Researchers, at the University of Manchester’s Centre for Audiology and Deafness, have recently studied the impact of hearing loss and tinnitus among professionals in the construction (machinery, construction plant, or building work), agricultural (farming or agriculture) and music (musician, director, or conductor) sectors.
These were deemed to be high-risk industries, i.e. industries associated with high levels and long durations of occupational noise exposure, with the available clinical literature suggesting that the typical daily noise dose for classical musicians ranges between 75 dB(A) and 98 dB(A).[i]
Earlier this month, retrospective cross-sectional study findings were presented in the Trends in Hearing journal.[ii]
A sub-sample (22,936 individuals) of the UK Biobank resource (containing over 500,000 participants in total, aged between 40 and 69-years[iii]) was tested for hearing loss [using a digits-in-noise (DIN) speech recognition test], with Smits et al (2004)[iv] having previously remarked that DIN testing correlates strongly with pure-tone audiometry.
In addition, tinnitus testing was based on self-reporting, as it is a subjective condition. Participants responded to the question: ‘Do you get or have you had noises (such as ringing or buzzing) in your head or in one or both ears that lasts more than 5 minutes at a time?’, with presence of tinnitus requiring the existence of symptoms both ‘now’ (i.e. not only in the past) and ‘some of the time’.
Combined with pre-existing epidemiological Biobank data, the researchers were able to analyse the extent to which the increased burden of hearing loss and tinnitus in high risk industries (compared to low risk industries, e.g. the finance sector) were not simply attributable to excessive occupational noise exposure (in a ‘noisy place’ where you ‘had to shout to be heard’), but exacerbated by:
- Demographics (age, sex, socioeconomic status and ethnicity);
- Health and lifestyle (body mass index and physical activity);
- Smoking and alcohol consumption;
- Diabetes, cardiovascular disease, high cholesterol, hypertension, and ototoxic medication; and
- Other noise exposure (to recreational music).
The ‘most striking’ discovery to emerge from this investigation was that music industry workers were almost twice as likely [odds ratio (OR) of 1.99] to report symptoms of tinnitus compared with workers in the finance industry.[v]
Further, that occupational and recreational noise exposure increased the probability of tinnitus reports in the music industry, having already accounted for other factors that had little effect on incidence. Essentially, noise exposure was the most significant risk factor for tinnitus among these workers.
That being said, the researchers observed that workers in the music industry were no more likely to have difficulties discerning speech in the presence of background noise than those in finance.
While lead author, Dr. Samuel Couth, acknowledged that music industry professionals are ‘not immune’ to noise-induced hearing loss (NIHL),[vi] the outcomes of DIN testing demonstrated that years of musical listening and training had likely caused them to ‘enhance’ their ‘auditory perception’ and ‘cognitive skills [working memory, attention, etc.]’, which, in turn, allowed them to ‘counteract’ the presumption that NIHL would cause them to perform poorly in speech-in-noise assessment. At least, this was the inference made by Coffey et al (2017).[vii]
Ongoing research, carried out by the same team of researchers, is seeking to ascertain whether musicians’ ‘superior’ ability to understand speech in background noise is, in fact, hampered by NIHL, in such wise that they would complete DIN examinations with the same degree of success as finance workers. This was initially theorised by Skoe et al (2019).[viii]
It was also hypothesised that ‘less harmful’ occupational noise stimuli for those working in the music industry,[ix] compared with ‘more damaging impulse sounds’ in the construction and agriculture industries,[x] could have been the reason why fewer musicians were gauged to have ‘hearing difficulties’?
Having established that noise-induced tinnitus in the music industry may pose an occupational health risk, the research team has already planned a subsequent investigation, which should help them to understand ‘why so few musicians use hearing protection’. They cite Laitinen (2005), who documented that only 6% of classical musicians, in ‘five major [Helsinki, Finland] orchestras’, ‘always’ wore hearing protection.[xi]
[Source: Geograph – Thomas Nugent (22 November, 2016): ‘Royal Philharmonic Concert Orchestra at the SSE Hydro’]
How might these observations be relevant to occupational disease litigation?
In edition 297 of BC Disease News (here), we reported that the 15th edition of the Judicial College Guidelines for the Assessment of General Damages in Personal Injury Cases (JC Guidelines) had inserted a new bracket into Chapter 5, in respect of ‘mild tinnitus alone or mild NIHL alone’.
Could this mean that musicians, who are not diagnosed with hearing loss, but nevertheless complain of tinnitus, are prompted to bring civil claims against their (former) employers for tortiously exposing them to excessive noise?
The prospect of musicians advancing NIHL and/or tinnitus claims is, naturally, compounded by the Court of Appeal ruling in Goldscheider v The Royal Opera House Covent Garden Foundation  EWCA Civ 711, on noise-induced ‘acoustic shock’, which we analysed in edition 271 (here).
Although Sir Brian Leveson (the 3rd judge sitting) explained that the finding of liability in Goldscheider would not have a ‘cataclysmic’ effect on ‘all music making in the UK’, the Court perilously ruled that:
‘... the risk of injury through noise is not removed if the noise – in the form of music – is the deliberate and desired objective rather than an unwanted by-product (as would be the case in relation to the use of pneumatic machinery)’.
In what way might the validity of the University of Manchester study be impaired?
