Keywords

Tinnitus; Music teachers, Hearing.

Introduction

Music can be defined as the art of combining sounds or musical notes with harmonious patterns that are pleasant and satisfy emotions. Music is also a melody [1] In the last decade, there has been a marked increase in the number of people listening to music and the time spent listening to music. One of the most important reasons for this increase is the easy access to the instruments required for listening to music (advances in technology for personal music players and smartphones) [2]. In addition, listening to loud music can cause various hearing disorders, especially in adolescents and young adults [3,4]. Even listening to light music for 8-10 hours a day can cause hearing impairment.2 The World Health Organization (WHO) estimates that 1.1 billion young people and young adults are at risk of hearing loss due to exposure to entertainment noises such as music [5]. Listening to music is seen as a positive aspect of life in most cultures. However, exposure to loud noise causes hearing loss and is responsible for 16% of hearing loss worldwide [6]. Exposure to chronic noise, oxidative stress, metabolic exhaustion and ischemia also causes the internal and external hairy cells in the cochlea to gradually disappear [7,8] Those who are interested in professional music (music teachers) are at risk for hearing loss, tinnitus, hyperacusis and diplacusis. Tinnitus is defined as perception of sound without any external stimuli and affects 10-25% of the adult population [9,10]. Tinnitus negatively affects individuals’ daily activities and quality of life. Hearing loss and exposure to loud sounds are among the risk factors of tinnitus. In individuals with hearing loss due to noise, tinnitus ranges between 35-77% [11,12]. Hyperacusis is often a condition associated with tinnitus (Heller, 2003) [13]. It is defined as a reduced tolerance accompanied by painful sensitivity in perceptual, psychological and social dimensions, with sounds of average intensity, sometimes ordinary environmental sounds. Those dealing with professional music can be constantly exposed to loud sounds. This situation brings problems with the hearing system. The aim of this research is to evaluate the hearing thresholds of music teachers and to determine whether they cause tinnitus or hyperacusis.

Materials and Methods

Participants: This study was conducted in the Audiology and Speech Disorders clinic of Turgut Ozal University Medical Faculty Hospital. Approval was obtained from the Non-Invasive Clinical Research Ethics Committee of Turgut Ozal University. A total of 35 people (17 music teachers, 18 control groups) participated in the study. In this study, 17 music teachers (11 females, 6 males) aged 24-39, and 18 volunteers (12 females, 6 males) participated in the control group. The ages of the individuals participating in this study range between 22 and 38. The average age of music teachers is 26.40±5.6, and the average age of control groups is 27.19±6.3. Informed consent form was taken from all participants. After the otoscopic examination of all participants, pure tone audiometry (in the range of 125-16,000 Hz), immitansmetric examination and Distortion Product Otoacoustic Emission (DPOAE) tests were performed. Tinnitus Handicap Inventory (THI) was used in the evaluation of tinnitus. Those with normal otoscopic examination for music teachers and control group were included in the study. Those who had any history of ear, acoustic trauma, ototoxic drug use, and neurological and psychiatric illness were excluded from the study.

Turkey’s teachers are entering a total of 30 hours of classes per day 6 hours per week. Music teachers also attend classes in a similar way. The weekly hours of music teachers participating in the study vary between 25-30. Music teachers are also interested in music outside of school and this period varies between 8-10 hours weekly. In our study, these criteria were taken as basis to ensure standardization. In addition, the working time of the teachers who participated in the study as teachers varies between 10-13 years. There is also no acoustic feature (sound insulation in floors, ceilings and walls, etc.) especially in the classes where music teachers attend music lessons.

