Ear Damage (Tinnitus, etc.): Ear damage generally occurs as a function of age; hearing loss can start as early as age 40 and by age 70, most people have lost some hearing. Hearing loss can occur from over-exposure to loud sounds and can also be caused by infections and other pathological causes. The person may lose hearing in the low frequency or high frequency range. This is often accompanied by tinnitus (ringing sound in the ear). Those who lose hearing in the low frequency range tend to hear a low, roaring or throbbing tinnitus, and those who lose hearing in the high frequency range tend to hear a high pitched whine. Tinnitus may be caused by uncontrollable firing of the hearing nerves in the damaged section of the ear; however, there are many other causes. See the Reference section for information on the internet on hearing damage.
Although severe hearing loss is easily diagnosed by an audiologist, its cause and damage prevention are not well understood. A damaged ear is more easily damaged than a healthy ear. For example, those with mild hearing loss have difficulty hearing conversations, but are extremely sensitive to loud sounds – even moderately loud sounds that do not bother normal people can be painfully loud because even moderately loud sounds can cause further damage and damage generally causes pain. Ironically, those with hearing loss can be more sensitive to loud sounds; that is why hearing aid technology is so difficult – you can’t simply amplify all sounds. Soft sounds must be amplified but loud sounds must be attenuated. There is no method for diagnosing tinnitus except from the comments of the patient. For tests and treatments you need to see an ENT specialist (Ear Nose Throat). For non-pathological cases, damage is generally caused by exposure to loud sounds. Yet a few people exposed to very loud sounds, such as pianists who play every day for hours on concert grands, piano tuners who routinely use “pounding” during tuning, or members of rock bands, may not suffer hearing loss. On the other hand, some, who are exposed to less sound, can lose their hearing, especially with age. Therefore, there is a wide difference in susceptibility to hearing loss. However, there certainly is a tendency for those exposed to louder sounds to suffer more hearing loss. It is likely that hearing loss by pianists and piano tuners (as well as rock band members, etc., and people who routinely listen to very loud music) is much more widespread than is generally known because most of them go unreported.
Tinnitus is present in essentially 100% of people 100% of the time, but is so soft in normal people that it cannot be heard unless the person is in a soundproofed room. It may be caused by spontaneous firing of the hearing nerves in the absence of sufficient stimulus. That is, the human hearing mechanism effectively “turns up the amplification” when there is no sound. Totally damaged regions produce no sound because the damage is so severe that they cannot function. Partially damaged regions apparently produce tinnitus because they are sufficiently damaged to detect almost no ambient sound; this silence causes the brain to fire the detectors, or the system develops a leak in the sound signal circuit. These detectors are either piezo-electric material at the base of hairs inside the cochlea, or ion channels opened and closed by molecules associated with the hairs – there is conflicting literature on this topic. Of course, there are many other causes of tinnitus, and some may even originate in the brain. Tinnitus is almost always an indication of the onset of hearing loss.
For those who do not have audible tinnitus, there is probably no need to avoid loud music, within reasonable limits. Thus practicing the piano at any loudness should be harmless up to about age 25. Those who already have tinnitus should avoid exposure to loud piano. However, tinnitus usually “sneaks up” on you, so that the onset of tinnitus often goes unnoticed until it is too late. Therefore, everybody should receive tinnitus education and wear ear protection after age 40 during piano practice. Ear protection is an abhorrent idea to most pianists but when you consider the consequences (see below), it is definitely worthwhile. Before wearing protection, do everything possible to reduce sound intensity, such as soundproofing the room (adding carpets to hard floors, etc.), voicing the hammers, and generally practicing softly (even loud passages – which is a good idea even without possibility of ear damage).
Ear protectors are readily available from hardware stores because many workers using construction or yard equipment need such protection. For pianists, an inexpensive unit will suffice because you need to hear some music. You can also use most of the larger headphones associated with audio systems. Commercial protectors completely surround the ear and provide a better sound barrier. Since protectors available today are not designed for pianists, they don’t have a flat frequency response; that is, the sound of the piano is altered. However, the human ear is very good at adapting to different types of sound and you can get used to the new sound very quickly. The piano sound will also be quite different when you take the protection off (as you will need to do once in a while to see what the REAL sound is like). These different sounds can be quite educational for teaching us how much the brain influences what sounds you hear or don’t hear and how different persons will interpret the same sounds. It is worthwhile to try ear protection just to experience these different sounds. For example, you will realize that the piano makes many strange sounds you never noticed before! The differences in sound are so startling and complex that they cannot be expressed in words. For lower quality pianos, ear protection will result in sound simulating a higher quality instrument because the undesirable high harmonics and extraneous sounds are filtered out.
The brain automatically processes any incoming data, whether you want it to or not. This is, of course, part of what music is – it is the brain’s interpretation of incoming sounds, and most of our reaction to music is automatic. Thus when you wear ear protection, much of this stimulus disappears, and a large amount of the brain’s processing power is freed to do other jobs. In particular, you now have more resources to apply to your HS practice. After all, that is why you practice HS, and not HT – so that you can concentrate more on the difficult task of acquiring technique. Thus you may find that progress is faster HS when wearing ear protection! This is the same principle behind why many pianists close their eyes when they want to play something with high emotional content – they need all the resources available to produce the high level of emotion. With eyes closed, you eliminate a tremendous amount of information coming into the brain because vision is a two-dimensional, multi- color, moving source of high bandwidth information that must be immediately and automatically interpreted in many complex ways. Therefore, although most audiences admire that a pianist can play with the eyes closed, it is actually easier. Thus, in the near future, most piano students will probably wear ear protection, just as many athletes and construction workers use helmets today. It doesn’t make any sense for us to spend the last 10, 30, or more years of our lives without hearing – a most important lesson Beethoven taught us.
