OFFICIAL PUBLICATION OF THE CANADIAN ACADEMY OF AUDIOLOGY PUBLICATION OFFICIELLE DE L’ACAD ÉMIE CANADIENNE D’AUDIOLOGIE
www.canadianaudiology.ca
Vol. 8 No. 2 Revue canadienne d’audition 2013
Hearing Loss and Music: Special Issue A Musician's Hearing Loss Awareness Program in Turkey Beethoven and Me: The Effects of Hearing Loss on Music Composition
Publicatio ns Ag reeme nt Nu mber 40025049 | ISS N 1718 1860 ww w.and rewj ohnpublish ing.co m Widex Message froM the editor-in-Chief |
ot everyone is a used in the composition and recording Hearing Report for Spotlight on Science Nmusician but fields. with her column about noise and music music is something induced hearing loss. Patty’s guest that everyone needs. As you have probably guessed, this issue column is adapted from a guest blog that This is true whether of the Canadian Hearing Report is about she had written for me at Hearing- its background “noise” music and music-related issues. We have HealthMatters.org – a weekly blog about as a distraction when articles from virtually every realm of all aspects of hearing loss. And of course, doing aerobics or music. This includes articles from hard of Calvin Staples does his usual great job of jogging, or whether hearing musicians, hearing loss in selecting some recent music-related blogs one actually derives classical orchestral musicians, the various from HearingHealthMatters.org. pleasure from listening to, or playing effects of MP3 players, as well as articles music. The field of music and hearing is on the benefits of music in our brains. Ata Akdag writes all the way from Turkey relatively new, and the branch of music and shares the efforts expended to and hearing aids is even newer. A I haven’t seen Beethoven clinically for develop of musicians’ hearing loss misconception about the field is that it is many years now, but I know that the last awareness from in his country and about musicians. This is not the case. The time I did, he had a progressive hearing reviews some of the work that has been field of music and hearing is relevant to loss over his lifetime. Jay Alan done to “convince” musicians about everyone who, from time-to-time, just Zimmerman writes a most delightful hearing loss prevention strategies. Closer wants to listen to music. This is as true piece on how Beethoven’s music changed to home Alberto Behar and I examine for my mother and father who over the course of his lifetime – gradually hearing loss in classical musicians. occasionally attend a musical production shifting the key and playing range at the local theatre, as it is for the hard of towards the left hand side of the piano And finally, Julia Ruth Hopkins writes hearing 64-year-old jazz musician who keyboard (possibly in response to a about her struggles – personal and need some amplification to hear the gradually high frequency hearing loss). administrative – to become the first harmonics and other instruments also Like Jay, Richard Einhorn is a well- music teacher in Ontario to receive being played in the venue. known hard of hearing American coverage for her hearing loss through the composer and musician who writes provincial Worker’s Safety and Insurance My son Shaun recently graduated from about the limitation of many modern Board (WSIB). To date, only British the Berklee College of Music in Boston hearing aids to handle the more intense Columbia and Ontario provides coverage and when home for summer breaks, I components characteristic of music, to music teachers. was always amazed at how much his along with some strategies that have computer screen for composition and worked for him. And let’s not forget our 2013 is a special year for hearing loss song production looked like a typical own Peter Stelmacovich who writes our prevention for musicians – it is the 25th hearing aid programming screen. He has regular column The Deafened anniversary of the first flat attenuation control over all aspects of compression- Audiologist – top ways to enjoy music musicians’ earplug. I hope you all take a attack, release time, and compression with a hearing loss. Gael Hannan, who bit longer than usual to read through this ratio. He has control over gain and like me can only play the radio, asks in issue. We can all learn something from output, and his equalization is similar her regular column “The Happy HOH”, music and our hard of hearing musician (but more frequency specific) than those could somebody turn my music back on? clients that we can bring to our own found in my hearing aid clinics. It can be clinical environments. said that an audiologist is simply a New knowledge about music induced recording and production engineer for hearing loss is conveyed to us by Nina Marshall Chasin, AuD, M.Sc., Aud(C), hard of hearing people. I suspect that we Kraus who is a guest columnist for this Reg. CASLPO, Editor-in-Chief can learn a lot from the field of music and issue for All Things Central. Dr. Kraus [email protected] it is hoped that, in the not too distant writes about the musicianship’s effect on Canadian Hearing Report 2013;8(2):3. future, our programming screens will the brain. Patty Johnston is also a guest allow as much “fine tuning” as the ones columnist in this issue of the Canadian
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Vol .8 No 2 | 2013 contents Revue canadienne d’audition DEPARTMENTS FEATURES RESEARCH AND DEVELOPMENT FOCUS ______3 Message from the Editor-in-Chief 7 Message du L’editeur en chef 31 The Journey from a War to Loudness Wars: Vol. 8 No 2 • 2013 A Musician’s Hearing Loss Awareness 8 Letter to the Editor Program in Turkey Official publication of the BY GLYNNIS TIDBALL, M.SC. (AUD, SLP) RAUD BY ATA AKDAG Canadian Academy of Audiology 9 What’s New? 35 Beethoven and Me: The Effects of Hearing- Loss on Music Compositio n COLUMNS BY JAY ALAN ZIMMERMAN 11 THE DEAFENED AUDIOLOGIST | Hearing Loss in Classical Orchestra Publication officielle de l’académie Top Ways to Enjoy Music with 40 canadienne d’audiologie a Hearing Loss Musicians ww w.canadianaudiology.ca BY PETER STELMACOVICH BY ALBERTO BEHAR, PENG, CIH AND
E DITOR- IN-C HIEF / É DITEUR EN CHEF MARSHALL CHASIN, AUD Marshall Chasin, AuD., MSc, Reg. CASLPO, 14 FROM THE BLOGS@ Di rector of Research , Musicians’ Clinics of Canada HEARINGHEALTHMATTERS.ORG 43 The “Epidemic” of NIHL from MP3 Player BY CALVIN STAPLES, MSC Use A S SOCIATE E DI TORS /ÉD IT EU RS ADJOI NT S BY CORY PORTNUFF, AUD, PHD Steve Aiken, PhD, Dalhousie University 19 THE HAPPY HOH Alberto Behar, PEng, Ryerson University Could Somebody Turn My 45 SIN and SNR: The Unavoidable Importance Leonard Co rnelisse, MSc , Un itron Hearin g Music Back On? of Maximizing Signal to Noise Ratio BY RICHARD EINHORN, BA Joanne DeLuzio, PhD, Univer sity of Toront o BY GAEL HANNAN Lendra Friesen, PhD, Sunnyb rook Healt h Science s Cen tre Gael Hannan, Hearing Loss Advocate 21 ALL THINGS CENTRAL Bill Hodgetts, PhD , Un iver sity of Al berta Facing the Music: Musicianship’s Lorienne Jenstad, PhD , Uni versi ty of Britis h Colum bia Effect on the Brain André Ma rcoux, PhD , Un iver sity of Ott awa BY NINA KRAUS, PHD Sheila Moodie, PhD , University of Western Ontario Calvin Staples, MSc , Co nestoga Colleg e 23 SPOTLIGHT ON SCIENCE Kim L. Tillery, PhD, State University of New York, at Fredonia New Knowledge on NIHL About the Cover: Rich Tyler, PhD, Un iver sity of Iowa BY PATTY JOHNSON, AUD Michael Valente, PhD, Was hing ton Uni ver sit y Courtesy of Etymotic Research
M AN AGIN G E D ITOR /DIRECT EUR DE LA R É DACTIO N FEATURES (www.etymotic.com) the front cover shows a Scott Bryant, scottbryant@and rewjohnpublishing.com 26 An Audiologist is a Recording pair of musicians' earplugs that are now Engineer for Speech C ONTRIBU TORS celebrating their 25 year of age. These have BY MARSHALL CHASIN, AUD Steve Aiken, Ata Akdag, Rachel Arntson, uniform attenuation that allows the musicians to play and to listen to their music at a safe Alberto Behar, Marshall Chasin, Gael Hannan, 27 Work Related Hearing Loss – Julia Ruth Hopkins, Patty Johnson, Nina Krauss, A Difficult Journey level while maintaining the original balance of Cory Portnuff, Calvin Staples, Glynnis Tidball, Peter BY JULIA RUTH HOPKINS, ARCT, MUS.BAC, BED. the sounds. Stelmacovich, Jay Alan Zimmerman 29 Do It With a Song A RT D IRECTOR/DESIGN /DI RE CTEUR ARTI S TI QU E /DESIGN BY RACHEL ARNTSON, MS, CCC-SLP Follow us on Twitter @chr_infor Andrea Brierley, [email protected]
SALES AND CIRCUL ATION COORDINATOR ./ COORDONATRICE DES VENTES ET DE LA DIFFUSION Brenda Robinson, [email protected]
ACCOUNT ING /COMPTAB ILITÉ Susan McClung
G ROUP P UBL I SHE R /CHEF DE LA DIRE CTION John D. Birkby, [email protected] ______Canadian Hea ring Repo rt is pu blishe d six times an nual ly by And rew Joh n Pu blishing In c. with of fices at 115 King Street West , Dun das , On , Cana da L9H 1V1 . We welcome edito rial su bm issions but cannot assume res ponsi bility or commitment for unsolicite d mate rial . Any edito rial mate rial , including pho - tog raphs that are acce pte d from an unsolicite d cont ributo r, will becom e the prope rty of An dre w John Pu blishing Inc. FEED BACK We welco me you r vie ws and co mm ents .Please send them to Andre w John Pu blishing Inc., 115 King Street West , Dundas , ON , Canada L9H 1V1 . Co pyright 2013 by An dr ew John Publishing In c. All rights rese rved . Rep rinting in pa rt or in whole is for bidden without express written con - sent from the pu blishe r. Pu blications Ag reement Number 4002504 9 • ISSN 1718 1860 INDI VI DUAL COPIE S Return undeli verable Canadian Addresses to: Andrew John Publishing Inc. 115 King Street West, Indivi dual copies may be purchase d for a price of $19.95 Canadian . Bul k Dundas, ON, Canada L9H 1V1 orde rs may be pu rchase d at a discounted price with a mini mum order of 25 copies . Please contact Ms . Bren da Robinson at (905 ) 628-4 309 or brobinson@and rewjohn publishing.co m for more in formation and specif ic pricing . REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 5 Oticon Message du L’editeur en Chef |
oin de nous l’idée dans le domaine de la composition et de chroniqueuse invitée pour la chronique Lqu’on est tous l’enregistrement. Spotlight on Science de ce numéro de La musiciens mais tout le Revue canadienne d’audition avec sa monde a besoin de Comme vous l’aurez probablement chronique sur la perte auditive induite par musique. C’est vrai, deviné, ce numéro de La revue canadienne le bruit et la musique. La chronique de quand c’est une d’audition est sur la musique et les enjeux Patty est adaptée de son blog qu’elle a écrit musique de distraction qui s’y rapportent. Nous avons des articles pour moi au HearingHealthMatters.org – en arrière-plan quand virtuellement au sujet de chaque domaine Un blog hebdomadaire au sujet de tous les on fait sa dance de la musique. Parmi ces articles écrits par aspects de la perte auditive. Et bien sûr, aérobique ou son des musiciens malentendants, le sujet de Calvin Staples, comme à son habitude, jogging, ou si on prend plaisir à écouter la perte auditive chez les musiciens excelle dans sa sélection de blogs qui ont ou à jouer de la musique. Le domaine de d’orchestre classique, les effets variés des trait à la musique dans le la musique et de l’ouïe est relativement baladeurs numériques MP3, et des articles HearingHealthMatters.org. nouveau, et la filière de la musique et des sur les bienfaits de la musique sur nos appareils auditifs est encore plus récente. cerveaux. Ata Akdag nous écrit de sa Turquie Une méprise sur le domaine est la lointaine et partage avec nous les efforts croyance que c’est au sujet des musiciens. Ca fait des années maintenant que je n’ai consacrés à développer la sensibilisation à Ce n’est pas le cas. Le domaine de la pas vu Beethoven cliniquement, mais je la perte auditive chez les musiciens de son musique et de l’ouïe est pertinent à toute sais que la dernière fois que je l’ai vu, il pays et revisite certains travaux qui ont été personne qui, de temps à autre, veut juste avait une perte auditive progressive tout entrepris pour “convaincre” les musiciens écouter de la musique. Ceci est vrai pour au long de sa vie. Jay Zimmerman rédige qui souffrent de la perte auditive. Plus près ma mère et mon père, qui à l’occasion vont une pièce exquise sur la musique de de chez nous, Alberto Behar et moi-même voir une production musicale au théâtre Beethoven qui a changé durant sa vie – examinons la perte auditive chez les local, et aussi vrai pour le musicien de Jazz Graduellement déplaçant la touche et la musiciens de formation classique. malentendant de 64 ans qui a besoin de portée du jeu vers le côté gauche du certaine amplification pour entendre les clavier du piano (possiblement en réponse Et finalement, Julia Ruth Hopkins se harmoniques et les autres instruments à une graduelle perte auditive de haute penche sur ses difficultés – personnelles et aussi joués à l’endroit. fréquence). A l’instar de Jay, Richard administratives –pour devenir la première Einhorn est un musicien et compositeur enseignante de musique à recevoir la Mon fils Shaun a récemment obtenu son malentendant américain bien connu qui couverture pour sa perte auditive à travers diplôme de the Berklee College of Music se penche sur les limitations de plusieurs la commission de la sécurité de Boston et quand il rentrait pour les appareils auditifs modernes à traiter les professionnelle et de l’assurance contre les temps des vacances d’été, j’étais toujours composantes plus intenses des accidents du travail (CSPAAT). A jour, étonné de constater que son écran caractéristiques de la musique, et aussi sur seule la Colombie britannique et l’Ontario d’ordinateur pour la composition et la certaines stratégies qui ont marché pour fournissent une couverture pour les production de chanson était semblable à lui. Et n’oublions pas notre Peter enseignants de musique. l’écran typique des programmes pour les Stelmacovich qui rédige notre chronique appareils auditifs. Il a le contrôle sur tous régulière “L’audiologiste devenu sourd” – 2013 est une année spéciale pour la les aspects de compression – attaque, étalage de la tête de liste des moyens utiles prévention de la perte auditive chez les temps de libération, et taux de pour prendre plaisir à écouter la musique musiciens – c’est le 25 eme anniversaire du compression. Il contrôle les gains et même avec une perte auditive. Gael premier bouchon d’oreille à atténuation sorties, et son égalisation est similaire Hannan, qui comme moi peut seulement plate. J’espère que vous prendrez tous plus (mais plus spécifique à la fréquence) que jouer de la radio, se pose la question dans de temps que d’habitude à feuilleter ce ce que j’ai dans mes cliniques d’appareils sa chronique régulière “The Happy HOH”, numéro. Nous pouvons tous apprendre de auditifs. On pourrait dire simplement Ya-t-il quelqu’un pour brancher ma la musique et de nos clients musiciens qu’un audiologiste est un ingénieur musique? malentendants, un apprentissage que d’enregistrement et de production pour les nous pouvons amener dans nos personnes malentendantes. Je me doute Une nouvelle connaissance de la perte environnements cliniques. bien que nous pouvons apprendre auditive induite par la musique nous est énormément du domaine de la musique acheminée par Nina Kraus qui est la Marshall Chasin, AuD, M.Sc., Aud(C), Reg. et il y a lieu de croire que, dans un futur chroniqueuse invitée de ce numéro pour CASLPO pas très lointain, nos écrans de la chronique All Things Central. Dr. Kraus Éditeur en chef programmation vont nous permettre traite les effets de la musique sur le [email protected] autant de “réglage fin” que ceux utilisés cerveau. Patty Johnson est aussi une Canadian Hearing Report 2013;8(2):7. REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 7 | Letters to the editor
Dear CAA members,
he recent CBC Marketplace report on the foLLowing Letter was management. They work to address Tthe high cost of hearing aids was sent to the ProduCers of classroom noise and poor acoustics that terrible journalism and a disservice to MarketPLaCe hinder children’s ability to hear their our members and to Canadians with CBC News teachers. They write letters supporting hearing loss. It misrepresented the true Marketplace, P.O. Box 500 patients who need equipment or cost of hearing aids and suggested that Toronto, ON M5W 1E6 accommodation for hearing loss. They audiologists are grossly overcharging for Fax: 416 ‐205 ‐2246 educate families on how to communicate hearing aids and services. with their hard ‐of ‐hearing loved ones. To the CBC Marketplace producers: They reassure clients who fall apart The Marketplace episode claimed that when they learn that they are losing their they contacted a “national audiology I am writing in response to your segment hearing. They provide services for association” that was not helpful, and on the cost of hearing aids that aired people struggling with tinnitus. They do did not wish to appear on camera. February 5 on CBC Marketplace . research, often “off the side of their desk” Unfortunately the national organ- and on their own time. They prescribe ization that Marketplace contacted As a practicing audiologist, I am hearing aids. And yes, many audiologists was not the CAA. When I learned concerned about your portrayal of are also licensed to dispense hearing about the upcoming Marketplace story I audiologists as hearing aid hawkers who aids, a complex process that requires contacted the CBC on behalf of the CAA, aim to rob the public of their commitment from both the dispenser but this was not included in the episode. hard ‐earned dollars. and the consumer to be successful. I have every confidence that CASLPA and the other organizations responded My experience is that audiologists are Your segment also portrayed our to the CBC in good faith, but I am drawn to the profession because they are professional associations as organizations saddened that the CAA was not given the passionate about hearing and hearing intent on hiding the cost of hearing aids opportunity to respond to this very health care. And they do a lot besides from consumers. The two national important matter. dispense hearing aids. professional organizations representing audiology – the Canadian Academy of This reaffirms my conviction that we Audiologists perform diagnostic tests for Audiology and the Canadian Association need to increase our national profile and hearing and balance disorders. They alert of Speech ‐Language Pathologists and our advocacy to the public. As you physicians to possible medical problems Audiologists ‐ aim to promote the know, the CAA is a volunteer-based picked up during testing. They run profession and encourage a high level of organization. Please consider how you hearing screening programs to identify professional and ethical practice. They can get involved and support your hearing loss in infants and children. are not regulatory bodies and play no profession. Together we can improve They run cochlear implant programs for role in the business of selling hearing public awareness about audiologists, people too deaf to benefit from hearing aids. audiology services and the importance of aids. They teach speech ‐reading courses hearing, and we can help prevent the for those struggling with the invisible It is a shame that CBC Marketplace type of disinformation that resulted from disability of hearing loss. They run would misrepresent the profession of this poorly handled story. Together we hearing conservation programs to Audiology and its professional can make a real difference in our educate the public and workers on the organizations. It certainly does a great profession and in the lives of the people hazards of noise and the use of hearing discredit to your program. that we serve. protection. They work with seniors to minimize the isolating effects of hearing Sincerely, Sincerely, loss. They teach educators, health care Glynnis Tidball, M.Sc. (Aud, SLP) RAUD Steve Aiken, President, professionals and the public on hearing Registered Audiologist Canadian Academy of Audiology and balance disorders and their Canadian Hearing Report 2013;8(2):8.