Audiological Evaluation: Hearing thresholds of all participants in the range of 0.125-16 kHz were determined. Interacoustics AC-40 clinical audiometer (Assens, Denmark) was used to detect hearing thresholds and speech tests. Audiometric Earphones TDH-39P Telephonics are used for hearing thresholds between 0.125-8 kHz, and Koss HV-IA supraaural headphones are used for hearing thresholds between 10-16 kHz. Speaking tests were done live by microphone. The Speech Reception Threshold (SRT), Words Discrimination Score (WDS), the Most Comfortable Level (MCL) and Uncomfortable Level (UCL) were determined. Whether or not middle ear functions are normal was determined by Interacoustic AZ-26 impedance meter (Assens, Denmark). Measurements were made between +200 daPa - 400 daPa pressure range, 226 Hz probe tone and 80 dBSPL. Distortion Product Otoacoustic Emission (DPOAE) measurements were made with Madsen Capella (GN Otometrics A/S 2630 Taastrup, Denmark). Measurements were made at the frequency of 2f1-f2 (f2/f1 ratio 1.22), at the level of 65 dBHL (for L1) and 55 dBHL (for L2). DPOAE measurements were made between 0.75 kHz and 8 kHz, and in industrial cabins, “Industrial Acoustics Company (IAC)”. Signal Noise Ratio (SNR) ratio was recorded for all frequencies.

Tinnitus Handicap Inventory (THI): Tinnitus Handicap Inventory is a highly reliable and consistent survey used to measure the symptoms of patients with tinnitus. It was adapted to Turkish by Aksoy et al (2007) [14]. There are 25 questions in this questionnaire and the answers are three options: “Yes”, “No” and “Sometimes”. Yes answer is 4, Sometimes answer is 2, No answer is 0 points. The lowest 0 and the highest 100 points can be obtained. The evaluation according to the score result is shown in Table 1.

  DISCUSSION

When music is the dominant sound source, the resulting auditory conditions are called Music Induced Hearing Disorders (MIHD). The marked increase in prevalence of MIHDs in music industry professionals as compared to the general population indicates that music should be considered a potentially damaging stimulus. Music differs from noise in both acoustical and psychophysical qualities. Even within music professionals’ subgroups, variability in occupational settings, work schedules, and dominate sound sources further complicates risk criteria generalizations of music industry professionals Koelsch et. al. (2005)15 investigated the functional neuroanatomy of music perception in children and adults. As a result of the research, they stated that music studies in children and adults caused strong activations in the frontal and temporal anterior regions of the brain 16 According to the studies, children educated at an early age with music become more comfortable, peaceful, mild and selfconfident. It is known that music has a positive effect on fields such as language, mathematics, working memory, focus and attention and increases success 17. There are cases where music is harmful besides this benefits (such as hearing loss). Just like noise-related hearing losses, music-induced hearing losses occur in the region of 3000-6000 Hz notch 18. Affection in music-related hearing loss is bilateral and symmetrical19 Music professionals may not be able to continue their careers due to hearing problems arising from music. In addition, hearing loss, tinnitus, hyperacusis, diplacusis and tolerance problems may occur in these people6-15. In this research, we compared the music thresholds and hearing thresholds of people who did not deal with music (control group), SRT, WDS, MCL, UCL and DPOAE test results. We could not find a statistically significant difference between the hearing thresholds, SRT, MCL WDS test results of the music teachers and the control group. However, it was thought that the hearing thresholds of music teachers increased compared to the control group, and this occurred as a result of continuous exposure to music. A statistically significant difference was found between the UCL test results between the groups 20. This is called the tolerance problem. Music teachers are uncomfortable with loud sound. These results show that cochlear sensitivity develops in music teachers. In other words, it suggests that there is an effect on the outer and inner hair cells. In DPOAE test, a statistically significant difference was found between the groups at bilateral 3000 Hz. It is noteworthy that there is a significant difference in 3000 Hz. Depending on the noise, temporary or permanent threshold changes are observed in the cochlea.20 Affecting the cochlea at the low level of noise occurs at the stimulus frequency, and at high intensity levels at the 1 octave frequency of the frequency that stimulates threshold changes21-22. Sataloff stated that, depending on the frequency spectrum, the first signs of noise-induced hearing loss started on the audiogram as “V” at a maximum of 2-6 kHz 23. This explains the difference in emission values of 3000 Hz in DPOAE test results in music teachers. In other words, the high intensity music noise at the frequency of 2000 Hz may have affected the 3000 Hz region. As can be seen, although music is a pleasant melody, it can negatively affect people’s hearing health. Plontke et. al. (2004)24 stated that the noise in musical instruments is at the level of 75-105 dB (A). They reported that sounds more severe than 75 dB (A) negatively affect the human body, especially the hearing system24. Fligor and Cox (2004)

 CONCLUSION

Music professionals are constantly exposed to music. Accordingly, sensitivity develops in the inner ears. Depending on this sensitivity, tinnitus may occur. Tinnitus negatively affects auditory perception and people who are psychologically interested in music. Music professionals are not a homogeneous group spread across the population, it is necessary to educate this group on music-related hearing disorders and to carry out public health campaigns.