Of course, the discussion above presumes that these findings are legitimate, but the study authors admit several limitations of their methods that may have impeded reliability:
- The Biobank subsample may not have been representative of the general population.
- The inaccurate ‘shout to be heard’ criterion (corresponding to a noise level of ³99 dB) for occupational noise may have meant that only workers with the highest levels exposure were identified.
- Music noise exposure alone may not be the best indicator of recreational noise exposure levels generally, but may have been the most appropriate indicator for musicians – Tufts and Skoe (2018) found that musicians had higher levels of both occupational and recreational music noise exposure than non-musicians, and that recreational music noise exposure contributed more to some musicians’ total noise exposure than occupational musical activities.[xii]
- The collation of data was restricted to individuals who were currently employed or self-employed (i.e. no one with unemployed or retired status was included) and no record of past job history was kept – could this have skewed the results?
- Some (potentially) influential factors were not been taken into account, e.g. exposure to chemical contaminants.[xiii]
[i] McBride D et al., Noise and the classical musician. BMJ. 1992 Dec 19; 305(6868): 1561–1563. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884712/pdf/bmj00105-0055.pdf> accessed 29 January 2020.
Pawlaczyk-Łuszczynska M et al., Evaluation of sound exposure and risk of hearing impairment in orchestral musicians. Int J Occup Saf Ergon. 2011;17(3):255-69. <https://www.tandfonline.com/doi/pdf/10.1080/10803548.2011.11076892?needAccess=true> accessed 29 January 2020.
Royster JD et al., Sound exposures and hearing thresholds of symphony orchestra musicians. J Acoust Soc Am. 1991 Jun;89(6):2793-803. <http://asa.scitation.org/doi/pdf/10.1121/1.400719?class=pdf> accessed 29 January 2020.
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[ii] Couth S. et al., Hearing Difficulties and Tinnitus in Construction, Agricultural, Music, and Finance Industries: Contributions of Demographic, Health, and Lifestyle Factors. Trends Hear. 2019 Jan-Dec;23:2331216519885571 <https://journals.sagepub.com/doi/pdf/10.1177/2331216519885571> accessed 7 January 2020.
[iv] Smits C et al., Development and validation of an automatic speech-in-noise screening test by telephone. International Journal of Audiology. 2004 Jan;43(1):15-28. <https://www.tandfonline.com/doi/abs/10.1080/14992020400050004> accessed 28 January 2020.
[v] Samuel Couth, Tinnitus: scale of hearing damage for music industry workers revealed (21 November 2019 Manchester University) <https://www.manchester.ac.uk/discover/news/tinnitus-scale-of-hearing-damage-for-music-industry-workers-revealed/> accessed 7 January 2020.
[vi] Jansen EJ et al., Noise induced hearing loss and other hearing complaints among musicians of symphony orchestras. Int Arch Occup Environ Health. 2009 Jan;82(2):153-64. <https://www.researchgate.net/profile/Wouter_Dreschler/publication/5448992_Noise_induced_hearing_loss_and_other_hearing_compaints_among_musicians_of_symphony_orchestras/links/0c96052315b5bae5cf000000/Noise-induced-hearing-loss-and-other-hearing-compaints-among-musicians-of-symphony-orchestras.pdf> accessed 31 January 2020.
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[viii] Skoe E et al., Noise Exposure May Diminish the Musician Advantage for Perceiving Speech in Noise. Ear Hear. 2019 Jul/Aug;40(4):782-793. <https://insights.ovid.com/crossref?an=00003446-201907000-00003> accessed 29 January 2020.
[ix] Grinn SK et al., Hidden hearing loss? No effect of common recreational noise exposure on cochlear nerve response amplitude in humans. Frontiers in Neuroscience. 2017 Sep 1;11:465. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585187/pdf/fnins-11-00465.pdf> accessed 31 January 2020.
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Valderrama JT et al., Effects of lifetime noise exposure on the middle-age human auditory brainstem response, tinnitus and speech-in-noise intelligibility. Hearing Research, 2018 Aug;365:36-48. <https://www.sciencedirect.com/science/article/pii/S0378595517306287?via%3Dihub> accessed 31 January 2020.
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[x] Bramhall NF et al., Auditory brainstem response altered in humans with noise exposure despite normal outer hair cell function. Ear and Hearing. 2017 Jan/Feb;38(1):e1-e12. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313078/pdf/nihms846624.pdf> accessed 31 January 2020.
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[xi] Factors affecting the use of hearing protectors among classical music players. Noise Health. 2005 Jan-Mar;7(26):21-9. <http://www.noiseandhealth.org/article.asp?issn=1463-1741;year=2005;volume=7;issue=26;spage=21;epage=29;aulast=Laitinen> accessed 28 January 2020.
[xii] Tufts JB and Skoe E, Examining the noisy life of the college musician: Weeklong noise dosimetry of music and non-music activities. International Journal of Audiology. 2018 Feb;57(sup1):S20-S27. <https://www.tandfonline.com/doi/full/10.1080/14992027.2017.1405289?scroll=top&needAccess=true> accessed 31 January 2020.
[xiii] Rybak LP., Hearing: The effects of chemicals. Otolaryngol Head Neck Surg. 1992 Jun;106(6):677-86. <https://journals.sagepub.com/doi/10.1177/019459989210600611> accessed 29 January 2020.