8 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION what’s new? |
And there are two new cool features; users have the ability to directly select Minitek reMote aPP the hearing program they desire, and Manon Larivière the phone’s screen serves as a read out display informing the user of which Spring is in the air! Snow is melting, patches of program has been selected. grass are appearing, and I am compelled to get an early start on my spring cleaning. It’s much Non-techies will love the seamless overdue, since I may have skipped last year! As integration of all electronic gadgets I was cleaning out my storage closet, an into one central piece, so no more impressive pile of old CDs fell out of a box. I juggling devices. Phone calls, haven’t seen those since high watching TV, and listening to music school! And, so started, after a are all possible with one device. The short musical walk down “buttons” are nice and large, making memory lane, the lovely task of controlling friendlier, especially for sorting through the mess and those with dexterity or vision transferring my favourite problems. albums to my new Google Play library. Bon Jovi is in, Ace of Users can configure their Base is out. Just saying. smartphone’s Widgets. This is an Android feature that allows you to When I bragged about my create a “favourite” command on your accomplishment to my friends, homescreen. The user could have they happily welcomed me to the age of mp3s! So now that access to their hearing instruments’ volume and programs I have all my old faves (including some new ones, I swear!) right on their homescreen without having to launch the App. on my smartphone and at my fingertips, I can bop to them For users who may not be familiar with the operation of the anytime, anywhere, and also use the Bluetooth remote+streamer, a built-in interactive user guide is supplied remote+streamer to stream directly to hearing aids! But here with the Remote App. is what’s REALLY new: Using your Remote App makes it look like you are simply Beginning in May 2013, the miniTek Remote App will be texting, or checking your e-mail. No one has to know! available for download free of charge via the Google Play Control of the remote+streamer and the instruments via the Store. That means users can use their Android phone as a smartphone App provides the ultimate in discretion. remote control to command and conquer every conceivable audio source for their hearing instruments, right on their Offered in two languages, the Remote App has been available smartphone! The download is free and simple to do, and the for download from the Google Play Store since in May 2013, screen of the phone becomes a visual display for the free of charge; languages offered in Canada include English remote+streamer. Whether they are watching TV, talking on and French. the phone, or enjoying a conversation with a friend, users are freed from the hassle of juggling multiple devices. In my opinion, this smartphone application gets full marks Everything is managed from their smartphone. on all fronts, including usability, simplicity, and overall coolness. My thirteen-year-old nephew would love this App. Techie types will love this because of the advanced Wow, even my dad could easily use it. As for me, I’d love to functionality. The smartphone’s screen becomes the display discover a spring cleaning app that would finish the job for for the remote+streamer, so the user knows what is going on me! Since I can’t find one, I’ll just have to tackle the rest of with their hearing instruments and the listening situation. the storage closet myself. Maybe with some good tunes in the Users don’t have to guess the status, they can easily see it. background…
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 9 GN Resound the deafened audioLogist |
Top Ways to Enjoy Music with a Hearing Loss
By Peter Stelmacovich [email protected]
really enjoy music. when I got the cochlear implant in that This study showed that while neither IIt might be due to now can hear the high frequencies really device (HA or CI) provided satisfactory my upbringing as well, but not the lows. music perception results, the CI users both my parents sang gave slightly better ratings than the HA in the Toronto In my quest to better understand my users. So now we are actually seeing Mendelssohn Choir as hearing capabilities, I decided to review some data showing music perception well as some smaller the literature and see what the research getting better with a CI, but still not opera companies. My tells us about music perception in great. sister is an excellent cochlear implants (CI’s). piano and clarinet player and is a Another study by Looi et al. looked professional mezzo-soprano. My brother If you look at some of the earlier research again at CI users and HA users who were plays piano quite well and pretty much prior to 2000, you barely see much potential CI candidates. 3 So again these knows most Elton John songs by heart. reference to music perception in CIs. I HA users also had significant hearing think the researchers, and engineers loss. On a rhythm recognition task, both I wonder if it could be genetic as well. were busy working on getting good groups did about the same. On the pitch My son Alexander has this innate ability speech perception. This does make perception task, the HA users to play guitar and write songs. If he was sense. And as the speech perception outperformed the CI users. In fact many born 30 years ago, he would be teaching abilities of CI users began to improve, of the CI users needed two pitches to be Jimmy Hendrix and Jimmy Page a thing interest began to shift to other important at more than a quarter of an octave apart or two. listening abilities such as musical before the notes sounded any different. perception. In western music you need to be able to And then there is me. The guy with the hear a one semitone difference. sensorineural hearing loss who became One researcher who has done a lot of an audiologist, and then kept losing his work in this area is Dr. Kate Gfeller. In a After reading this article, I checked what hearing over time and needed to get a 2000 article, Gfeller et al. found that my skills were like using a CI only. I had cochlear implant. I never had the same 83% of adult CI users reported my brother play a bunch of two note degree of success with music that my diminished music enjoyment post- pairs on a piano keyboard. My task was siblings enjoyed, which I am sure was implantation. In fact one third of the CI to say if the two notes were the same or related to my disability. But, users even avoided music altogether as different and then secondly which note nevertheless, I did get to grade 3 Royal they found it to be an aversive sound. 1 was higher in pitch. For the notes above Conservatory piano, learned to play These are not encouraging results. But middle C, I was able to reliably report if guitar a bit, and played trumpet in high do remember that these folks received the two notes were same or different school. their implants in the 1990s. This even if they were only one semi-tone technology is now 20 years old. In 2007, apart. I was about 80–90% accurate at As my hearing loss became progressively Looi et al. did a study comparing the identifying which note was higher or worse, it became more difficult to hear music perception of CI users compared lower. For notes below middle C, I all the notes I needed to play. So I to hearing aid (HA) users. 2 Note that the needed notes to be at least one full tone switched to playing bass guitar since I HA users were all potential CI apart to get the same level of accuracy, could hear low frequencies better than candidates, so they all had significant but performance deteriorated as the high frequencies. Then things reversed hearing loss. pitches got lower. Therefore, It appears
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 11 | that I am not getting good low frequency So here’s what I can conclude from these starting point and fine tune from there. pitch perception with the CI which is so articles: If there is hearing impairment at all critical for music. Low pitches may not frequencies, I tend to add more low be that important for speech as the 1. The newer studies seem to show frequency gain. In addition I try to avoid consonants are mainly high pitched and better music perception in CI users high compression ratios. Therefore I may consonants give you speech intelligibility. than older studies. This is most add more gain for loud sounds and/or I therefore personally decided to use a likely due to improvements in lower the gain for softer sounds to keep hearing aid in my non-implanted ear. I technology in which the newer the compression ratios to 2:1 or less. hear music much better whilst using a implants give a richer sound than combination of a HA and a CI. the older devices. 2. Listen to MusiC or taLk, 2. Music perception with a CI via But not Both Is this phenomenon idiosyncratic to just electrical stimulation could still be People with normal hearing can enjoy me, or do other patients experience the improved. It seems to be related to music while talking to someone else or same thing? A study by El Fata et al. the poor perception of the low while driving. As a person with hearing looked at 14 adults who continued to frequencies. loss, I find this does not work for me. use a hearing aid in their non-implanted 3. If you still have some usable residual The impaired auditory system cannot do ear after getting a CI. Subjects were hearing in your non-implanted ear, both tasks simultaneously because one asked to identify excerpts from 15 the use a hearing aid in that ear of them ends up being a competing popular songs which were familiar to could assist you in your music noise for the other. I get much more them. 4 The presentations were done perception. enjoyment from listening to music in a bimodally, with the CI alone and then quiet room with no one else talking at HA alone. Musical excerpts were I still play the bass in a band and enjoy the same time. presented in each condition with and music by incorporating various then without lyrics. Those subjects who strategies. The strategies listed below 3. turn it down had more low frequency residual reflect both personal experiential Most hearing aids or cochlear implants hearing (> 85 dB HL in the lows) did learning and learning gained during my cannot handle inputs that are too loud much better on all the tasks with both a formal audiological training. They can (over 90 dB). Keeping the music at a CI and an HA than either the CI only be incorporated by most patients with comfortable level ensures that the music condition or HA alone. hearing loss. sounds clean and undistorted.
Another study by Gfeller et al. in 2007 1. use a MusiC PrograM on 4. use a digitaL wireLess also confirms the need for better low hearing aids aCCessory or an fM systeM frequency hearing for music perception. Most hearing aid companies provide a Since I use two different types of In this study, CI users which electrical music program in their hearing aids. technologies (hearing aid and cochlear only stimulation (the regular type of CI) Some even automatically switch the user implant) I cannot use a ComPilot were compared to subjects with a hybrid to the music program if that is what is in wireless streamer. Instead I use my implant. 5 The hybrid implant uses a the environment. I encourage you to SmartLink+ FM system to accomplish shorter electrode array for giving you the activate a music program for your client. the same goal. Both strategies involve high pitches whilst still using a hearing These programs automatically make a plugging the FM or DWA into the aid type of air conduction for the low number of important changes that will headphone jack of an iPod or home pitches. Using low frequency acoustic ensure music sounds better, because sound system. The advantage of this hearing significantly improved pitch what is good for speech perception is not approach is that it bypasses the perception compared with electric only necessarily good for music perception. microphones of the hearing devices, CI’s. But before you go rushing off asking Generally speaking, less is more when it keeping the music clear and undistorted. for a hybrid implant, you need to know comes to a music program. This means that not everyone can get one of those. turning off noise reduction features, 5. use an fM for Live MusiC You need to still have sufficient low frequency compression, and things of I play bass in a band and I also like to frequency hearing. that nature. I tend to use the default listen to live music. When I play in my settings of the music programs as a own band, it gets too loud for my
12 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION | hearing devices to handle. So, I plug an learning a bit of musical theory. I found FM system into the headphone jack of that after I did this, it seemed to further the sound board and turn up the volume activate my top-down processing to a comfortable level. Listening to other capabilities. For example, I now know bands can be tricky. But if I am feeling that many popular music songs often brave, I have asked the sound technician use the first, fourth and fifth chord of a at shows to allow me to plug my FM into scale. Therefore, I now know that I need other bands’ boards, the same way I do to use the Ionian (I), Lydian (IV), and for my own performances. It sounds so Mixolydian (V) modes when playing my much better that way. bass. I can therefore use brain power to compensate for what I lack in hearing 6. watCh MusiC dvds or BLue capabilities. rays I have a collection of about 50 live 9. PiCk Less CoMPLex MusiCaL concerts on DVD or Blue Ray. Listening genres to music while watching it being played Easier music is just plain easier to listen is a far more enriching experience for all to. So classical music is going to be of us, but this is especially true for people harder to enjoy compared with popular with hearing loss. Sometimes a person music. Bach’s Toccata and Fugue in D with hearing loss cannot identify the type Minor requires more listening skill than of instrument being played; however, if John Lennon’s Imagine. Yet both are still adult cochlear implant recipients. J you can see the instrument, it helps your beautiful. Complexity can also refer to Am Acad Audiol 2000 Jul Aug; brain make better sense of it all. the number of instruments used. I find 11(7):390–406) it easier to listen to a quartet of 2. Looi V, McDermott H, McKay C, 7. take MusiC Lessons/PLay an musicians compared a full-blown Hickson L. Comparisons of quality instruMent symphony. ratings for music by cochlear I had the pleasure of participating in a implant and hearing aid users. Ear study on music perception in cochlear 10. foLLow aLong with the Hear 2007 Apr;28(2 Suppl):59S– implant users at the University of LyriCs 61S. Toronto Mississauga. We had to do Back in the days of my youth, we did not 3. Looi V, McDermott H, McKay C, various tasks such as pitch perception, walk around with iPods stuffed in our Hickson L. Music perception of pattern perception, song identification ears. Instead we had vinyl records, with cochlear implant users compared and instrument identification. The gorgeous album art work on the cover with that of hearing aid users. Ear results have not been published yet, but and lyrics printed inside the album Hear 2008 Jun;29(3):421–34. doi: I got a chance to see some of the cover. We sat down and listened to the 10.1097/AUD.0b013e31816a0d0b. preliminary data. It was quite striking in music with our full attention and 4. El Fata F, James CJ, Laborde ML, that those of us in the study who have followed along with the lyrics. This Fraysse B. How much residual had musical training performed much made it easier to figure out the song. You hearing is 'useful' for music better at these music appreciation tasks. can still do that today with a wonderful perception with cochlear implants? Note that there were no tasks in the invention called the Internet. People Audiol Neurootol 2009;14 Suppl study that required musical training per with hearing loss should download and 1:14–21. doi: 10.1159/000206491. se such as asking someone to play a G print the lyrics to the songs and listen Epub 2009 Apr 22. major scale for instance. Instead, it carefully. It will make the songs much 5. Gfeller K, Turner C, Oleson J, et al. appeared that the musical training more enjoyable. Accuracy of cochlear implant enabled us to better “hear” the music. recipients on pitch perception, referenCes melody recognition, and speech 8. Learn soMe BasiC MusiC 1. Gfeller K, Christ A, Knutson JF, et reception in Ear Hear 2007 theory. al. Musical backgrounds, listening Jun;28(3):412–23. To take this further, I highly recommend habits, and aesthetic enjoyment of Canadian Hearing Report 2013;8(2):11-13.
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 13 | froM the [email protected]
for a desired output. Even for an 85 dB sensori-neural hearing loss at 1000 Hz, while a person may require 45 dB gain By Marshall Chasin for certain speech sounds, they may only require several decibels of amplification Because of the inherent problems with 16 for many types of music. The best bit hearing aid architecture, the “front strategy for many hard of hearing end” of the hearing aid is frequently consumers may be to simply remove overdriven by intense inputs – specifically their hearing aids when listening or By Calvin Staples, MSc it is the analog to digital (A/D) converter playing music. Hearing Instrument Specialist and associated pre-amplifiers that is the Faculty/Coordinator, Conestoga College culprit. Intense inputs frequently come strategy #3. use sCotCh taPe [email protected] from music, but a hearing aid wearer’s This is the lowest technology level and usic is a vital part of everyday life own voice can also overdrive the input. is perhaps the easiest to implement Mfor many Canadians. I know at Normal conversational speech is not clinically. Like the use of a less sensitive our house we enjoy music in many typically a problem. microphone (e.g., one that has reduced forms, but also use music as a tool with sensitivity to the lower frequency our children. Music is often used in The question that arises is “given a region), using a temporary microphone various forms of therapy and within the hearing aid that seems to be great for covering such as Scotch tape shifts its field of audiology we regularly use speech, what can be done to also make ability to transduce sound downwards music to facilitate tinnitus treatment. it great for music?” This has been by about 10 dB for three or four layers The treatment of hearing loss however, covered in previous blogs so I will not of the tape. The A/D converter is is regularly and potentially rightfully retrace my steps, but following are four therefore presented with a signal that is focused on enhancing communication easy-to-implement strategies that 10 dB less intense and can often be and not focused on music or other less improve the fidelity of music over what within its optimal operating range. There common patient concerns. Our patients a hearing aid may currently provide. needs to be some trial-and-error and the tend to focus or clinicians tend to focus hard of hearing consumer can be on the amplification of speech and the strategy #1: turn down the instructed to play with one, two, or three difficulties we encounter in addressing inPut (stereo) and turn uP pieces of tape over both hearing aid background noise. Often the peripheral the hearing aid voLuMe (if microphones. The exact number does goals such as the appreciation of music neCessary) depend on the gauge and the brand of for the hearing impaired is left without If the excessive level of the input to the the tape. Attenuations of 10 dB which much consideration. Over the years, hearing aid does cause distortion of the are relatively flat across the frequency audiology has been blessed with a few A/D converter, then turn down the input range have been measured using this wonderful researchers working if at all possible. If traveling in a car, turn clinical “low tech” approach. tirelessly trying to improve the music down the level of the radio and (if listening experience for the hard of necessary) turn up the level of the strategy #4. Change the hearing. This volume of the Canadian hearing aid to compensate. The output MusiCaL instruMent Hearing Report focuses on music so will be the same, but the input would This is a common strategy used by many please enjoy the following blogs from have been reduced to a level that is well musicians. Change to an instrument that Hearinghealthmatters.org within the operating range of the front has more of its energy in an audiometric end of the hearing aids. region of better hearing. Many violin players have switched to the viola which strategy #2: reMovaL of is a fifth lower in frequency. For many hearing aid for MusiC this is a simple approach that has Given the higher level inputs of music, extended a musicians’ enjoyment of their the required gain may be close to 0 dB music for many years.