References

1. Sheriff A. Music and its Effects. Scotts Valley, CA: Create Space Independent Publishing Platform. 2014.
2. Manchaiah V, Zhao F, Ratinaud P. Young Adults’ Knowledge and Attitudes Regarding “Music” and “Loud Music” Across Countries: Applications of Social Representations Theory. Front Psychol. 2019;25:139-40.
3. Zhao F, Manchaiah VK, French D, Price SM. Music exposure and hearing disorders: an overview. Int J Audiol. 2010;49:54-64.
4. Jiang W, Zhao F, Guderley N, Manchaiah V. Daily music exposure dose and hearing problems using personal listening devices in adolescents and young adults: A systematic review. Int J Audiol. 2016;55:197-205. 5. World Health Organization. Billion People are at Risk of Hearing Loss. 2015;1:6-100.
5. Di Stadio A, Dipietro L, Ricci G, Della Volpe A, Minni A, Greco A, et al. Hearing Loss, Tinnitus, Hyperacusis, and Diplacusis in Professional Musicians: A Systematic Review. Int J Environ Res Public Health. 2018;15:120-22.
6. Fetoni AR, Garzaro M, Ralli M, Landolfo V, Sensini M, Pecorari G, et al. The monitoring role of otoacoustic emissions and oxidative stress markers in the protective effects of antioxidant administration in noise-exposed subjects: a pilot study. Med Sci Monit. 2009;15:1-8.
7. Henderson D, Bielefeld EC, Harris KC, Hu BH. The role of oxidative stress in noise-induced hearing loss. Ear Hear. 2006;27:1-19.
8. Baguley D, McFerran D, Hall D. Tinnitus. Lancet. 2013;382:1600-7.
9. Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: Causes and clinical management. Lancet Neurol. 2013;12:920-30.
10. Mrena R, Savolainen S, Kuokkanen JT, Ylikoski J. Characteristics of tinnitus induced by acute acoustic trauma: A long-term follow-up. Audiol. Neurootol. 2002;7:122-130.
11. Nageris BI, Attias J, Raveh E. Test-retest tinnitus characteristics in patients with noise-induced hearing loss. Am. J. Otolaryngol. 2010;31:181-4.
12. Aazh H, McFerran D, Salvi R, Prasher D, Jastreboff M, Jastreboff P. Insights from the First International Conference on Hyperacusis: causes, evaluation, diagnosis and treatment. Noise Health. 2014;16:123-6. 14. Aksoy S, Firat Y, Alpar R. The Tinnitus Handicap Inventory: a study of validity and reliability. Int Tinnitus J. 2007;13:94-8.
13. Wartinger F, Malyuk H, Portnuff CDF. Human exposures and their associated hearing loss profiles: Music industry professionals. J Acoust Soc Am. 2019;146:390-6.
14. Koelsch S, Fritz T, Schulze K, Alsop D, Schlaug G. Adults and children processing music: an fMRI study. Neuroimage. 2005; 25:1068-76.
15. Atherton RP, Chrobak QM, Rauscher FH, Karst AT, Hanson MD, Steinert SW, Bowe KL. Shared Processing of Language and Music. Exp Psychol. 2018;65:40-8.
16. Royster JD, Royster LH, Killion MC. Sound exposures and hearing thresholds of symphony orchestra musicians. J Acoust Soc Am. 1991;89:2793-803.
17. Chasin M. Musicians and the Prevention of Hearing Loss (Singular Publishing, San Diego, CA). 1996;2:1-6.
18. Mills JH, Gilbert RM, Adkins WY. Temporary threshold shifts in humans exposed to octave bands of noise for 16 to 24 hours. J Acoust Soc Am. 1979;65:1238-48.
19. Schmiedt RA. Acoustic injury and the physiology of hearing. JAcoust Soc Am. 1984;76:1293-1317. 22. Ward WD. Adaptation and Fatique. In Jerger, J. edition. Modern Developments in Audiology. 2nd. Edition. New York: Academic Press. 1973;1:241-86.