How does piano sound damage the ear? Clearly, loud sound containing many notes should be most damaging. Thus it is probably not an accident that Beethoven became prematurely deaf. This also cautions us to practice his music with ear damage in mind. The specific type of piano is also important. Most uprights that do not produce sufficient sound are probably least damaging. Large grands that transfer energy efficiently into the strings with long sustain probably do not cause as much damage as medium quality pianos in which a large amount of energy is imparted into the initial, instantaneous bang associated with the hammer striking the strings. Although much of this damaging sound energy may not be in the audible range of the ear, we can detect it as an unpleasant or harsh sound. Thus the medium size grands (about 6 ft) may be most damaging. In this regard, the condition of the hammer is important, since a worn hammer can produce a much louder initial bang than a properly voiced hammer. This is why worn hammers cause more string breakage than new or well voiced hammers. With old, hardened hammers, probably most pianos can cause ear damage. Thus proper voicing of the hammer may be much more important than many people realize, for pianissimo, playing musically, technical development, and protecting the ear. If you have to close the lid of a grand in order to play softly, or to reduce the sound to a pleasant level, the hammers probably need voicing.
Some of the loudest sounds are produced by those ear phones used to listen to music. Parents should warn their youngsters not to keep turning up the volume, especially if they subscribe to the culture that plays loud music. Some youngsters will fall asleep with their ear phones blasting; this can be very damaging because the damage is cumulative. It is a bad idea to give gadgets with ear phones to youngsters – postpone it as long as possible. However, sooner or later, they will end up with one; in that case, warn them before they suffer ear damage.
Except for some special cases of tinnitus (especially those cases in which you can alter the sound by moving your jaws, etc.), there is no cure yet. Large doses of aspirin can cause tinnitus; in that case, stopping its use can sometimes reverse the process. Small amounts of aspirin taken for cardiac purposes (81mg) apparently do not cause tinnitus, and there are some claims in the literature that these small amounts may delay the onset of tinnitus. Loud tinnitus can be extremely debilitating because it cannot be changed and is present all the time, and it only increases with time. Many sufferers have been driven to thoughts of suicide. Although there is no cure, there are remedies, and all indications are that eventually, we should be able to find a cure. There are hearing aids that reduce our perception of tinnitus, for example, by supplying sufficient sound so that the tinnitus is masked or the person is distracted from the tinnitus. Thus for tinnitus suffers, absolute quietness can cause the tinnitus to become annoying.
One of the most annoying traits of hearing loss is not that the ear has lost its sensitivity (frequently, sensitivity tests reveal very little deterioration), but the inability of the person to properly process the sound so as to understand speech. People with normal hearing can understand speech mixed with a large amount of extraneous sound. Understanding speech is usually the first ability that is lost with onset of hearing loss. Modern hearing aids can be quite helpful, both by amplifying only those frequencies needed to understand speech and for suppressing sounds that are loud enough to cause damage. In other words, if your hearing aid just amplifies all sounds, it may cause even more damage. Another approach to tinnitus is to train the brain to ignore the tinnitus. The brain is amazingly trainable, and part of the reason why tinnitus causes suffering is the inappropriate brain response of the person. The brain has the ability to either concentrate on the sound, thereby driving you crazy, or to ignore it, in which case you won’t hear it unless you are reminded of it. The best example of this effect is the metronome. Most pianists do not know that if they practice with the metronome too long, the brain will play tricks so that you either do not hear the click at all, or hear it at the wrong time, especially if the metronome click is sharp and loud. This is one reason why modern metronomes have flashing lights. In addition to enabling you to time yourself without the sound, it allows you to check to see if what you hear matches the light flashes. Thus modern treatments of tinnitus start with teaching the patient that others have succeeded in living with it with minimal discomfort. Then the patient receives ear training in such a way as to be able to ignore the tinnitus. Fortunately, the brain is quite adept at learning to ignore a constant sound that is always there.
If you read enough stories about tinnitus suffers, you will probably follow the advice to wear ear protection after age 40, at least when practicing loud passages for long periods of time. At the first hint of tinnitus, it is imperative that you start ear protection procedures because once the tinnitus starts, ear deterioration can proceed rapidly with exposure to loud sounds, with significant deterioration every year. Use of a digital piano and turning the volume down is one solution. Look for an ENT specialist immediately, especially one experienced in tinnitus treatments. Ear protection applies to other members of the household; therefore, if at all possible, isolate the piano room acoustically from the rest of the house. Most quality (glass) doors will be sufficient. There are a few herbs and “natural” medications that claim effectiveness against tinnitus. Most of these do not work, and the ones that seem to benefit some people have dangerous side effects. Although it is true that there are precious few specialists treating tinnitus, the situation is improving and there are many sites on the internet with information on tinnitus, such as The American Tinnitus Association.
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