14 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION |
The above straegies are just a few of the be reminded that they need to face a many that have been found to be useful child to be sure they understand don’t Let hearing Loss LiMit over the years. The Association of Adult directions and try to have the child a ChiLd Musicians with Hearing Loss is an seated in a place where he or she can Music is just one part of a kid’s life, but organization of hard of hearing and easily see and understand. Teachers need it is important for everyone to always deafened musicians as well as interested to understand the limits of technology – give a child the chance to do whatever hearing health care professionals who they need to know what the child will he wants to try and do. With today’s work with those in the performing arts. and will not hear and at what distance. technology, the sky is the limit (but In addition to their very active listserv And they need to know how to adapt. talent plays a role too). Oh, well. blog, they have recently come out with a book entitled, Making Music with a PiCk an instruMent the http://hearinghealthmatters.org/hearin Hearing Loss edited by Cherisse W. Miller ChiLd Likes gandkids/2012/music-lessons-for-kids- (2011). Chapter 4 of that book is aptly Kids need to like the instrument if they with-hearing-loss/ entitled “Personal Stories and Strategies” are going to make it work. They need to where many musicians talk about what want to play it. There are easier works best for them. Copies of this instruments (ones like piano where if excellent book can be obtained through you hit a key it always makes the same the AAMHL.org site. sound) and more difficult ones (like By Marshall Chasin violin where a slight move of the finger http://hearinghealthmatters.org/hearth can really alter the sound.) Kids with There are many myths about music and emusic/2012/four-strategies-to- hearing loss can and do play the violin how hearing aids should be fit. This is improve-music-listening-through-heari so if that is what the kid wants to do, about three of those myths. ng-aids/ give it a try. 1. As technology gets better so will do hearing aid settings music fidelity need to Be adjusted for 2. Wider is better MusiC? 3. More advanced features are better By Jane Madell Sometimes some pitches will sound tinny through the hearing aids. The Every single hearing aid design engineer Thanks to the advanced technology audiologist may be able to adjust the has to come to grips with the similarities available today, many kids with hearing hearing aid so the high frequencies are and differences between speech and loss are playing musical instruments. less tinny and have more timbre. music. Although this has always been Some will be good and others not – just the case, even more importantly with the like kids with typical hearing. I have two what Parents Can do to advent of portable (and more accessible) kids with typical hearing, both of whom heLP get kids ready to study music, both speech and music are took music lessons as kids. One was MusiC desired stimuli for hard of hearing really good, and the other wasn’t. It had There are some basic things that parents consumers. Both speech and music are nothing to do with hearing. can do at home to help prepare all kids necessary for most people to get the for music lessons. Kids need to learn most out of life. Make kids with hearing Loss rhythm. Sing songs, clap in time to feeL weLCoMe in MusiC CLass music, play clapping games where you The design engineer’s boss, however, Music teachers need to be told that kids clap a pattern and the child has to repeat would rather that they spend their time with hearing loss can take music lessons it. As they get more complex, kids and energy dealing with speech. Speech and will be able to learn. They need to develop more skills. Start with rhythm quality is what sells hearing aids- music be reminded that some kids are good at instruments – bells, chimes, tambourines, fidelity just goes along for the ride. music and others are not, but that every drums. Let kids develop some musical Speech quality is number one, and kid deserves a chance. Teachers need to sense from those. music quality is its poor cousin and
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 15 | really only addressed once the “number one” issue is taken care of. Here are three myths about music and hearing aids:
1. as teChnoLogy gets Better so wiLL MusiC fideLity This sounds like a mother and apple pie statement. After all, hearing aids of the 1930s are not as good as those today. However since the late 1980s, hearing aid microphones could transduce 115 dB SPL with virtually no distortion. Since the 1990s, hearing aid receivers could be made broadband enough to provide significant output in the rarefied regions above the piano keyboard (>4000 Hz). And wide dynamic range compression (WDRC) hasn’t really changed in over 20 years (and I am going to get some “comments” about this statement- but I am really only Table 1. A survey of some hearing aid manufacturers with some suggested changes. Most state that referring to the level dependent there should be less compression and less noise management than for a speech program. As characteristic of all modern non-linear discussed in the text, these suggestions are probably quite valid but only for mild hearing losses, with hearing aids). So what needs to “get a gently sloping audiometric configuration. Some manufacturer’s use a proprietary circuit and these better”? are marked with a ™symbol where appropriate. Note- this is not a complete listing of the manufacturers nor is this a full listing of all of the parameters suggested by the manufacturers for music. Well, not much but this is not an “evolutionary” change that gradually “hearing aids will simply get better.” many represent mere “opinions” of the 3. More advanCed features Something specific needs to be done and respective marketing departments. are Better this relates to the “front end” of the Noise reduction, feedback management, hearing aid. Specifically the analog-to- If the hearing loss is mild AND if the and impulse control to limit overly digital converter needs to improve so configuration of the hearing loss intense environmental signals may be that it can handle the more intense relatively flat, then a broad bandwidth useful for speech, but with the lower components with minimal distortion. does make sense and this is indeed gains required with music (in order to Several manufacturers have successfully supported by the literature. If, however, obtain a desired output) these features addressed this problem but most have the loss is greater than about a 60 dB HL may degrade music. Feedback not. Unless this problem is resolved, sensori-neural one, then because of the management systems may blur the aided music fidelity will not improve. possibility of dead regions in the music (adaptive notch filters), cause cochlea, a narrower bandwidth may be rogue “chirps” in music (phase 2. wider is Better better. The same can be said of steeply cancellation systems), and may even The broader the bandwidth for music, sloping sensorineural hearing losses – a turn off the musical instrument (e.g., the the better it will be. The chart above narrower bandwidth may be better than harmonics of the flute may erroneously shows a sampling of some manu- a wider one. be viewed as feedback signals). Many facturer’s suggested bandwidths for manufactures (e.g., Siemens and Oticon) music (as well as some other suggestions Table 1 does make sense, but only for have restricted the function of their for the music program). These are not mild hearing losses with a relatively flat feedback management systems to 1500 based on comprehensive science and audiometric configuration. Hz and above to minimize the above
16 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION | problems, but this is a case where “less features are implemented, the internal More can be better, but when it comes is more.” With the lower gains required noise floor will be lower. And let’s turn to music, less is usually more. of music (about 6 dB lower than the off the impulse control systems (as respective speech-in-quite program), correctly pointed out by Unitron with a http://hearinghealthmatters.org/heart feedback management systems may not disabling of their Anti-Shock function). hemusic/2012/three-myths-about- even be required. Impulse sounds occur frequently in music-and-hearing-aids/ music but rarely in speech – if they do Canadian Hearing Report 2012;8(2):14-17. The same can be said about noise occur in speech, they are of a low level reduction but again, if fewer advanced such as for the affricates (‘ch’ and ‘j’).
CAA Job Board Gets Results!
Reach audiologists across Canada For pricing details contact [email protected]
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the haPPy hoh |
Could Somebody Turn My Music Back On? By Gael Hannan [email protected]
ow and when can flown on the music, dreamed with it and people enjoy. This first struck home HI get my music lived it, losing the ability to enjoy it is a when I was around 20; at a performance back? deep source of grief. When I could really of Handel’s Messiah my friend said hear it, music sent shivers down my something to the effect of, “Wow, that I’m not exactly sure spine. And now, when I have difficulty harpsichord is amazing!” I looked at the who I should direct this getting a tune, or when the violins or stage where I saw the beautiful question to – would it flutes go so high as to disappear off my harpsichord and then back at her, “I can be my audiologist, my audiogram, I feel deprived, cheated. see it, but I can’t pick out its sound.” And, hearing aid manu- I have never actually heard the sound facturer, or the government who helps My family was very musical – I am the made by the person hitting that triangle me pay for hearing aids? Or all three? descendant of song-and-dance men on thing – so it just looks stupid to me (with one side and church-singing preachers all due respect to professional triangle As my hearing loss progressed through and teachers on the other. There was players). the years, so did my music loss and I always music in our house. My father would like to have it back, please. I know bought the best stereo “hi-fi” he could And the day I knew I was really in that out there, somewhere, there are afford because he wanted me to enjoy trouble was at age 41, when I went from hearing aids, assistive technology, and music, in spite of my hearing difficulties. a single BTE to bilateral CICs. Going to a listening courses that would help me I would spend hours lying on the floor dance, the sound of the band almost appreciate music better. I’m always with my ear pressed to the cloth-fronted flattened me – it was a non-stop reading tantalizing news bits about stereo, listening to records. On family cacophony. I thought that perhaps I was breakthroughs in this area. But how do I, road trips, in the time before everybody still in an extended brain adjustment the consumer at the end of the supply was glued to their own smartphone, we period, but since that time loud music chain, access all these new sang and harmonized to our favourite made with more than one instrument has advancements? The research and new songs. Our collective taste in music never been enjoyable because I can’t pick technology I read about is at a high level, wasn’t terribly cerebral, but out the different bits – like using words that are outside my we loved a good the harpsichord, comprehension. I have yet to read tune. or the anything that says: “Want to hear the music again? To get YOUR magic-music- As I grew up, I making hearing aids, call this number began to suspect today…or visit your local hearing care I wasn’t getting professional and ask for it by name!” the full-on music experience that Like most people, I love music. Plato “hearing” said, “Music gives a soul to the universe, wings to the mind, flight to the imagination and life to everything.” And once you have
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 19 | bass guitar, or the anything. The challenge, even non-existent. At a party, your belief in Santa Claus. instruments tend to drown out the someone might ask if the music is too singer’s voice, taking the lyrics loud, and I would answer, “oh, is it on?” So my question is this, how can I get my completely out of my reach. If music were played at the level I need – music back? If there are really good somewhere well above ambiance-level music programs available for hearing I now have two digital ITEs, with T- but below blowing out the windows – aids, do I have to wait until I buy my switches that I had to ask for, and things we would end up with a very different next set? Alternatively (and preferably), are a bit better. I think. But to appreciate party – and I still wouldn’t get the words. could we do something about the price music the most, I have to bring it right of hearing technology to make them into my ears. I have good Bose over-the I know we’ve come a long way. I sat next more widely available to those who need ear-headphones which, if I position them to a dear friend, a recent CI recipient, at them and want them? Because, if I didn’t just-so, won’t cause any feedback. And I a conference concert and watched her have to wait another two years to get the also have a neckloop to use with my face as she realized she was hearing government subsidy, I would buy iPod, but I have to walk where there are music for the first time in years. Another another pair faster than you can say name no telephone wires or I become alive friend didn’t know she could connect her that tune! with static. CI to her iPod; it was Christmas time and Canadian Hearing Report 2013;8(2):19-20. her face, as she listened to Silent Night Listening to music in a room is a come into her ears, was enough to revive
Professional Liability Insurance – Are You Covered?
Audiology malpractice errors don’t often make clinical error – perceived or actual – I would be cover the following: headlines; but even the most competent among us covered by my employer’s liability plan. A • Work done outside of your regular can make mistakes. The issue was first brought to discussion with colleagues led me to look into what employment, including volunteer work my attention by a university instructor who told our professional liability coverage from an employer or even advice given to someone class the story of an audiologist who had made a includes, and what it doesn’t. Here’s what I outside of work clinical error with serious consequences for both the discovered: • Legal defense costs for complaints or patient’s family and, it turned out, herself: she had disciplinary matters brought by or to failed to counsel parents of a child with a congenital • Regulatory bodies require audiologists to professional regulatory bodies, such as loss to have their other children’s hearing tested. It have a minimum amount of professional a provincial college. was an unfortunate and cautionary tale. liability coverage per claim for liability arising • Legal cost for defense of work-related from an error, omission or negligent act. The criminal charges An article by Younker and Beyers amount varies by province (e.g. $1 million in • Sexual abuse therapy counseling fund http://www.audiologyonline.com/articles/preventing- Alberta, $2 million in BC and ON). The for the injured patient. medical-errors-for-audiologists-8060) highlights insurance must be provided by an audiologist common errors in audiology practice. These include who is self-employed and working While most of us likely have some liability coverage inadequate documentation, errors in test independently or by the employer of an in place, it is worth considering the benefits of taking interpretation, inadequate supervision of students, audiologist. out an additional plan independently. Do you need failure to make appropriate referrals and • In provinces where Audiology does not have additional professional liability insurance? This will inappropriate masking. These are errors that could a regulatory body (which is distinct from a depend on your current coverage, regulatory be made in any public or private audiology clinic. professional organization such as CAA or requirements, and professional activities, both paid CASLPA), there may be no requirement for and unpaid. Do you want additional liability Having worked for years in a public healthcare professional liability coverage although insurance? I know I do. For the relatively small facility, I’ve always assumed that in the (hopefully employers may provide coverage. amount I pay each year, it’s absolutely worth the unlikely) event that I found myself liable for a • Liability coverage from an employer will not peace of mind.
Canadian Academy of Audiology Heard. Understood. CAA members are eligible for professional liability insurance through LMS Prolink. For more Information, e-mail [email protected] or call 1-800-663-6826 or visit www.LMS.ca/CAA Académie canadienne d’audiologie Entendus. Compris.
20 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION aLL things CentraL |
Facing the Music: Musicianship’s Effect on the Brain By Nina kraus, PhD [email protected]
About the Author Nina Kraus, PhD, Hugh Knowles professor, (communication sciences; neurobiology and physiology; otolaryngology) at Northwestern University, directs the Auditory Neuroscience Laboratory. Dr. Kraus investigates biological bases of speech and music. She investigates learning- associated brain plasticity throughout the lifetime in normal, expert (musicians), clinical populations (dyslexia; autism; hearing loss) and animal models. In addition to being a pioneering thinker who bridges multiple disciplines (aging, development, literacy, music, and learning), Dr. Kraus is a technological innovator who roots her research in translational science. http://www.brainvolts.northwestern.edu.
usical training has a pervasive cortex of the fingers of the left hand, the physiological corroboration to these Mpositive effect. This is manifested hand in extensive intricate use in string findings. 8 in number of interesting ways. First, playing, is larger in string instrument unsurprisingly perhaps, musicians excel players than in non-musicians. This Arguably more interesting, because they at pitch and rhythm perception and difference is not present in right-hand involve less obvious cause and effect discrimination. Likewise, instrumental representation, consistent with the outcomes than the somatosensory, musicians tend to have superior fine- smaller motor demand arising from motor and auditory examples that might motor skills. More intriguingly, bowing. 2 In keyboard players, grey be predicted from the inherent demands musicians outperform nonmusicians in matter is larger in visiospatial, motor and of mastering an instrument, are ways that are farther removed from those auditory brain centers, consistent with behaviour and brain changes in farther that might be expected from exposure to the demands of the task. 3 Greater white afield areas. For example, music training the acoustics and mechanics of playing matter volume, representing increased is associated with increased vocabulary, an instrument. For example various connectivity between and within cortical reading, phonological processing, studies have found that musicians excel areas, is found in musicians, as well. This attention, and reasoning skills in in vocabulary, reading, non-verbal has been seen in the corpus callosum children. 9–11 Of particular interest to me reasoning, perception of speech in and other structures. 4,5 is the tie-in between musicianship and background noise, auditory memory, literacy. Learning to read is very closely and attention. For a review, see Kraus & There are other examples of brain tied to the sounds of language and Chandrasekaran, 2010. 1 changes in musicians explicitly making the sound-to-meaning involving auditory centers. In both connections in speech. Therefore, an With all of these perceptual and adult and child musicians, there is activity like music practice, which hones cognitive advantages, there must be evidence of structural and functional the auditory system as well as a host of underlying neurological changes that the reorganization of cortex. 6 For example, other processes, provides a channel brain undergoes with music training. in a magnetoence-phalography (MEG) toward gaining literacy proficiency. There is evidence of this from a number study, adult musicians have an increase Further, there are many overlapping of sources. A classic example is the in auditory cortical activation to piano attributes between music and reading, reorganization of motor cortex that takes tones relative to pure tones that is not such as anatomical overlap in the brain place in string-instrument players. The seen in non-musicians. 7 Evoked systems that process music and speech, representation in the somatosensory electrical responses provide neuro- and the attentional and emotional
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 21 | centres that are activated by music. 12 distinctions in consonants, such as those 4. Bengtsson SL, Nagy Z, Skare S, brought about by changes in place of Forsman L, Forssberg H, and Ullen In my lab, I have been building upon the articulation, are detectible in the F. Extensive piano practicing has body of research briefly reviewed above response, and these distinctions are more regionally specific effects on white by examining the biological changes that salient in musicians. Finally, the matter development. Nat Neurosci accompany music training in a variety of consistency with which the auditory 2005;8:1148–50. populations, using both cross-sectional system responds to the crucial 5. Schlaug G, Forgeard M, Zhu L, and longitudinal designs. The particular consonant-vowel component of speech Norton A, and Winner E. Training- physiological metric I employ is the – measured by inter-trial correlations – is induced neuroplasticity in young auditory brainstem response to complex enhanced in musicians and relates to children. Ann N Y Acad Sci sounds (cABR). The auditory brainstem literacy. These findings have been 2009;1169:205–8. is a central hub of sound processing. It replicated in a number of age groups, 6. Peretz I and Zatorre RJ. Brain is at the crossroads of the ear and the from very young children to older adults. organization for music processing. cortex and the response that is recorded Additional studies are underway to help Annu Rev Psychol 2005;56:89– from it is deeply tied to the rich acoustics address the question of whether musical 114. of the evoking sound. At the same time, experience brought about the changes or 7. Pantev C, Oostenveld R, Engelien it is influenced by factors of experience whether pre-existing physiological and A, Ross B, Roberts LE, and Hoke M. and training. These attributes, as well as literacy-based differences are inherent in Increased auditory cortical its ability to be reliably recorded in those who are prone to pursue m usic representation in musicians. Nature individuals, make cABR a valuable education. 1998;392:811–4. addition to the arsenal of the auditory 8. Trainor LJ, Shahin A, and Roberts neuroscientist studying experience- The implications of these findings are of LE. Effects of musical training on dependent brain effects of music a deep interconnection between music the auditory cortex in children. Ann training. and language abilities including reading N Y Acad Sci 2003;999:506-13. and hearing speech in noise. A purported 9. Anvari SH, Trainor LJ, Woodside J, The cA BR to speech sounds offers a rich commonality between brain regions and and Levy BA. Relations among approach to studying the neural changes mechanisms between music and musical skills, phonological experienced by musicians, first because language is confirmed by findings from processing, and early reading ability of the tie-ins between music and literacy, my lab and others using cABR and other in preschool children. J Exp Child and second because not all speech is methods. Taken together, evidence Psychol 2002;83:111–30. created equal. Within the spectrum of strongly supports the promotion of 10. Forgeard M, Winner E, Norton A, spoken speech, certain consonants prove music practice in concert with the and Schlaug G. Practicing a musical to be especially vulnerable to noise- development of crucial literacy skills in instrument in childhood is masking, or otherwise “mishearing” children. associated with enhanced verbal because of their low-amplitude, fast- ability and nonverbal reasoning. moving, and complex acoustic referenCes PLoS ONE 2008;3:e3566. composition. So consonants, or in 1. Kraus N and Chandrasekaran B. 11. Strait DL, Hornickel J, and Kraus N. particular consonant-vowel syllables, Music training for the development Subcortical processing of speech form the bulk of the speech cABR of auditory skills. Nat Rev Neurosci regularities underlies reading and research that I have investigated in 2010;11:599–605. music aptitude in children. Behav musicians. These spectrotemporally 2. Elbert T, Pantev C, Wienbruch C, Brain Funct 2011;7:44. complex acoustic sounds evoke a Rockstroh B, and Taub E. Increased 12. Patel AD. Why would musical correspondingly spectrotemporally cortical representation of the fingers training benefit the neural encoding complex cABR that reveals musician of the left hand in string players. of speech? The OPERA hypothesis. advantages, particularly in the timing Science 1995;270:305–7. Frontiers in Psychology associated with the information-bearing 3. Gaser C and Schlaug G. Brain 2011;2:142. consonant (but not the vowel) and the structures differ between musicians Canadian Hearing Report 2012;8(2):21-22. spectral encoding of the speech and non-musicians. J Neurosci acoustics. Additionally, acoustic 2003;23:9240–5.
