational speech, as well as to the normal sounds of nature.

But this is not the world in which most of us live. Ambient sound levels can be excessive, particularly in places where we work and socialize. While the maximum amount of “safe” noise exposure in the workplace has been determined to be 85 decibels (for an 8-hour day), this number is misleading. For one thing, it used to be 95 dB, and the downward adjustment clearly reflects an evolving and increasing appreciation of the damaging effect of noise—I would not be surprised if this maximum “safe exposure” limit continued downward. For another, as the noise level increases linearly at about 85 dB, the time of safe exposure decreases at a much steeper rate.

It may not surprise you that many restaurants exceed this number. The noise level in many New York restaurants is around 90, 95, even over 100 decibels. Looking at the maximum safe exposure limits set by the Occupational Safety and Health Administration (OSHA), you will see that a couple of after-work drinks at your favorite watering hole (at 100+ decibels noise exposure) could permanently damage your hearing!

More likely, that initial damage would be temporary, with some sensation of blockage, perhaps some transient ringing. But we are all creatures of habit, and as we return to those noisy places—whether restaurants, parties, or music performances—the cumulative damage becomes permanent.

Early noise damage is subtle and its effects insidious. Damage initially occurs around 4,000 Hz, well above the speech range, and the initial symptoms may well be just some fullness or tinnitus. For musicians, this is already a significant handicap—tinnitus interferes with the monitoring of sound and, if tonal, can be a major distraction during performance. Although a 4,000 Hz hearing loss is well above the singing voice and most instruments, it is not above some of the harmonics generated by those instruments. So your perception of fundamental pitch may remain, but your appreciation of color or timbre changes, particularly for instruments that have high overtones, such as the flute or the oboe.

Over time and with continued exposure to damaging sound, the sound notch at 4,000 Hz deepens and broadens, eventually creeping down to impair the higher speech frequencies (2,000-3,000 Hz). And this is the domain where the consonants dwell, sounds that give speech articulatory distinction. Now, the effects of hearing loss become significant in everyday life—significant and permanent.

What to do? Since we now (hopefully) live longer and more fully, we need to make sure that our organs, including our cochleas, keep working for the whole trip. So, take care of your ears! Here are some suggestions.

First, consider spending some time in silence. As Wordsworth said (in a different context, to be sure), “The world is too much with us.” Turn off the TV, turn off the radio, try walking in the park without your iPod. This not only gives your ears a break, but also gives your brain, beaten into submission by the constant flood of sound, a chance to re-emerge and seek out, rather than hide from, the normal, unamplified sounds that are in our natural environment. As a fringe benefit, you may also find that music regains its original emotional impact and depth of meaning.

Second, if you live in a loud city, always carry earplugs. You may wish to routinely wear them on the street to prevent assault from ambulances, pneumatic hammers and hydraulic brakes, or just to carry them in your pocket for when you get on the subway or in a noisy restaurant. Don’t be embarrassed to plug your ears with your fingers if a fire truck or ambulance roars by. Opening your mouth as in a yawn also provides some protection, by opening the Eustachian tubes and tensing the tiny protective muscles in the middle ear. Consider purchasing custom-fitted “musicians” plugs, which are molded to fit your ear canal, and have high fidelity filtering characteristics. I often prescribe these to Broadway pit musicians, but there is no reason for you, as a vocal musician, not to have them as well, especially if you also sing at non-classical venues.

Third, consider the effects of cigarettes and alcohol, often found in those noisy watering holes. Nicotine is a vasoconstrictor and narrows the blood vessels to the inner ear. Noise, incidentally, does the same thing, and the two may have a cumulative effect in decreasing the circulation to the inner ear and increasing damage to your hearing. Alcohol can disinhibit you and may in turn lead to spending more time in that noisy environment, time spent yelling into your neighbor’s ear.

Since singers monitor their voice mostly by hearing, consider the ears as the “silent partners” of your voice. To sing well, to sing with appropriate dynamics and in tune, your ears must work well. If you are having intonation difficulties, consider a hearing test. By protecting your ears from noise damage and identifying and possibly treating your hearing loss, you will do better in this sound-saturated world.

Anthony Jahn, M.D.

Dr. Anthony F. Jahn is a New York-based ear, nose, and throat physician with special expertise in ear and voice disorders. He has a 40-year association with the Metropolitan Opera and is medical consultant to several music schools in the tristate area. Dr. Jahn is professor of clinical otolaryngology at Mount Sinai School of Medicine and the author of over 100 publications, including The Singer’s Guide to Complete Health. He lectures internationally on ear and voice related disorders.