22 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION sPotLight on sCienCe |
New knowledge on NIHL
By Patty johnson [email protected]
About the Author Dr. Johnson received her master’s degree in audiology from the University of Iowa and her AuD from Salus University. Her professional experience spans pediatric and educational audiology, industrial hearing conservation, university teaching and private practice. For the past 17 years she has been a research audiologist at Etymotic Research, Inc., where she is involved in research, education, technical writing and new product development.
Science (noun): systematic knowledge of practices based on this knowledge. It’s a repeated auditory insults over many the physical or material world gained pretty strong claim, supported by solid years. through observation and experimentation. scientific evidence. Yes, OHCs are affected by noise It’s a noisy world, and hearing damage You’re probably familiar with TTS exposure, but they’re not the only from loud sound (hearing loss, tinnitus (temporary threshold shift), which is a structure in our auditory system that’s and/or hyperacusis) affects all of us in change (worsening) of pure tone hearing damaged by a noise overdose. Kujawa one way or another. Noise-induced thresholds after a noise overdose. and Liberman 1,2 studied the effects of hearing loss (NIHL) is caused by Temporary threshold shift is just what noise exposure in mice and found that exposure to sound that’s too loud for too the name implies – temporary. The outer while outer hair cells are affected and do long. It can occur from a single activity hair cells (OHCs) in the cochlea were recover post-exposure (with a such as an explosion or a loud concert, overexposed, suffered metabolic corresponding recovery of hearing but it usually occurs gradually, exhaustion, lay down and took a nap. thresholds and otoacoustic emissions imperceptibly, over many years. Those Because OHCs are amplifiers for quiet [OAEs]) there are other changes in the affected are typically unaware of the sounds, when they stop working our basal region of the cochlea that don’t damage until it’s significant, and by then hearing for quiet sounds gets worse. recover. Sound exposures that produced it’s too late: NIHL is permanent. We all After a period of auditory rest (quiet) the moderate TTS in mice (100 dB SPL for know we should protect our hearing OHCs perk up, start working again, and two hours, equivalent to an 800% noise from loud sound, but new information our pure tone hearing thresholds dose using a criterion level of 85 dB and suggests that the consequences of not recover. Because of this recovery, most of an exchange rate of 3 dB) resulted in doing so may be worse than we thought. us assumed that the primary damage dramatic degeneration of both pre- and from noise occurred at the level of the post-synaptic elements of the inner hair In this month’s Spotlight on Science, I’d OHC only, and that the structure and cells and spiral ganglion cells. There was like to share what I think is one of the function of the auditory system was only acute loss of afferent nerve terminals and most (if not the most) important temporarily affected by the noise delayed degeneration of the cochlear scientific observation of our time. This overdose. We consoled ourselves that the nerve. new information on noise-induced damage wasn’t permanent and vowed to hearing damage will (I hope) influence do better to protect our hearing next What does this mean? All signals going you to completely rethink NIHL and time, believing that permanent changes to the brain from the auditory system lead you to adopt and recommend new in auditory anatomy happened only after come from the inner hair cells (IHCs).
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 23 |
When the connections (synapses) to the taBLe 1. reaL-Life dose LiMit exaMPLes IHCs are damaged, the nerve fibres event time final dose connecting to them eventually die. Middle School Basketball Game 1 hour 91% Degeneration of synaptic elements of the Consumer Electronic Show 9 hours 190% IHCs and spiral gangling cells means a Shop Vac 1 hour 200% loss of signal transmission to the brain, Half Drumline (measured at 3 m) 45 min 300% and the damage may be expressed as Summerfest (Milwaulkee, WI) 6 hours 690% tinnitus, hyperacusis, or difficulty (outdoor music festival) hearing in noise. This concept is so Half Drumline (measured on snare) 45 min 1,400% important I’m going to repeat it: a noise Live Music 1 hour 1,600% overdose in animal models causes Green Mountain Tavern, Vermont dramatic, irreversible degeneration of Poi Dog Pondering concert 4 hours 17,000% pre- and post-synaptic elements of the inner hair cells and spiral ganglion cells. These changes aren’t seen until weeks or Radio Shack analog sound level meter, months after the noise exposure, and which has A or C weighting, fast or slow For our purposes we’ll use an 85 dB they can’t be measured using standard response, and a scale of 60–120 dB. The criterion and 3 dB exchange rate, with audiometric tests (pure tones thresholds, analog model was discontinued several an 8-hour 85 dB Leq constituting a OAEs, ABRs). This damage eventually is years ago but similar digital models are 100% noise dose. Exposure limits expressed as tinnitus, hyperacusis, or available at Long and McQuade and originated in the occupational realm, so problems hearing in noise. You’re other music stores. You can also we’re allowed 8 hours per day, but only probably wondering if animal models download SLM apps; I like “SPL Meter” 5 days per week (40 hours total; the apply to humans. This can’t be answered by Studio Six Digital, which looks and standards assume non-occupational definitively yet, but sub-clinical damage behaves just like my analog Radio Shack quiet). This produces a weekly dose has also been found in other mammals SLM. While I haven’t done extensive limit of 500%. Based on these numbers, after noise exposure 3,4 so the evidence testing, when I’ve checked the two side let’s look at some real-life examples (see suggests that we may be at risk. by side results were remarkably close. Table 1). When noise levels vary (concerts, So, how’s your hearing? Have you had a sporting events, live music) you’ll need The first thing to note is that every one noise overdose lately? Don’t think you’ve a noise dosimeter to get an accurate of these exposures, with the exception of ever been exposed to an 800% noise estimate of your risk. A noise dosimeter the Poi Dog Pondering concert, would dose like the mice in these studies? measures sound levels continuously over not produce a noise overdose if the Think again. How about the loud music time and integrates them into a single listener were wearing earplugs with a at the last professional convention you value, the noise dose. As far as noise reasonable amount of attenuation. The attended? Your kids’ school dances and dosimeters, I’m admittedly biased: I like Poi concert, measured in the front row, sporting events? How about concerts or the Etymotic ER-200DW7 Personal resulted in a noise dose of 17,000%, live music in a bar? Ever use power Noise Dosimeter. It’s small, lightweight, equivalent to three weeks plus two days’ tools, a lawn mower, snow blower, or inexpensive, and can be programmed to worth of exposure, and more than vacuum cleaner? All of these have the measure noise dose using just about any double the dose used in the Kujawa & potential to give you a noise overdose. criteria you’d want. Liberman experiments. It’s absolutely But how do you know if your ears are essential that concert-goers protect their receiving an overdose? Thanks to An explanation of damage-risk criteria, hearing, but informal observation science, we have devices – and apps – noise exposure limits and noise dose is suggests that few of them do. A for that. beyond the scope of this paper; for more reduction of 20 dB produces a 100-fold information see “Noise Exposure: decrease in exposure, so with 20 dB A sound level meter (SLM) measures Explanation of OSHA and NIOSH Safe- earplugs the 17,000% dose is reduced to sound level at a single point in time, Exposure Limits and the Importance of a 170% dose. While this is still over a which is useful when noise is steady- Noise Dosimetry,” available at single-day’s limit, it’s a far cry from the state (power tools, lawn mower, vacuum http://www.etymotic.com/pdf/er_noise_ unexposed level. Other exposures are cleaner, etc.). To measure these I use a exposure_whitepaper.pdf. much less; for example, the middle
24 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION | school basketball game (crowd noise, protecting our hearing. All we have to do 3. Lin HW, Furman AC, Kujawa SG, et referee whistle, and buzzer) resulted in is use them. al. Primary neural degeneration in a 91% dose. Not terrible, but other the Guineau pig cochlea after factors need to be considered: this was a referenCes reversible noise-induced threshold tournament day and parents, players 1. Kujawa SG, Liberman MC. shift. J Assoc Res Otolaryngol and referees attended up to five games Acceleration of age-related hearing 2011;12:605–16. per day over a two-day period. loss by early noise exposure: 4. Liu L, Wang H, Shi L, et al. Silent evidence of a misspent youth. J damage of noise on cochlear afferent The bottom line: the damage produced Neurosci 2011;26(7):2115–23. innervation in Guinea pigs and the by a noise overdose appears to be worse 2. Kujawa SG, Liberman MC. Adding impact on temporal processing. than we thought and noise overdose is Insult to Injury: Cochlear nerve PLoS One 2012;7(11):1–11. not uncommon. The good news is that degeneration after “temporary” Canadian Hearing Report 2013;8(2):23-25. there are tools to measure our exposures noise-induced hearing loss. J and there are many great options for Neurosci 2011;29(45):14077–85.
Save the date!
Canadian Academy of Audiology Heard. Understood. 16th Annual CAA Conference and Exhibition October 16 to 19, 2013 in St. John’s Newfoundland Académie canadienne d’audiologie Entendus. Compris.
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 25 | feature
An Audiologist is a Recording Engineer for Speech By Marshall Chasin [email protected]
t is always tempting to much more than we typically require, but and perhaps it is just wishful thinking that Ilook at the field of like a few things in life, more is better. this, one day, may be available to the hard recording engineering for Figure 1 shows the computer screen of a of hearing. music to see what can be recording engineer. Other than some gleaned for hearing aid customization for ease of use, it is really I suspect that are two fields can learn fittings. Sound engineers identical to the screen we see in a typical quite a bit from each other. (incidentally called “tone audiology office. meissters” in German) are aCknowLedgeMent concerned with the ideal I have always viewed the realm of hearing I would like to acknowledge the mix for the various elements of music and aid amplification as being a recording assistance of my son, Shaun Chasin, their goal is optimization for the normal engineer for speech. An audiologist has B Mus, who just graduated from the hearing person. Audiologists are well defined attributes that need to be Berklee College of Music in Boston, MA. concerned with the ideal mix of the accomplished. Overly compressed signals Canadian Hearing Report 2013;8(2):26. various elements in speech (and music) tend to be less intelligible than ones that but for the hard of hearing person. In this are more linear. The correct balance or sense, an audiologist can be thought of as equalization between the lower and a recording engineer for speech. higher frequency ranges is crucial for optimal speech clarity and naturalness. It is frequently surprising how similar the The same is true for recording engineers two fields of recording engineering and – an overly compressed jazz performance audiology are. Both are concerned with sounds dull and unexciting, and a gain and output; both are concerned with wideband balanced response tends to be non-linear level dependent compressors the best equalization for most forms of and expanders; both are concerned with music. appropriate attack and release times; and both are concerned with appropriate One difference between our two fields is equalization. In short, the factors that the limitation that hearing aids need to be concern a sound engineer and similar to stable down to about 1 volt (and a couple those factors that concern an audiologist. of hundred milli-amps). No such limitation exists for a recording engineer. When we turn on the equipment in our While this may not make a major Figure 1. This is a screen shot from Protools – offices, we boot up the computer and the difference it does point out that not a popular music recording and processing familiar NOAH screen pops up (at least everything that is available in the program – showing the “compressor” section. we hope it does) and depending on the recording industry can be transferred to This is essentially the same screen that one would see when programming a hearing aid parameters of the fitting software, we can the hearing aid industry. There are some through NOAH, replete with adjustments for have control over everything that is wonderful (and new) anti-reverberation compression ratios, as well as attack and required. In fact, we have control over software fixes in the recording industry release times. Equalization is also possible.
26 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION Editor’s note: I had requested that Ms. Hopkins share her experiences with us. She is the first music teacher to have her hearing loss covered through the WSIB. To my knowledge, to date, only British feature | Columbia also covers music teachers.
Work Related Hearing Loss – A Difficult journey By julia Ruth Hopkins, ARCT, Mus.Bac, BEd. Former Music Specialist for the Toronto and Peel School Boards
y life has always bands, jazz and concert choirs, and Orff In hindsight, I realize that I had already Mbeen full of music, keyboard ensembles. I worked in junior showed signs of hearing loss. For studying classical piano, schools too and later accepted a plum example, my own children at home competing in festivals, job at a middle school in Brampton would complain that the TV was too singing and travelling where our administrator encouraged the loud. But now, on that memorable day with an award-winning development of a flourishing arts in January, I knew the damage was done! Toronto choir, playing in program that included instrumental From that point on my professional and the high school band music, vocal classes, and a fully private life changed forever. How could and orchestra, and equipped keyboard lab. I continue in my present assignment? I listening to wonderful recordings. Even was devastated. What could I do now? though becoming a professional In this supportive atmosphere, I loved musician was a viable option, I had my job and so welcomed as many Now my battle with the Peel Board always felt a calling to be a teacher. students in my classes and extra- began. Not only did I have to prove to curricular groups as was allowed. My them that my hearing loss was caused by And, so, having obtained my ARCT in band classes were larger than normal my work environment, but I also had to piano performance in high school, I and my vocal program included Orff apply for and be interviewed for a type entered the Bachelor of Music in keyboards and percussion. I remember of job for which I had had no previous Education Program, Faculty of Music, thinking how terribly loud my classes experience; a daunting task indeed! University of Toronto, continuing were; yet, I continued teaching for advanced piano study, private singing another seven years in this wonderful The first of many steps in this process lessons, playing in the faculty concert school. In my ignorance, I didn’t realize was to see a local audiologist in band, in a brass ensemble, and singing that by enduring loud music year after Mississauga who recommended in the concert choir. year, I would permanently and seriously Marshall Chasin at the Musicians’ Clinics damage my hearing! of Canada. Once I saw Marshall, he My career began at Bloor Collegiate diagnosed the severity of my hearing teaching band classes and vocal music. On one momentous morning in January, loss, concluding that my work After we moved to Mississauga, where at as usual I entered a grade 8 band class. environment was indeed the cause. He the time no high school jobs were As soon as my percussionists began guided me on the path to PROVE that available, I accepted a position teaching warming up, I suddenly became dizzy my hearing damage was the result of my middle school music for the Peel School and my ears hurt unbearably. Quickly I work as a music teacher, not caused by Board. summoned another teacher to supervise genetics or advancing age! the class while I ran down to the Later on, I stayed home to raise my two principal to tell her I could no longer Marshall began by giving me a hearing children but soon again returned to tolerate the noise! Since this was not the test and then took a mold of my ears. middle school music classes and running case before Christmas, she accepted my This mold was used to make my new extra-curricular groups such as explanation with doubt and confusion in hearing aids, and also to make ear percussion ensembles, jazz and concert her eyes. protection filters. These filters would
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 27 | moderate the decibel levels in the the required experts I could not recoup When I moved schools, which I did classroom so I could continue my either! Once these appointments were twice after I changed my job description, present job until the end of June. completed and the results sent to the my colleagues were empathetic to my board, the WSIB approved my claim. I plight. However, people do not Since I had always taught music and was was the first music teacher in Ontario to understand that hearing damage is not also only qualified to teach history and have done so. like natural hearing loss. In my case, English in high school, I needed to certain decibel levels are relatively retrain for a different teaching job! In In the aftermath of my ordeal, the Peel normal but listening to speech is difficult Peel, elementary and high school Board adjusted their health and safety without hearing aids. The worst teachers are on different panels. If I were rules for music teachers, suggesting that symptom for me is that I am very to move back to high school, I would teachers wear hearing protection in their sensitive to loud decibel levels. lose all my seniority, certainly not a risk music classes. Once in my new position I was prepared to take! Would the board in the junior school, I also felt a Over the years, I successfully adapted to rehire me in an entirely new elementary responsibility to share my experience my new jobs in the junior school setting, capacity? Frankly, I was terrified! with my students and also warned all but now my life contains permanent the music teachers I knew about the tinnitus and acute pain in loud After speaking with my administrators, possible danger of their work environments. I can no longer sing in I made a decision to retrain for a junior environment. the large Mendelssohn Choir which I school position teaching a core loved. Not surprisingly, I have severe curriculum that included English, math, In this article, I wish to point out to you difficulty in loud movie theatres even and science in grade 4 or 5 along the that elementary music rooms with my hearing aids turned down or on quieter planning-time vocal music. characteristically have low ceilings and mute! Very loud performances are reverberating noise from black boards. painful and sometimes impossible for In the meantime, I would have to wear No acoustic ceiling tiles are present me to attend. When singing in the hearing protection in my classes. When either. Most new schools built only Oakville Masterworks Choir that uses I put in a health claim for the cost of the contain an “all purpose” room designed professional orchestral or band $79 ear filter protection, the health and like any other classroom. And many accompaniments, I must secure strategic safety officer was convinced that my junior schools have NO music room seating further away from the hearing loss was the result of my age whatsoever! Planning-time music instruments. Even then, my tinnitus and/or family genetics. As I expected, he teachers have to “cart” their program becomes much worse for many days or did not approve my claim! Furious at his down the halls to the core classrooms. weeks following the performance. Also, reaction, I immediately called Marshall To make matters worse, performances I no longer attend concert venues that for help. often take place in echo-ridden gyms use high decibel electrical amplification. with high ceilings! At this point, Marshall sent a detailed I want to leave you with this important letter and my hearing chart to the Peel Perhaps you are not aware that in the message: hearing damage is permanent! Board. However, Marshall’s expert elementary system, the delivery of arts Music damages your hearing just as opinion was not enough for the Peel programs varies widely according to effectively as exposure to factory noise. Board! Over the course of the next few individual administrator preference! Please take care! months, they compelled me to see a And as always, music programs often Canadian Hearing Report 2013;8(2):27-28. myriad of doctors and audiologists in disappear in response to austerity order to collect more evidence to prove measures when lack of funds for the my point. The “sick” days I used to see school system becomes an issue.
28 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION feature |
Do It With a Song
By Rachel Arntson, MS, CCC-SLP Speech-Language Pathologist [email protected].
About the Author Rachel Arntson has been a practicing speech-language pathologist in the greater Minneapolis, Minnesota area since 1980 with a specific interest in using music to enhance the speech and language skills of children. Rachel has recorded 9 critically acclaimed CDs (2 in Spanish) and written a parent training book entitled, WE CAN TALK as well as other related products that serve as simple, engaging speech and language practice for young children. In addition, Rachel presents nationally and internationally, sharing her passion for music through creative and interactive workshops. Check out her website at www.TalkItRockIt.com.
ractice! That’s what children often language began many years ago with a and to take turns. They listened, but no Pneed to improve their speech and little boy named John. John was verbal practice was achieved. language skills. But where do we find diagnosed with ASD (autism spectrum Consequently, my song-search for John practice tools that are so enjoyable and so disorder) and was fixated on certain came to a screeching halt. I never found motivating that a child would objects – especially fish and ducks. John a song that could reach him, but I always independently choose to practice each also loved music, and I did my best to kept John in mind… day? What kind of tools can provide the engage him in songs. He was interested necessary practice for our children while and attentive to music but was never able There was no choice but to write my own allowing and encouraging participation to sing the songs I sang to him. Honestly, songs, and years later, I am still writing by their parents and siblings? it was a one-sided conversation. His lack songs – a new song whenever I see a of verbal participation initiated my child with a different need or different Is there a tool out there that can help journey of finding music, and motivation. Let me give you some children with oral motor planning needs, subsequently writing songs based on examples. articulation problems, receptive and children’s interests. My goal and dream expressive language delay, interaction was to entice and empower my students One of my students, James, omitted final and engagement issues, and poor turn- to practice speech on days when I did not consonant sounds and needed more taking and imitation skills? I have one see them for therapy. opportunities to practice. Because of him, great answer to that HUGE question: I wrote “Put the Sound on the End” – a My search for songs which would song which has been helpful not only to do it with a song! improve verbal skills was frustrating at him but to many other children. With almost every child and with every first. There were many songs on the speech and language challenge I have market, but there were very few that Then there was Sam who didn’t faced, there has been a song that could would meet the verbal needs of my understand or use action words. Inspired have been used to help. students – the sentences were too long, by his love for puppies, I wrote the the vocabulary was too complex, and the “Puppy Song.” This song, better than This journey of finding the power of rate was too fast. There was no room in any other tool I could have used, taught music to help children with speech and them for children to imitate, to respond, him the actions of run, jump, sit, eat, and
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 29 | talk. His mom and dad would sing the The benefits of these songs became far- that you attempt to sing, and that you do song with him and use a stuffed animal reaching as they created an opportunity it with them. They just want to be to demonstrate the actions. Such for interaction, turn-taking, and FUN engaged with you. They simply want a activities were motivating to him and with parents and siblings. They gave the simple song that they can … putting it became a part of his daily practice. children something to listen to and to simply: sing! The key word here is practice during daily activities, like riding SIMPLE. In my musical journey, I have There was also Ben who needed simple in the car. They gave children new explored what makes a truly enticing verbal practice of vowel sounds and vocabulary to use in certain situations. song for a child. What do I look for in a simple words. The result was the song For example, my little friend David was song that I know will create verbal “Drive a Car.” able to say “Owie all gone” to his mom practice in children? Well, that depends for the first time after listening repeatedly on the needs of each child, and that has From Kelsey’s need to imitate practice at to our “Owie Song.” been my journey with my first company, a more reflexive level came yet another Kids’ Express Train and my company song, “Noisy, Noisy, Noisy” where she You may be thinking, “I can’t write now, Talk It Rock It. was encouraged to imitate sounds such music, so this is not for me!” Quite to the as a kiss, a sneeze, or a cough. contrary, studies show that children do My job as a speech-language pathologist not mind how you sing. They only care does not always include music, but to avoid the obvious gift of music is to avoid a power that can do so much for us in our work. Remember that every moment is a note, every situation a song, and every person is a player. If you hold on FEATURE CAA to that thought, your mind will be open to the endless possibilities that every day MEMBER BENEFIT of your life brings, and you will reap the benefits. Professional Liability Insurance what aBout fish and duCks and john? ~ Exclusive reduced rates Whatever happened to the little boy with ASD who was overly hooked on fish and ~ No administration fee ducks? I am happy to say that he is a ~ Competitive limits of liability young adult now and going to college. I wrote a song called “Fish, Sharks, and ~ Enhanced product offering Shells” in his honor, and have been teaching it to children ever since. Was I a good speech-language pathologist for John? Yes, I think I was. Would I be
Canadian Academy of Audiology Heard. Understood. better now? No doubt, because I have many more tools now than I had back
Académie canadienne d’audiologie Entendus. Compris. then and the biggest one of all is the power of music and knowing how to use www.canadianaudiology.ca/benefi ts it. Canadian Hearing Report 2013;8(2):29-30.
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The journey from a War to Loudness Wars: A Musician’s Hearing Loss Awareness Program in Turkey By Ata Akdag [email protected]
this, could loud music do the same as About the Author well? I decided to base my bachelor Ata Akdag is a student at Yildiz Technical University degree’s thesis around this question. working towards a master’s degree in art and design. Thankfully my faculty was open to He is also the singer/songwriter/keyboardist for interdisciplinary studies: “Right, focus Turkish progressive band Yaya He has been working your studies on that area, but we can’t to raise awareness about musicians’ hearing loss in really help you. This is the Department Turkey since 2009. of Music and Performing Arts and there are no doctors here!” I understood my situation; I was by myself. When I started my research I realized that there a day in the Life was introduced to the head-shadow wasn’t a single program or an article in 14 P 844. I’m not sure if this counts as effect). My rifle had caused me to age 40 my country about hearing protection for betraying military secrets, but that was years in a few minutes. I still saw the musicians. I felt I was under a heavy the serial number of the rifle I used same person when I looked in the responsibility. Just when I was about to during my service in the Turkish army. mirror, but my audiogram told me give up, I came across Musicians’ Clinics A rifle is of great importance to a private. something else entirely: “You can’t of Canada on the Internet. When Dr. As Gunnery Sergeant Hartman says in perform music without ear protection Marshall Chasin sent me his book Hear Full Metal Jacket , “This is my rifle, this is any more. You can’t listen to the albums the Music , I knew where to start. The my gun. This is for fighting, this is for you love at loud volumes with auditory system, classical orchestras and fun!” To be honest, a G3 rifle was not earphones on. And, I leave you this rock bands, hearing protectors… If it much fun compared to the band G3, ringing in your ear, so that you will never wasn’t for this help from across the formed by guitar heroes John Petrucci, forget this trauma for the rest of your ocean, perhaps the studies about Joe Satriani, and Steve Vai. Back in those life.” The army doctor who saw my musicians’ hearing health would never days I had never heard of noise-induced audiogram was more optimistic: start in Turkey. hearing loss (NIHL), head-shadow effect, “Wouldn’t you give an ear for your country?” Apparently the Hippocratic or acoustic trauma. Nor did I know that with a LittLe heLP froM My Oath had changed a bit in the army. I this fun toy could produce a sound that friends could reach 161 dB SPL and that this went back home. As someone with I looked to the Istanbul State Symphony could permanently damage my hearing. NIHL, it was quite difficult for me to Orchestra to start my research. First of I was a young man playing keyboards in become a sound engineer. In one day the all, I had to meet with the ISSO rock bands and studying sound course of my life had changed. That was members and join their rehearsals. engineering. But now I couldn’t hear the my rifle and this really wasn’t fun at all. Music history classes at my faculty were frequencies above 4 kHz with my left ear taught by ISSO flute artist Aydin Buke. and there was an audiometric notch in o Canada How lucky! Thankfully I had survived my right ear’s hearing (which is how I I kept asking myself, if a rifle could do the first part without getting bogged
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Figure 1. Author’s audiogram before using a gun (hearing loss related to 15 years of music Figure 2. Author’s audiogram after shooting a G3 rifle. experience).
for the project. ME-DI ENT Center’s founder Dr. Mehmet Omur, whom I had met during my studies, provided with all his resources – ear examinations and hearing tests. Completely free! Indeed, at first it had seemed like there wasn’t anyone who cared about the subject enough to help. But after pressing the right buttons, all the doors were opening. I was also quite lucky to have Ali Barutcuoglu as my thesis advisor, who believed in the importance of my work and was helping me every step of the way. By then, the orchestra musicians seemed to be more interested as well. I think they had finally believed Figure 3. A french horn player's audiogram (27 years' experience in orchestra). that I wasn’t some sort of agent sent to inspect their performance and health down by the state orchestra bureaucracy. come from?” Japanese movie character adequacies! The difficult part was “convincing” the Kambei Shimada could find seven musicians to participate in the hearing samurais to fight against the bandits; I The results of the exams were quite tests and the survey. I use the word was luckier. In the end I convinced eight interesting. 60% of the orchestra “convince” purposefully, because orchestra members to participate in this members had never had hearing tests. Turkish people are quite reluctant to go “unnecessary” activity. The number of None of them used hearing protectors. through with routine medical those who filled the survey was greater Most of those who thought there could examinations. And, filling surveys is a than I expected: 41 members. So, where be a connection between music and complete waste of time. I could read would the hearing tests be held? I had to NIHL were those who had hearing tests their first reactions in their faces: “I can find a comfortable, private clinic in the done before. So, contacting a hearing hear just fine, where did this hearing test city and there was no financial support centre even once was enough to see the
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and Awareness for Rockers) had suffered weLCoMe to the MaChine hearing loss and dedicated herself to It’s hard to point to a definite link raising awareness about musicians’ between music and NIHL, since not hearing. The Who’s guitarist Pete only the loudness of music, but all Townshend had experienced similar sound levels are elevated in the problems as well because of listening to industrial age and there are countless loud music with headphones in the factors that threaten to damage our studio and had become an important hearing. If we are living in a noisy world, supporter of H.E.A.R. I had also the sound engineers working in studios gravitated towards the same area since I are as at risk as any of us. So I simply had NIHL and tinnitus as well. We had ask: “Could a mixing engineer with all become figures in the same cause NIHL continue to do his job with the after our bitter experiences. I had help of visual references?” EQ’s, acquired ear plugs which attenuated all frequency analyzers, spectrograms, and sounds by 15 dB and I still continued to other visual tools. How much more can perform, but I could not reverse my computers help us? I have designed an hearing loss. I was wondering if there experiment in collaboration with were others like me and I wanted to raise Kadikoy Hearing Center for mixing awareness among musicians who did engineers, which is still ongoing. Figure 4. Percentage of musicians using various not know about musicians’ hearing Professional sound engineers in Turkey types of hearing protection. problems. With this in mind, I prepared are also currently answering an online an online survey and reached 275 survey. I am impatiently waiting to share link between noise and hearing loss. The pop/rock/jazz musicians in Turkey who the results once they are done. SAE musicians who had ringing in their ears regularly performed on stage. Istanbul, one of the organizations in after concerts or rehearsals also thought Turkey with sound engineer certification NIHL could be linked to music. And Inadequate venues, raised volumes, programs, is raising awareness with those with no tinnitus problems? Not irregular working hours… Despite all audiology products company Hearsafe’s one of them thought music could lead these negative conditions, 75% of seminars given by Eckhard Beste. Also, to hearing loss – psychological factors performing musicians in Turkey did not Westone’s distributor in Turkey is were significant as well. If there was no use any kind of hearing protection endorsing well known performing pain, there was no fear either. The (Figure 4). Furthermore, 76% of those musicians and moving forward in the in- woodwind players, who sat in front of who filled the survey thought there was ear-monitor and musicians’ earplugs the brass players, were the group with a connection between music and NIHL. markets. The same company is the highest risk factors due to the They knew about the risk, but they took marketing products for military use as loudness level of the brass instruments. no precautions. 17% of those who took well. God! Isn’t it a bit late? The audiogram results seemed to prove the survey had permanent tinnitus, this. The horn players’ hearing at the especially the drummers. And, the stiLL haven’t found what high frequencies was considerably instruments that the musicians with no i'M Looking for damaged. The oboe players had hearing problems were most There is still no cure for NIHL. Stanford sensorineural hearing loss. Even in the uncomfortable with? The answer was, University Otolaryngology Department symphony orchestra, which rehearsed in none of them. Just as it was with the is conducting promising experimenting an acoustically satisfactory environment, symphony orchestra, there were no on mice, but the answer Dr. Stefan one could observe the traces of NIHL. problems for pop-rock musicians as long Heller gave me today is still negative: So I moved on to a “noisier” domain: as there wasn’t any pain. “We are unfortunately still several years pop/rock musicians. away from human trials.” I moved out of the “noisy” domain and My generation turned to the group with the supposedly The current picture in Turkey is like this: Kathy Peck, executive director and co- lowest NIHL risk factors: Sound There is a lack of a common terminology founder of H.E.A.R (Hearing, Education, engineers. and communication between musicians
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 33 | and audiologists. None of the Analyzed with the AHAAH Model. Audio Engineers Employing OSHA organizations I spoke to keep a database 2010. http://www.arl.army.mil/ PEL Criteria. MEIEA Journal of professional musicians’ hearing tests. www/default.cfm?page=351. 2003;3:55–83. When you need to examine musicians 2. Chasin M. Hear The Music: 8. Chepesiuk R. Decibel Hell: The about occupational hearing loss, there is Hearing Loss Prevention for Effects of Living in a Noisy World. only one way to do it: You have to do it Musicians 2010. 3rd edition, Dan Environmental Health Perspectives yourself. So I gave the first seminar at Art Diamond and Associates, Inc. 2005;113:A34–A41. Medicine Work Group’s educational 3. Mikl K. Orchestral Music: An 9. School of Audio Engineering (SAE) module. I advised the doctors of Assessment of Risk. Acoustics Istanbul Hearsafe Seminar 2011. tomorrow to work on the subject of Australia 1995;23:51–55. http://istanbul.sae.edu/tr/news/ musicians’ hearing loss. A common 4. Akdag A. Music and Hearing 7520/Hearsafe_Semineri. musician, telling doctors something they Health. Undergraduate Thesis. YTU 10. Saydam B and Oral A. Art & need to do and sharing the results of his Music & Performing Arts 2010. Medicine Educational Module. research! 5. H.E.A.R. Story. Hearing Education Istanbul Faculty of Medicine. 2010. and Awareness for Rockers 1991. http://www.itf.istanbul.edu.tr/ What will I do next? I’ll be wherever http://www.hearnet.com/about/ index.php?option=com_jevents there’s a musician complaining about about_kathy.shtml. &task=icalrepeat.detail&evid ringing in their ears. Wherever there’s a 6. Britt RR. Sound Science: Pete =1217&Itemid=36&year= soldier suffering from NIHL because of Townshend Blames Headphones 2010&month=11&day= guns, I’ll be there. And whenever for Hearing Loss 2006. 25&uid=9463daa5fcdc56b musicians enjoy performing without http://www.livescience.com/ 01efb9c9da74635d4&Itemid=36. fearing it, whenever mastering engineers 522-sound-science-pete- 11. White T. Aiming to Cure Deafness, stop the loudness wars, I’ll be there, too. townshend-blames-headphones- Scientists First to Create Functional hearing-loss.html. Inner-ear Cells 2010. BiBLiograPhy 7. Bulla WA. Daily Noise-Exposure of http://med.stanford.edu/ 1. Price GP. U.S. Army Research Audio Engineers: Assessment of ism/2010/may/hair-cell.html. Laboratory. Weapon Noise Daily Noise-Exposures of Canadian Hearing Report 2013;8(2):31-34. Exposure of the Human Ear Professional Music-Recording
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Beethoven and Me: The Effects of Hearing- Loss on Music Composition By jay Alan Zimmerman [email protected]
About the Author Jay Alan Zimmerman is a composer, author, and multimedia installation artist with a BFA from NYU/Tisch.
Theatrical works include his award-winning INCREDIBLY DEAF MUSICAL (seen at The Duke on 42nd Street), A ROYAL SOAP OPERA (with Prospect Theatre at The Clurman), and the multimedia song cycle PUNCTUATED THOUGHTS – originally directed by Broadway legend Tom O’Horgan. Visual music installations include WINDOW MUSIC (New York Academy of Medicine), ART/SONG (chashama Times Square), and ROBOTICUS – a video/robotic symphony created during residency with the LEMUR musical robots.He scored the dancefilms THE LAST LEAF (Best Score – First Run Festival) and DO NOT CALL IT FIXITY (Pompidou Centre, Paris), and the London- produced plays BOOTH and OUR BRUTUS.
The son of a Midwestern music theory professor, Jay had normal hearing while studying piano, saxophone, oboe, and frequently performed as a boy soprano. Last month, despite becoming deaf to all sound above middle C, he was selected for the New Dramatists Composer-Librettist workshop where he created new works daily and collaborated with Tony nominated playwrights via transcribers and frequency-analysis software. He lives in New York City with his wife, the painter Lisa Ingram, and son.
Most scholars insist hearing loss didn’t affect Oh, and yeah, we both slowly became Sure, you can compose with just theory, Beethoven’s music. I say that’s crazy… and deaf. memory, and virtual music in your head. he hid clues in his piano sonatas that prove But if you’re like Beethoven (and me), it. It’s jarring to see the phrase “deaf you’ll do whatever it takes – including composer,” because it’s not a job anyone chopping the legs off your piano — in hen people find out I’m a willingly pursues and few people order to hear a bit of what you’ve Wcomposer, the first thing they say understand what it really means. Yes, it’s written… for yourself. is “You’re like Beethoven!” And though more challenging to compose music our music is not remotely the same, it’s without normal hearing. But “deaf” Understanding this reveals how hearing- actually true in many ways: We both rarely means “no sound.” What it means loss can affect music composition. The grew up playing piano and other for a composer that lives through all the changes aren’t glaring wrong notes or instruments as children; earned income stages of hearing-loss – normal, mild, bizarre music–mistakes are easily caught performing, composing, and arranging moderate, severe, and ultimately by reading the scores. No, the changes music while still teenagers; and then profound deafness – is a life of are small and subtle, probably moved to the major artistic city of our disappearing notes, altered harmonics, unconscious most of the time. Because time and became self-employed and a never-ending quest to capture hearing-loss sneaks up on people, and composers who wrote many types of snippets of musical tones like a dying you don’t notice you’re adjusting to it music. man seeking drops of water in the desert. until it smacks you in the face.
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This is the story of how Beethoven and I got smacked and how our music changed. In the great master’s case, these changes might even have influenced what became known as the Romantic Era of music. At least it would be nice to say hearing loss was responsible for something positive! norMaL hearing One of the first things I did after discovering my hearing loss was to make a new hearing chart. Because audiologists kept telling me I don’t hear much, and I kept telling them I heard most of the piano, so what the heck is going on here? So I made a chart that covers the entire human hearing spectrum and includes musical terms I understand. A musician Figure 1. Beethoven’s original piano (top) with the highest fundamental being about 1500 Hz and the doesn’t think of “frequencies.” We think lowest being roughly 40 Hz. The modern piano keyboard ranges from 27 Hz to just over 4000 Hz of pitch. We don’t think in decibels for (4196 Hz for the purists among us). Audiologists rarely test below middle C (roughly 250 Hz). volume, we think in dynamics. And since music is louder and lower in pitch improvisation. He’s known as a brilliant The overall effect of these works fit than speech, on an audiology chart I improviser and performs often. So I perfectly with the Classical Era and don’t hear much – but on MY chart, I focused on these early piano sonatas reflect the influences of Mozart, who hear a lot. Guess which one I prefer to (Opus 2 Nos. 1, 2, and 3) to get a general Beethoven wanted to study with but met look at? sense of his composing style before only once prior to his death, and Haydn, hearing loss. who Beethoven studied with and to Since Beethoven (and me) grew up with whom he dedicated his first sonatas. This normal hearing, this first chart shows The main melodies of each movement of is the result of a young man composing what he hears from birth to about age 25: these works are in the soprano range and with normal hearing: You end up He hears all the frequencies in speech the left hand parts are very light. By light, composing works similar in style and and music, from 20 to 20,000 Hz. He I mean that there are no low, thick chords construction to your influences and what hears all the volumes, which were or “rumblings” (low tremolos) so you hear others writing. probably quieter than today’s noisy characteristic in his later pieces. The only world. He hears every note on his piano, low triads appear briefly at end of Similarly, my early works were piano- the top one, which is smaller, brighter, movements (as in the F minor chord at based and developed through and more quiet than the modern piano the end of first movement of No. 1) and improvisation. There’s something below (which was developed during his in a passage of No. 3 where the left hand thrilling about sitting at a piano and lifetime). Figure 1 shows the ranges of sustains low triads under a right hand creating at the same time you hear the Beethoven’s original piano and the broken arpeggio (measures 108 – 119). results. Every “accident” can lead to a modern piano keyboard. The same is true of Opus 7, with the new development. Every emotional exception of the largo movement, which outburst can flow from your fingers and In this normal-hearing phase of life, begins with an alto theme, centering be instantly translated into music. It’s Beethoven is most focused on works for around middle C. However, the left hand addictive, and hard to give up when piano – his first and most intimate means accompaniment is still written with open faced with withdrawal… of expression – and it’s likely he voicings, like the natural overtone developed them through sketches and structure. My hearing has become weaker
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composing, but keeping his hearing loss a dark secret. And, when I looked closely at his piano sonatas of this time, there are some interesting changes:
Opus 10, No. 2 (1797) is the first time he begins a movement (the Presto) with a bass clef theme. But it is just a fugue, so not that unusual. Opus 10, No. 3 actually begins with the right hand in the bass clef, but it is short lived – a little more than one measure. The trio of this sonata also begins with a bass clef theme, but it has sparse voicings and is a very short movement. However, this sonata contains the most emphasis on the low register in Beethoven’s work thus far.
With the Pathetique (Opus 13), low register emphasis begins to take over. Figure 2. Audiogram with a high frequency roll-off above 750 Hz. The sonata begins a strong C minor chord stacked from middle C down to two octaves below. The left hand tremolos in the first movement go all the during the last three years… and instruments, which suggests he has way down to the G two octaves below When somewhat at a distance I a high-frequency hearing loss. middle C – twice as low as the only other cannot hear the high tones of tremolos in Beethoven's previous work instruments, voices… – Beethoven He writes that he cannot hear “soft (Opus 2, No.1). The second movement speech.” So if we assume that includes begins with both hands in the bass clef How humiliating it was when the volume of a whisper, sounds would and is that way for about half of the someone standing close to me have to be at least 20 decibels loud for movement. Its melody is in the tenor heard a distant flute, and I heard him to hear anything. He also writes that range. nothing, or a shepherd singing, and he cannot hear the high notes of again I heard nothing.– Beethoven instruments, so if we use a modern piano Opus 14, No. 1 & 2, composed in 1798, as his limit, that would mean nothing both seem to be a diversion from this high frequenCy hearing- above 4000 Hz. But, Beethoven’s piano trend. However, in No. 1 almost every Loss was only five octaves, and he says he has melody note above a high D (octave The best information we have on trouble hearing the high notes of singers above middle C) are doubled with the Beethoven’s hearing-loss comes from his – which means at a maximum, a octave below. So, if Beethoven performed own letters. While it’s possible he had a soprano’s high C – which is this work himself, he would hear the slight hearing loss in childhood, he (like approximately1046 Hz, though he may lower version of the melody while me) didn’t notice any loss until his mid- have still heard those notes at very loud playing the higher one. He still gets to twenties (around 1796). There is no volumes. Using these clues, the first stage enjoy it. evidence that it appeared suddenly, and of his hearing-loss (age 29) in he is inconsistent as to when it began. audiometric terms, may have looked With Opus 22 (1800), the opening His hearing also continues to get worse something like this (Figure 2): melody is in the second voice in the right throughout his life. This means he had a hand. The low tremolos are back, this progressive hearing loss. And, he has As the high notes disappeared, time even lower than the Pathetique (F trouble hearing the high notes of voices Beethoven was still performing and two octaves below middle C). One the
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music than the Classical Era? Subconsciously – as a result of his losing the ability to hear the high notes? Or, consciously – so that he could perform these pieces with more confidence?
As a composer who’s gone through this same stage while writing and performing my own works, my guess is: a combination of all three. Sometimes I “hide” low note cues in my work so that I can perform it. Sometimes I just want to enjoy the hearing the music, so I write it in my hearing range. And, sometimes, frankly, I have no clue what I’m doing. It happens instinctively.
It was owing to virtue, and to my art, that I did not end my life by suicide. – Beethoven
Figure 3. Author’s audiogram with a moderate to severe high-frequency hearing loss. Moderate-severe As Beethoven’s hearing keeps changing, so does his music. Having considered themes of the first movement is written are quite low when compared to with suicide, he instead accepts his increasing two octaves below middle C and three piano sonatas of Opus 2. If you hearing loss and the label “hard of constantly comes back to this same F. I’m compare the highest to the highest (Opus hearing.” He writes to himself at age 35: going to skip the theme and variation 2, No.3 last movement vs. Opus 27, No. “Let your deafness no longer be a secret sonata, Opus 26, except to say that four 2 last movement) and the lowest to the – even in art.” of its sections begin with both hands in lowest (Opus 2, No. 2 second movement the bass clef. vs. Opus 27, No. 1 last movement) there He can still compose but is soon forced is a difference of a sixth or seventh. This to give up his first love – performing Around 1800–1801, Beethoven began to is also generally true for Opus 28 and the piano publicly. His last piano concerto admit his hearing loss to his friends. His three sonatas Opus 31. was written at age 38. He only writes one compositions have already stretched opera, as he would have been unable to melodies to their lowest extremes, and So the overwhelming trend in hear the sopranos nor most of the this is now a permanent part of his Beethoven’s music of this period is a slow consonants required to understand what writing. His use of thick, low chords has stretch of melody to its lowest possible words they are singing. And, in his grown and will reoccur most extremes, followed by a reduction in its symphonies, which he began to write at prominently in Opus 31, No. 2 and highest. He moves from open chords in age 30, he breaks the rules and Opus 53 (1803), as well as in many of the low register to thick triads. And, introduces themes with lower pitched his other sonatas. An interesting change, though the new, modern piano has extra instruments than the standard violin. however, is that he now begins to reduce high notes, he focuses instead on its Even the tympani plays melodic motifs. his usage of the extreme high register – ability to express a darker, louder, In my opinion, these are not only creative no longer a major melodic element, but dynamic range. choices but “musical treats” for his more for runs, repetition of lower severely impaired hearing and cues to melodies, and effects. Did this lowered “pitch shift” occur: help him conduct. Unfortunately, he Accidentally – as a part of his desire to even has to give up conducting, having The melodies of Opus 27 Nos. 1 and 2 create a darker, more emotional style of been humiliated by conducting a
38 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION | performance long after the piece had the poor deaf man hammered in such a When working at the keyboard he also ended. way upon the keys that entire groups of tried to overcome his tinnitus: notes were inaudible ... Instead of loose sheets of staff paper he Cotton in my ears at the pianoforte begins to use “sketchbooks” – bound I felt moved with the deepest sorrow at frees my hearing from the books of staff paper and notebooks to so hard a destiny. It is a sad misfortune unpleasant buzzing. carry with him on long walks. It is as if for any one to be deaf; how then should he is training himself to rely more on a musician endure it without despair? These struggles show up musically in his imagination and theoretical skill and less Beethoven's almost continual extreme changes in tempo, register, and on improvisation. But at the same time melancholy was no longer a riddle to dynamics, but the way is clear: when he increases his output – as if hoping to me now. Beethoven is most emotional, passionate, compose everything he can before his depressed, confused, he writes in the hearing is completely gone. There is a line you cross with hearing loss bass clef – not only for its dark sound, where you give up trying to hear even but also where he can possibly hear it; To get an idea of his hearing-loss at this though some sounds still make it to your thereby releasing these feelings through point, I include this chart of my own loss brain. I am loath to call this “acceptance,” writing the music, performing the music, in the moderate-severe stage (Figure 3). because you can’t move on from and hearing the music. This combined something that follows you. But, sensory experience is the only source of Precisely because of that [your acknowledging your limits can be pleasure Beethoven can count on. deafness] you are famous. somewhat freeing. Everyone is astonished, not just Beethoven – who had no wife, no that you can compose so well, but In this phase, Beethoven’s musical output children, no other source of income – particularly that you can do it in slows down (he has finished all of his was unable to participate in society and spite of this affliction. If you ask symphonies except for the ninth) but he endured constant physical suffering, me, I believe that it even doesn’t quit. At age 44, he makes another there was no choice. He continued to contributes to the originality of shift in his compositional system and push himself, finally creating his greatest your compositions.– Beethoven’s begins to use pocket notation work: the ninth symphony. nephew Karl sketchbooks. With these little sketchbooks he can wander in nature Beethoven proves one can compose by ProfoundLy deaf and write musical ideas completely free using a combination of imagination, By age 42, Beethoven could still hear of the keyboard. And between ages 45 memory of sound, music theory, and some low frequencies but for the most and 47 he tries to communicate with “ear maximizing whatever hearing remains. part he was profoundly deaf. This is best trumpets” – specially designed for him. But the larger question for him (and me) illustrated by his friend Louis Spohr, a But they do not help, and he soon resorts has been “why bother?” If you can’t ever respected composer and violinist of the to conversation books. enjoy the result, why go through all that time, who met Beethoven in 1812 (age struggle and pain? 41). Spohr wrote: And yet, even though he has trained himself to compose mostly on notation The answer for me is that when I’m in At the time I made Beethoven's paper, he is still desperate to hear his the zone of creating, using vibration, acquaintance, he had already music. Special pianos are constructed for tactile, technology, and yes, some hearing discontinued playing both in public and him that have extra strings for every note, – sometimes I think I heard my music. at private parties; I had therefore but making the piano twice as loud. Some And that’s almost as satisfying as the real one opportunity to hear him, when I sources claim he attached an ear trumpet thing. As Beethoven said: casually came to the rehearsal of a new to a specially designed “resonance plate” Trio at Beethoven’s house. It was by no which, when placed on the piano, I live only in my music . means an enjoyment; the pianoforte amplified the sound directly into his ear. was woefully out of tune which, And, famously, he cut off the piano legs Canadian Hearing Report 2013;8(2):35-39. however, troubled Beethoven little, since so he can feel his music when it made the he could hear nothing of it. In the forte, floor vibrate.
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Hearing Loss in Classical Orchestra Musicians
By Alberto Behar, PEng, CIH and Marshall Chasin, AuD [email protected] [email protected]
About the Author Alberto Behar (far left) is a research fellow with the SMART Lab at Ryerson University.
Marshall Chasin is director of auditory research with the Musicians’ Clinics of Canada
uian et al. performed a noise divided in five groups according to their use of uniform attenuation earplugs was Qexposure survey on members of the respective locations on the orchestra discussed. National Ballet Orchestra, using noise floor (See Figure 1) and similarity of the dosimeters. 1 They concluded that the spectral profile of the sound they resuLts noise exposure due to the musicians’ generate. Groups were as follows: Group Noise Exposure activities with the orchestra was below 1 (Violins); Group 2 (Violas/Cellos); Normalized L ex,8 hs noise exposures the hazard level of 85 dBA. As a follow- Group 3 (Woodwinds); Group 4 levels were calculated and shown in up to the survey it was decided to (Brasses); Group 5 (Percussion / Double Table 1. perform hearing tests to the members of Basses). the orchestra. A questionnaire was also Questionnaire used to gather information on particulars audioMetriC assessMent Forty-four of the 52 musicians of the surveyed members. After completing an audiological history completed the questionnaire (85%). and otoscopic examination a full Twenty-one of the 44 respondents were questionnaire audiometric battery including middle female (48%). Average age of males was Musicians had to be assured that the ear assessment was performed on all 51.7 years (SD = 11.1), while average age questionnaire will be anonymous with participants. Air conducted and bone of females was 48.7 (SD = 9.9). Average no names included, something essential conducted audiograms were obtained age of participants was reasonably to the participants because of the nature using a clinical audiometer with 5 dB matched across the five groups. of their occupation. In addition to basic steps. All measurements were conducted questions concerning demographics, in a sound treated audiometric booth Table 2 shows the numbers of years questions were asked about the Speech testing (word recognition scores participants were playing in general and musician’s principal instrument (some and speech reception thresholds), and professionally. An analysis-of-variance participants play more than one), the admittance measures (tympanometry (ANOVA) determined that the groups duration of exposure through practice and acoustic reflexes) were also part of did not differ with respect to the length and performance and exposure to other the evaluation. of their exposure. sources of noise. The results of the test were explained to The majority of respondents reported Because of the small number of each musician and a range of hearing listening to music through speakers (40). participants involved, musicians were loss prevention strategies, including the Many also used earbuds with portable
40 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION | instruments (21). Very few listened through circumaural headphones (5). Participants did not normally limit themselves to only one music listening device. Relatively few respondents reported involvement in noisy activities (9). However, it should be noted that a proper definition of “noisy activity” was not provided.
Audiometric Results Figure 2 shows the average audiometric pure tone test results for the musicians. On average the data suggest only a slight to mild mid to high frequency sensory- neural hearing loss in the 4000–6000 Figure 1: Location of the instruments groups on the orchestra floor. Hz region. This is consistent with hearing losses observed with other forms taBLe 1. norMaLized average and standard error noise of noise exposure. exPosures group instruments average st. error Measured and Predicted Hearing 1 Violins 86.5 0.8 Losses 2 Viola/Cello 86.8 0.3 The ISO 1999 Standard predicts hearing 3 Woodwinds 89.8 0.8 loss at different frequencies for males 4 Brasses 92.7 0.5 and females, according to age and 5 Percussion/Double basses 89 0.5 number of years of exposure at a given 2 noise level. Figure 3 shows the taBLe 2. years of PLaying. measured and calculated hearing losses groups 12345 for the group in this study. It may be Average playing 41.8 35.6 40.4 38.6 32.5 observed that there are practically no Average playing differences between measured and professionally 26.0 23.9 31.5 29.9 22.8 calculated hearing losses at 3000, 4000, and 8000 Hz. Although the difference at 500 Hz is likely due to background noise in the audiometric booth, there is no obvious explanation for differences at 1000 and 2000 Hz. In any case, the differences between measured and predicted losses do not exceed the limits of measurement accuracy. disCussion Pure tone audiometry showed that threshold varied as a function of instrument group and frequency region. Brasses and percussion/basses had the highest thresholds, bordering on clinically significant losses in the 4000– 6000 Hz region. These differences across Figure 2. Average hearing loss of the different groups.
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Figure 3. Measured and predicted hearing losses (as per ISO 1999) in dB groups could not be explained by age, times will increase the risk. It seems estimation of noise-induced hearing years of playing, or years of playing reasonable to recommend that impairment. ISO TC/43 N1139. professionally, and are thus most likely orchestras comparable to the National Revision of ISO 1999:1990. Second due to individual differences in noise Ballet Orchestra adopt a Hearing CD March 2010. exposure. Brass players had the highest Conservation Program, and that linear 3. NIOSH (National Institute for hearing losses (10 dB or greater than ear-plugs be considered for those Occupational Safety and Health) strings and woodwinds between 4000 orchestra members that are exposed to (1998). NIOSH criteria for a and 8000 Hz). This finding is consistent higher noise levels. 3 On the basis of the recommended standard: with other noise-exposure surveys and current study, it appears that such occupational noise exposure, revised audiometric investigations which raises interventions may be most necessary Criteria 1998. DHSS(NIOSH) some concern about long-term hearing among brass players. Publication No. 98–126. Cincinnati, health of brass players. Nonetheless, it is OH: U.S. Department of Health and important to acknowledge that at the referenCes Human Services, Public Health time of testing, none of the groups had 1. Quian C. Behar A, Wong W. Noise Service, Center for Disease Control, hearing loss that would be considered exposure of musicians of a ballet National Institute for Occupational outside the limits of normal hearing. orchestra. Noise & Health, Jan-Feb Safety and Health. 2011;13:(50)59–63. Canadian Hearing Report 2013;8(2):40-42. Noise exposure levels in the orchestra, 2. ISO 1999 (International normalized to 360 hr/year were below Organization for Standardization) the hazard limit of 85 dBA with the (1990). Acoustics—Determination exception of the brasses. Longer playing of occupational noise exposure and
42 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION researCh and deveLoPMent foCus |
The “Epidemic” of NIHL from MP3 Player Use
By Cory Portnuff, AuD, PhD [email protected]
look at the literature examining PLD use. assumptions must be made to guess at First, there is a strong understanding that how people will actually use their PLDs. MP3 players can produce high output First, we’ll assume that 16.7% of users of levels with any type of headphone, PLDs will exceed their 100% weekly ranging from 102–108 dBA with noise dose with their typical listening earbuds, and up to 120 dBA with activities. Of that group, let’s assume that aftermarket earphones. 1,2 Beyond the only the most tender ears (8%) will incur output levels, we have to ask how people a material hearing impairment (MHI). So, choose to use their PLDs. We know that 1.2% of the total users of PLDs will incur people tend to listen at higher levels in an MHI. With 342 million iPods and About the Author background noise. 2,3 In the laboratory, we iPhones on the market, let’s assume that Cory Portnuff is an audiologist at the see that the vast majority of people half of those devices are still in use (about University of Colorado at Boulder. choose levels above 85 dBA when they’re 170 million). So, if 170 million people in 80 dBA of background noise. In the are using PLDs, and 1.2% of them will n the past few years, a wide range of real world, the effect of noise is especially incur an MHI, then a total of 2.04 million Imedia coverage has declared hearing clear. For example, on a noisy urban people will have hearing loss attributable loss from overuse of MP3 players and college campus, up to 52% of students to overuse of PLDs. other portable listening devices (PLDs) to reported listening at levels that would be at epidemic proportions. Indeed, the exceed 100% of their daily noise dose. 4 While the example above is not the most MP3 player has become a ubiquitous conservative estimate of hearing loss accessory in for many younger people. In our lab, we’re particularly concerned caused by PLD use, it does show that Over 342 million Apple iPods and with looking at the actual listening levels there is some cause for concern about iPhones have been sold across the world, of people in the real world. To look at MIHL from the current listening habits of and it’s now common to see the white, this, we completed a dosimetry study young people. Certainly, when compared Apple earbuds in the ears of many where we connected dosimeters to the to the 10 million workers in the United teenagers and college students. A 2010 PLDs of a group of 18–29-year-olds for a States with occupational hearing loss, 2 Kaiser Family Foundation survey found week. Of our study group, 16.7% million people with hearing loss from that ownership of iPods and MP3 players exceeded a 100% weekly noise dose, and PLD use is small. Perhaps PLD use won’t among children has increased from 18 to 20.8% exceeded a 50% weekly noise result in an epidemic of hearing loss. 76% in just the past 5 years. While these dose from their PLD use alone. 5 We However, it’s important to remember that devices are widely used, the risk of concluded that a small, but substantial hearing loss from music is entirely music-induced hearing loss (MIHL) from group of listeners are putting themselves preventable . In industry, there are jobs PLDs is dependent on how people at risk for hearing loss from their typical where exposure to noise may be choose to use their music players. So, is PLD use. unavoidable. The choice to listen to music it really correct to declare MIHL from through a PLD is entirely optional – PLD use to be a public health crisis? So, let’s try a little math to see what the anyone can choose to listen at safe levels. actual risk to the population is. For the To help answer this question, we can purposes of this example, several For many people, their PLD overuse is a
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 43 | taBLe 1. player users. J Speech Lang Hear Res % of volume Maximum listening time per day 2011;54:263–77. Control earbud isolator supra-aural 5. Portnuff, CDF, Fligor BJ, Arehart KH. 10–50% No limit No limit No limit Self-report and long-term field 60% No limit 14 hours No limit measures of MP3 player use: how 70% 6 hours 3.4 hours 19 hours accurate is self-report? Int J Audiol 80% 90 minutes 50 minutes 4.6 hours 2013;52:S33–40 90% 22 minutes 12 minutes 66 minutes Canadian Hearing Report 2013;8(2):43-44. 100% 5 minutes 3 minutes 16 minutes Recommended listening time as a function of volume control level. These times reflect exposure to 50% noise dose, NIOSH damage-risk criteria. “Isolator” style earphones are earphones that seal the ear canal, blocking out background noise. generaL reCoMMendations for PLd use case of a lack of knowledge. If we, as PLD users choose levels that put 1. 80-90 Rule: You can listen at 80% of audiologists, can provide good themselves at increased risk for hearing the max volume for 90 minutes per information to the public, perhaps we loss. As audiologists, the burden of day safely. Listening at higher leve can influence people to make good informing the public about their sound ls gets less time, listening at lower choices about their listening levels. A exposure falls on us. Even if the amount levels gets more time. good rule of thumb is the 80–90 Rule – of MIHL from PLD use is not yet at 2. When listening in noisy you can listen at 80% of the maximum “epidemic” levels, we have the ability and environments, choose earphones volume for 90 minutes per day safely (see obligation to inform our patients and the that block out background noise. Table 1 for recommended listening times public of how to listen safely. Isolating earphones can decrease at varying volume control settings). This Audiologists are in a unique position to noise levels in your ear canal, rule works well for earbuds and cheaper be the experts on preventing hearing meaning that you don’t have to turn supra-aural earphones. Some earphones loss, both occupational and recreational. the volume up as high to hear the that are designed for high outputs (i.e., Whether it’s outreach to local schools or music. earphones for DJs, musicians’ monitors) just talking to your patients, you have the 3. Be aware of your surroundings. may require shorter listening times or opportunity to make a difference. So, let’s When you’re listening to music, it’s lower volume control settings. take the next step and put what we know harder to hear warning signals, so be into practice! sure to use your other senses to Research in our lab has also shown that know what’s happening around you. we need to target several specific areas in referenCes 4. If you’re concerned about your order to affect change in peoples’ 1. Keith SE, Michaud DS, Chiu V. hearing, see an audiologist for a listening behaviour. First, when people Evaluating the maximum playback hearing evaluation. feel more susceptible to hearing loss, they sound levels from portable digital will tend to listen at lower levels. audio players. J Acoust Soc Am Interventions must show people that 2008;123:4227–37. hearing loss can cause a significant 2. Portnuff, CDF, Fligor BJ, Arehart KH. impact on their life, and that their actions Teenage use of portable listening can cause them to incur that hearing loss. devices: a hazard to hearing? J Am Second, when people feel fewer barriers Acad Audiol 2012;22:663–77. to listening at lower levels, they choose 3. Muchnik C, Amir N, Shabtai E, those lower levels. So, if people know Kaplan-Neeman R. Preferred what levels are safe and how to protect listening levels of personal listening themselves, they will be more likely to devices in young teenagers: Self make better choices for their hearing. reports and physical measurements. Int J Audiol 2012;51:287–93. Without a question, the research shows 4. Levey S, Levey T, Fligor BJ. Noise that a small but substantial percentage of exposure estimates of urban MP3
44 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION researCh and deveLoPMent foCus |
SIN and SNR: The Unavoidable Importance of Maximizing Signal to Noise Ratio By Richard Einhorn, BA [email protected]
About the Author Richard Einhorn is a modern classical composer.He graduated summa cum laude and Phi Beta Kappa from Columbia University in New York City in 1975, and studied composition and electronic music with Jack Beeson, Vladimir Ussachevsky, and Mario Davidovsky.
His most notable work, Voices of Light, premiered in 1994, is an oratorio, scored for soloists, chorus, orchestra and a bell. It was inspired by Carl Theodor Dreyer's silent film The Passion of Joan of Arc 1928). In the 1980s, he composed many horror and thriller film scores, including The Prowler and Sister, Sister. He also contributed to the soundtrack of Liberty! The American Revolution.
Richard lives in New York with his wife, Amy Singer, and their daughter, Miranda.
s a composer, I have spent common audio recording techniques hearing loss; it will, at best, only help us Athousands of hours at my piano and that I've used for over 40 years, I've come cope. computer fashioning sounds, harmonies, up with what is apparently a somewhat rhythms, melodies – trying to write unusual, but practical, approach to All that said, I believe that through the down the music I hear in my hearing assistance. I'm able to compose approach I take in my day-to-day imagination. I have also worked equally music without compromise, participate hearing assistance, it is often possible to long and hard as a record producer and fully in rehearsals, and enjoy both live minimize a considerable number of the engineer, carefully adjusting micro- performances and recordings. Of equal audio problems that prevent me – and phones, mixers, equalizers, limiters, and importance, my approach also enables many others – from hearing as well as we other professional audio gear to capture me to hear speech in noise (SIN) well possibly could in many difficult the performances of great musicians like enough in situations where I would be situations. Glenn Gould and Yo-Yo Ma with the hopelessly deaf if I had to rely simply on most beautiful sound quality possible. my hearing aid. As a result, I am able to There is no magic: I simply use high participate fully in nearly all of the quality audio equipment in a way Hearing is, by far, my primary sense; it activities I was involved in before my appropriate to the situation. Fortunately, is through sound that I have always hearing loss, musical and otherwise. excellent audio equipment useful for aligned myself to the world and to my hearing assistance is quite affordable life. Listening closely to music and the I certainly realize that many people today. And if good equipment is properly sounds around me are, along with my struggling with their own hearing used, I have found it is often quite family life, among my greatest pleasures. problems will not achieve the same level possible to significantly improve my I remain a “sound person” even today, as of benefit I get from the techniques I use, ability to comprehend both music and I try to cope with several different kinds and the equipment, while simple for me, speech. of very serious hearing losses, including, might be a bit daunting to someone not three years ago, the complete loss of my comfortable with technology. Indeed, do whatever it takes to right ear from Sudden Sensorineural there are trade-offs, and no audio hear Hearing Loss (Einhorn 2012). 1 technology I know, including standard I start my approach to hearing assistance By adapting and extending some hearing assistance devices, will “solve” with a simple desire:
1 Briefly, my right ear has severe recruitment with no speech comprehension; my left ear has roughly a 60 db mixed loss. I have moderate to severe tinnitus in both ears. REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 45 |
I want to hear. problem with a wheelchair – and I cancellation that significantly lowers the wouldn't be embarrassed to use it no gain of, say, loud jet engines. But that is Unless I hear the world with matter who saw me – I have no a relatively easy problem for modern understanding, my ability to function in compunctions about using whatever is technology to solve. it is vastly diminished. In addition, necessary to hear as well as I can. hearing well enough to take pleasure in A far more difficult problem than steady- the sounds around me – from There's one important caveat, however. state noise reduction is improving the conversations to environmental sounds To repeat: I don't care if my hearing intelligibility of a specific voice in the to music – is crucial to my emotional assistance is visible, provided it works . presence of speech babble – say, in a and psychological well-being. restaurant. It is true that, given Naturally, no one would be willing to sophisticated enough digital signal A fundamental principle follows that use visible hearing assistance if it didn't processing (DSP) – for example, via informs my entire approach to hearing do any good! Unfortunately, for a lot of careful equalization and precise multi- assistance: everyday situations, many common band compression, it is possible in assistive listening devices, including certain specific situations to improve I will do whatever it takes to hear as well as hearing aids, don't, in fact, work very SNR, but often that is not enough to my ears will allow. well. The problem, put simply, is signal make much of a difference to me and to to noise ratio. others with hearing loss. We require a There is a corollary to this principle: significantly higher SNR than people MaxiMize snr with normal hearing (see, for example, I don't care if my hearing assistance is Because I have spent my life recording, Killion 1997), and despite considerable visible, provided it works. producing, and composing, I can't help experience and experimentation with but think of the problem of effective numerous types and brands of DSPs, I Apparently, my reasoning about hearing hearing assistance as, first of all, an audio have not heard any processing assistance is quite rare. I have been told problem. I seek out audio equipment technology that dramatically and reliably repeatedly by audiologists, by otologists, and techniques that will provide me improves SNR in difficult situations. by hearing aid designers, and even with the best possible sound signal for a persons with hearing loss that those of given situation. Then, I adjust the However, if the SNR is already pretty us with hearing impairments care more equipment to compensate for my good, DSP properly applied to a sound about hiding our hearing devices than medical problem – my hearing loss − but source can be very effective. Put another we do about hearing well. That is why I try at all times to preserve sound way, the best way to create a significant hearing aids are so small, for example. quality, just as I would if I were improvement in the SNR is not to recording a great pianist or cellist. attempt to process a very noisy signal. While I realize this attitude is Instead, it is better to start by widespread, I do not understand either When I speak about sound equipment maximizing the SNR, and then process. the emotions or logic behind it. Why and techniques that provide “the best would anyone willingly choose to possible sound,” I mean an electronic On a practical level, “maximizing the withdraw from conversations, from audio signal with, first and foremost, a SNR” means: music – from life! – merely because they very high signal to noise ratio (SNR) and are embarrassed about using a hearing by high SNR, I mean that the audio device someone else might notice? I've signal must contain a desired signal 1. If the desired sound source is live, heard a litany of answers to this – source – say, a voice or a musical place the microphone (or hearing aids are stigmatizing; hearing ensemble – that is significantly louder microphones) as close as possible to loss is a signifier of old age and decline; than the background noise.Therefore, the source. a hearing device projects weakness the “best possible sound” is achieved by 2. If the desired sound source is during business meetings – but none of good equipment appropriately used to amplified, try to get a direct audio these makes sense to me, especially if, by maximize SNR. 2 I believe high SNR is feed from the originating sound using a visible hearing device, I can essential because, based upon my system. participate, at least partly, in the experience, there is simply no audio conversation. signal processing available – digital or Live sound sourCes analog – that can effectively extract a low For someone with my level of hearing As I see it, my hearing loss is a disability, gain signal from noise except in the most loss, hearing aids are absolutely no more, no less, and it is pointless for trivially noisy situations. For example, essential. They provide me with very me to try to hide it. Just as I would with specially designed headphones, it convenient general-purpose hearing compensate for a serious walking is quite possible today to achieve noise assistance for a wide variety of situations.
2 Also important for good sound are other factors, including 46 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION the SNR for the device's electronics and low total harmonic distortion. |
In quiet places, they keep my ear and microphone be easily and unobtrusively not only an ability to focus the sound on brain stimulated by ensuring that I hear moved, to point at a new sound source what is directly in front of the unit, but a constant background of room or – say, a second companion at a dinner also has better quality audio specs – a outdoor ambience. table. flatter frequency response and lower harmonic distortion – than is available However, in many other circumstances, After a lot of research and testing, I via the stock iPhone mic (Studio Six I have found that my state-of-the-art determined that a portable rig based Digital web site, accessed 2013). The hearing aids are ineffective, despite their around an iPhone could make a high- app – I use either SoundAmpR or FiRe extraordinarily sophisticated DSP. In quality, affordable, and – most 2 more or less interchangeably – restaurants, at parties, and even in importantly – very effective assistive provides a variety of adjustments for private homes with less-than-optimal listening system. It may sound odd to attenuation and signal processing, acoustics, it is often impossible for me to confront a serious condition like hearing including equalization, limiting, and understand speech; none of the included loss with a very common consumer compression. I can even record what I'm programs help despite careful product, but in fact, smartphones are listening to, for replay later. programming – and re-programming – increasingly used for important medical by my very committed, compassionate, purposes (NBC News, 2013). There is While the components of my iPhone rig and patient audiologist. Why? no intrinsic reason why such ubiquitous are extremely important, it is just as and powerful mobile computer critical for maximizing SNR to seek the From an audio producer's standpoint, technology shouldn't be used most optimal mic placement that is one answer is obvious: the microphones proactively for live hearing assistance. practical. At restaurants, I place the unit are simply too far away from the desired on the table with the mic as close as sound. Because my hearing aid's mics In fact, as an audio device, the iPhone possible to and pointed directly at the are placed by my ear (I wear a BTE), they has very good analog to digital (A/D) and speaker. I have learned how to quickly are located, under the best digital to analog (D/A) conversion as and unobtrusively move the device circumstances, at least three feet away well as a small but useful suite of DSP when someone else speaks to redirect the from the person I am interested in available to app developers. This makes microphone. At parties and other social speaking to, and sometimes farther. If it an excellent platform for hearing occasions, I hold the iPhone at slightly I'm in a very noisy environment, then assistance. 3 I've discussed my iPhone rig above waist-level, with the microphone the SNR – even at three feet! – is much in detail elsewhere (Einhorn, 2012). pointed up directly at the person too low for signal processing to do much Essentially, it consists of, in addition to speaking. While this often places the good. Nor will directional mics on my an iPhone, a sound app such as device farther away from a speaker than aids help that much: the pattern is too SoundAmp R or Fire 2, a good pair of the mics on my hearing aid, the Mikey broad. For directional mics to work well in-ear-style earphones, and a high- Digital provides superior directionality at that distance, the mic pattern, in my quality stereo cardioid microphone (and possibly, our clothing and bodies experience, needs to be fairly close to called a "Mikey Digital" from Blue somewhat help block and attenuate the hyper-cardioid; however, such a tightly Microphones that snaps onto the power ambient sound). At music rehearsals, I focused pattern would often require jack of the iPhone 4 or 4S. 4 sit as close as possible to the musicians more user adjustability than is practical and angle the mic so as to enable me to with an ear-mounted mic. Each component in this system is hear a complete blend of the instruments important for high performance and was with as little room reverberation as The problem I'm describing is, of course, picked to help maximize the SNR in a possible. At live concert, plays, and a classic illustration of the inverse square difficult hearing situation. The in-ear movies, I also try to sit close (the first law – the intensity of an audio signal is earphones, because they fit snugly in the row, if practical) and point the in inverse proportion to the square of its ear canal, prevent live sound from microphone directly at the stage or at the distance. Therefore, from an acoustical directly reaching my ears. Therefore, speaker under the screen. point of view, the simplest way to when using the rig, I hear the world improve the SNR is simply to place a almost exclusively through the iPhone. 5 In these and many other situations microphone closer to a desired sound The attached digital stereo cardioid where hearing aids would be inadequate, source (see also Killion in Palmer and microphone (which bypasses the analog proper use of my iPhone rig enables me Seewald, 2006). From an operational mic circuitry on the iPhone and to hear with useful clarity and precision. standpoint, it is also essential that the connects directly to the A/D) provides That said, it is by no means perfect.
3 Similar set ups are likely possible with other kinds of 4 I have not yet tested the iPhone 5 to see if an external mic 5 It is essential to use high quality in-ear or noise-canceling smartphones, but I have not personally tested them. will work in this fashion; the iPhone 5 has a different power headphones with an assistive listening device of this sort; the jack than the 4S, but it is likely that, with an adapter cable, the Apple earbuds do not provide acceptable sound or isolation. Mikey Digital or similar microphones can be used.
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 47 |
In order to use the rig properly, it is usually ship with low-quality earphones aids (and no other manufacturer's). The necessary to remove my hearing aid and and inferior microphones. The models I mics I've tried sound heavily processed wear an in-ear style earphone. While I tried also have a very harsh, unpleasant, and are fatiguing to listen to for have tried to use my iPhone rig with a and fatiguing sound. Unlike the iPhone extended periods. In addition, I have neck loop and my aid's t-coil, I have apps I use, these devices typically have found them unreliable, often losing their found that the sound quality of the neck no user-adjustable parameters besides connection with the streamer device. loops I have tried is very poor (inferior volume control or, in some models, bass response, among other problems). microphone polarity. At present, therefore, while it is not for Worse, neck loops are susceptible to everyone (especially if there is some severe hum if there is poor electrical Another feature missing from these discomfort using technology), I have wiring present, which is often the case portable sound amplifiers is limiting. found a properly configured iPhone to in New York City. The failure to include an effective “brick be the single most useful device for wall” limiter can expose the user to hearing assistance in situations where Another problem with the iPhone rig is painfully loud audio signal levels if the my hearing aids are inadequate. I use it that the user needs some time to adapt overall db SPL rapidly changes, as it nearly every day. When I do use this rig to both the occlusion effect and the often does in a restaurant or party when – or some other visible assistive device audible but slight latency (delay) people burst into laughter or applaud. besides my hearing aids – my friends between the actual live sound and the Again, some apps on the iPhone enable and colleagues often report that because sound as heard via the microphone. the user to switch on a limiter; Fire 2, for I am hearing and participating so well, Neither occlusion nor latency have example, enables the user to easily they forget I have a serious hearing troubled me much, but they are choose from two different kinds of impairment. In other words, by using noticeable. limiting and two kinds of output effective hearing assistance, clearly compression. visible though it may be, my hearing loss Finally, in especially difficult situations – disappears. for example, while dining with another While the FM wireless systems I've tried couple in a popular New York can sound quite good, and while the Of course, the same level of dramatic restaurant, where the noise level can be technology could be quite useful to me improvement in speech comprehension considerable – even a powerful cardioid at lectures and classes, they are may not be possible for every loss. microphone picks up too much ambient expensive. In addition, FM systems However, by making my primary goal noise for comfortable, adequate, cannot be used directly with hearing the maximization of SNR, not my comprehension. 6 aids, except for one product which costs personal appearance, I have certainly as least as much as a pair of hearing aids. improved my own ability to understand Despite these issues, however, in very In addition, I often find the control in otherwise intractable ambiences. And noisy situations – and again, for people panels extremely confusing, bristling no one cares that I'm wearing earphones, with hearing loss, a lot more situations with features that may be useful in a because I'm able to hear, follow, and stay qualify as “very noisy” than they do for classroom situation, but are not that connected to the conversation. people with normal hearing (Killion, important for use at restaurants, parties, 1997) – I have found that my iPhone rig business conferences, and other social going direCt usually enables me to hear comfortably gatherings. Whenever possible, I try simply to avoid enough to participate in the convers- live sound – i.e., sound heard live in an ation, whereas a hearing aid simply There are other issues with FM devices. acoustical space or over loudspeakers – cannot provide speech comprehension For example, at least one device has a in favour of sound provided directly for me under such difficult circum- range of 100 feet, which is very useful in from the amplified sound source to my stances. a large lecture hall, but can create hearing aids or other assistive devices. problems if a friend wears the Going direct often has the potential to There are alternative devices, such as transmitter at a restaurant. It would be truly maximize SNR. those commonly recommended for very easy for her to forget to remove the hearing assistance. However, I have device if she got up from the table, Before my hearing loss, for example, I found them to be of very poor quality, potentially creating very serious or used to compose at my computer, which very expensive, hard to use, and/or embarrassing privacy concerns. was hooked up to a high-end speaker unreliable for this kind of live hearing system. Although my studio is fairly assistance. Some hearing aid manufacturers make quiet – by New York standards – today, proprietary microphones that inter- with my reduced ability to resolve signal The relatively inexpensive hand-held connect either directly, or more typically, from noise, the very soft ambient sound “pocketalker”styles of sound amplifiers via a streamer device to their hearing in my studio is very disturbing, and the
6 The Etymotic Companion Mic, a wireless 4-mic-1-listener personal assistive 48 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION listening system, is the best and most affordable device I am aware of that can help dramatically in such a situation. Unfortunately, it has been discontinued and a newer model is not yet available as of this writing. | audio from these great speakers sounds system is often so loud that I have to from a guitar recording, remove loud smeared, muddy, and indistinct. I need turn my aid down, a very happy coughs from a live lecture recording, or to eliminate the sound of my studio and situation for someone with a serious clean up a 78 so well that only experts simply hear what I am composing, with hearing loss! could tell the recording was made in absolutely no live room ambience. 1940 – all without audible artifacts. Yet Induction loops are a critically important as powerful and flexible as this software Accordingly, I purchased a top-of-the- technology for people with hearing loss, undeniably is, there is one kind of line custom-fitted single in-ear monitor not only in the home but in many public processing that is nearly impossible to which featured four proprietary speakers places, from audiologist's offices to do reliably and well. and – because I now have unilateral concert halls. Loop advocates such as hearing – sums a stereo signal to mono. David Myers, Juliette Sterkens, Linda If there is too much of the wrong kind I simply plug the in-ear monitor directly Remensnyder, Janice Schacter, and of noise – speech babble, in particular – into a high end audio interface myself are seeking to install more loops a spectral processor, let alone multi-band connected to my computer. It sounds in the US, as very few public spaces in compressors, limiters, noise gates, and absolutely fantastic and the custom fit the US use this important assistive eq, often cannot effectively extract a makes it comfortable to wear for hours technology. This is unfortunate, because speech signal from the background. on end. I'm able to hear with precision the present infrared (IR) or FM public Even in less extreme circumstances, the and I can compose literally without assistive listening systems are not often DSP available in professional audio can compromise. For example, one recent properly maintained. Worse, the venues only provide some, not much, work has already been performed typically provide uncomfortable, poor- improvement. several times at New York's Metropolitan sounding headpieces that are so Museum of Art. aesthetically undignified that even I am The same holds true for the DSP in embarrassed to wear them! Further- hearing devices, which uses many of the For telephone calls, I use a neck-worn more, these headpieces leak sound; same processes – multi-band proprietary streamer manufactured by whenever I use them, the people near compression, limiting, different kinds of my hearing aid company. It can receive me inevitably complain. A loop system eq. While this DSP is just as powerful as Bluetooth and transmits via near-field used with a t-coil-equipped hearing aid it is in pro audio, it, too, has the same technology into my aid. That way, I has none of these problems, and a loop set of limits. Given a poor enough signal never hear a phone call through the air. receiver can accommodate people to noise ratio, especially where the The streamer can be unreliable, refusing without hearing aids just as well as IR or “noise” comprises significant amounts of to pair with my phone, and I have never FM systems can. speech babble, even the most precise successfully paired it to my computers. and sophisticated DSP algorithms will The sound quality of the streamer-plus- Because public assistance can be so meet their match. Unfortunately, in a lot hearing aid is more than adequate for inadequate, I often break my rule about of real world environments, people with phone calls, but I don't find it acceptable using direct audio wherever possible hearing loss regularly encounter exactly for serious music listening because it is when I go to a live concert, a movie, or that kind of poor SNR. grainy and harsh, with virtually no bass a play. Instead, I sit as close as I can and response. For music listening, I take my use my iPhone rig, pointing the DSP, at best, can provide an incremental hearing aid out and use my custom in- microphone directly at the stage or the improvement in SNR when compared to ear monitor or a high quality in-ear speakers. It's not perfect, but I often get the dramatic improvement obtained by earphones. The improvement in sound better sound from my rig than I do from close-mic techniques. This can easily be quality over the streamer is dramatic. the public IR assistive listening system. verified by anyone with normal hearing simply by listening to a conversation For listening to a TV – which is nearly ConCLusion: dsP is no recorded outdoors in a typically noisy impossible for me now via live room suBstitute for high snr urban background by a microphone at speakers, I use an induction loop system I've spent most of my life working with the ear versus the same event recorded attached to the audio output of the TV professional audio equipment, and I've by a microphone a few inches from the and switch my hearing aid to t-coil. I played with some great toys – as sound source. If you manipulate the used to use proprietary wireless expensive sound gear is affectionally “ear-microphone” recording using DSP, technology manufactured by my hearing known by everyone in pro audio. DSP you may get some improvement in aid company, but I found it unreliable has truly awesome power. I have on my speech to noise comprehension, but (again, pairing issues) and unpleasant home computer professional spectral what is achieved pales in comparison to sounding. Induction loop technology, audio processing software that is so the recording made by simply placing a when set up properly, delivers very clear, powerful it can, with the click of a microphone closer. Furthermore, the crisp sound. In fact, my home TV loop button, eliminate annoying fret squeaks close-miked, high-SNR signal is much
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 49 | easier to process to improve SNR. Nevertheless, people can learn, and Killion MC. The SIN report: Circuits Since often, DSP without good SNR resistances can change. What cannot Haven't Solved the Hearing-In-Noise provides only incremental assistance, change are the chaotic acoustics of our Problem. The Hearing Journal, October that leaves only two truly effective very noisy world. By altering the way 1997, p. 29. approaches for those millions, like those of us with hearing problems myself, who experience serious difficulty approach our hearing assistance, by Killion MC. Research and Clinical in extracting speech from noise. We can using high quality equipment and using Implications for High Fidelity Hearing try to close-mic the desired sound it properly, it is possible for many of us Aids, in Hearing Care for Adults. C. sources or, whenever possible, we can to dramatically improve our ability to Palmer and RC Seewald, eds. Stafa, find ways to provide the hearing devices hear in many circumstances. Millions of Switzerland: Phonak AG, 2006, p. 184. we're wearing with direct audio input. people can benefit from a higher quality of life if a more effective approach to NBC News, Could A Smartphone be the I understand that most people with hearing assistance can be found. We Future of Medicine? (Video report hearing loss do not, at present, need easier and more affordable devices accessed at http://www.nbcnews.com/ understand how to use the equipment to use, and we need help in learning ]video/rock-center/50582822# available to improve the signal to noise how to use them, but the potential of 50582822), January 24, 2013. ratio for themselves. I am also very present day audio and hearing sensitive to the undeniable fact that technology to improve SNR and thereby Studio Six Digital, Microphones and iOS many people with hearing loss would improve our hearing, is considerable. Devices (Web page accessed at much prefer to hide their hearing http://www.studiosixdigital.com/iphone problems if coping with them means referenCes _hardware/iphone_3gs_microphone.ht they would have to use technology that Einhorn R. No Compromise, Hearing ml), March 5, 2013. would be visible to others. Loss Magazine, May/June 2012, p. 13. Canadian Hearing Report 2013;8(2):45-50.
Alberto Behar is the Recipient of the 2012 Award of Merit from the Canadian Standards Association (CSA) Alberto Behar, BA Sc, P.Eng
lberto Behar is the recipient of the have spent many an hour with Alberto Department of Biomaterials and A2012 Award of Merit from the over pie and coffee (much to the Biomedical Engineering at the University Canadian Standards Association (CSA). detriment of my waist line) trying to of Toronto for many years and is now The CSA is a not-for-profit membership- grasp the subtle differences between working with Professor Frank Russo at based association serving business, sound pressure and sound intensity and the Ryerson University in Toronto. industry, government, and consumers in when one should be used over the other. Among his other “retirement years” Canada and the global marketplace. volunteer activities, Alberto is active in Alberto has been involved in several the National Hearing Conservation This award, now in its 15th year, has influential publications over the years Association (NHCA) in the United States, been given out since 1997 to individuals including Noise Control- a primer (2000, the Occupational Hearing Association who have served on a CSA Group Singular Publishing Group, with myself and the Canadian Acoustical Association, Committee in the realm of standard- and Dr. Margaret Cheesman as authors). and is a columnist “Noise About Noise” ization, demonstrated leadership, and for the Canadian Hearing Report – the have published and presented on related Alberto was a Fulbright Scholar who official publication of the Canadian topics. came to Canada during the military Academy of Audiology. dictatorship era in Argentina, and loved Alberto is a well-respected engineer, it so much, that he decided to stay. I can think of no better person to receive hearing conservationist, and noise Canada and Ontario Hydro (where he the Award of Merit from the Canadian control specialist who has spear-headed, worked in the field of noise control), are Standards Association. Congratulations and chaired, many noise-related beneficiaries of his engineering talents. Alberto! standards committees over the years. He has always been willing to answer During his “retirement”, Alberto has Submitted by Marshall Chasin, AuD questions and to clarify misconceptions worked with Professor Hans Kunov in that are in the field, especially my own. I the acoustics laboratory of the
50 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION Phonak Starkey