Music Health and Safety

Protecting Your Hearing Health: An NASM-PAMA Student Information Sheet on Noise-Induced Hearing Loss (November 2011, National Association of Schools of Music and the Performing Arts Medicine Association)

Hearing health is essential to your lifelong success as a musician.

Your hearing can be permanently damaged by loud sounds, including music. Technically, this is called Noise-Induced Hearing Loss (NIHL). Such danger is constant.

Noise-induced hearing loss is generally preventable. You must avoid overexposure to loud sounds, especially for long periods of time.

The closer you are to the source of a loud sound, the greater the risk of damage to your hearing mechanisms.

Sounds over 85 dB (your typical vacuum cleaner) in intensity pose the greatest risk to your hearing.

Risk of hearing loss is based on a combination of sound or loudness intensity and duration.

Recommended maximum daily exposure times (NIOSH) to sounds at or above 85 dB are as follows:

• 85 dB (vacuum cleaner, MP3 player at 1/3 volume) – 8 hours
• 90 dB (blender, hair dryer) – 2 hours
• 94 dB (MP3 player at 1/2 volume) – 1 hour
• 100 dB (MP3 player at full volume, lawnmower) – 15 minutes
• 110 dB (rock concert, power tools) – 2 minutes
• 120 dB (jet planes at take-off) – without ear protection, sound damage is almost immediate

Certain behaviors (controlling volume levels in practice and rehearsal, avoiding noisy environments, turning down the volume) reduce your risk of hearing loss. Be mindful of those MP3 earbuds. See chart above.

The use of earplugs and earmuffs helps to protect your hearing health.

Day-to-day decisions can impact your hearing health, both now and in the future. Since sound exposure occurs in and out of school, you also need to learn more and take care of your own hearing health on a daily, even hourly basis.

It is important to follow basic hearing health guidelines.

It is also important to study this issue and learn more.

If you are concerned about your personal hearing health, talk with a medical professional.

If you are concerned about your hearing health in relationship to your program of study, consult the appropriate contact person at your institution.

This information is provided by the National Association of Schools of Music (NASM) and the Performing Arts Medicine Association (PAMA). For more information, check out the other NASM-PAMA hearing health documents, located on the NASM website.

Recommendations for Preventing Noise-Induced Hearing Loss:

• Wear hearing protection when using loud machinery, such as lawn mowers, weed eaters, chainsaws.
• Wear hearing protection during recreational noise exposure, such as riding all-terrain vehicles, or shooting firearms.
• Determine the necessity to acquire musician earplugs. Several different manufacturers and attenuation values are available.
• Do not use personal stereo devices, such as iPods, mp3 players, etc., with earphones at levels that are high enough for other people to hear the music coming out of your system.
• If you experience pain from a sound, or ringing in the ears from a sound, it is important to take a break from the noise. If you cannot leave the area in which the noise occurs, you should move as far away from the noise source as you can.
• If you experience ringing in the ears that persists into the next day after you have heard a sound, you should seek services from an audiologist in order to determine whether your hearing has changed.
• If you believe your hearing has changed suddenly, it is essential to seek the services of an Ear, Nose, and Throat doctor within 48 hours.
• Many medications increase susceptibility to noise exposure, and therefore heighten the need to use protection when anticipating the presence of high-level sounds. Contact your doctor regarding these medications.

Resources

Resources for Information on Protecting your Hearing Health

• NASM-PAMA Student Information Sheet on Noise-Induced Hearing Loss (pdf)
• Music Induced Hearing Loss and Hearing Protection, by John F. King, Au.D.
• OSHA: Noise/Hearing Conservation
• Hearing Loss Decibel Levels
• Noises and Hearing Loss

Medical Organizations Focused on Hearing Health

• American Academy of Audiology (www.audiology.org/Pages/default.aspx)
• American Academy of Otolaryngology, Head and Neck Surgery (www.entnet.org/index.cfm)
• American Speech-Language-Hearing Association (ASHA) (www.asha.org)
• Athletes and the Arts (www.athletesandthearts.com)
• House Research Institute - Hearing Health ( https://hei.org/better-hearing-and-speech-month/ )
• National Institute on Deafness and Other Communication Disorders, Noise-Induced Hearing Loss (https://www.nidcd.nih.gov/health/hearing-ear-infections-deafness)
• Dangerous Decibels (www.dangerousdecibels.org)
• National Hearing Conservation Association (www.hearingconservation.org)

Tips for keeping your voice healthy (Norman Hogikyan, University of Michigan Health System)

• Drink water to keep your body well hydrated, and avoid alcohol and caffeine. Your vocal cords vibrate very fast, and having a proper water balance helps keep them lubricated. Important note: Foods containing large amounts of water are excellent hydration-conscious snacks, including apples, pears, watermelon, peaches, melons, grapes, plums, bell peppers and applesauce.
• Allow yourself several "vocal naps" every day, especially during periods of extended use. For instance, avoid speaking during the breaks between classes and find quiet ways to spend your free time rather than constantly talking.
• Don't smoke, or if you already do, quit. Smoking raises the risk of throat cancer tremendously, and inhaling smoke (even secondhand smoke) can irritate the vocal cords.
• Don't abuse or misuse your voice. Avoid yelling or screaming, and try not to talk loudly in noisy areas. If your throat feels dry or tired, or your voice is getting hoarse, reduce your voice use. The hoarseness is a warning sign that your vocal cords are irritated.
• Keep your throat and neck muscles relaxed even when singing high notes and low notes. Some singers tilt their heads up when singing high notes and down when singing low notes. "The high notes are on the ceiling and the low notes are on the floor," "Over time, you'll pay for that"—not just with strained vocal muscles but also by causing future limits on the vocal range.
• Pay attention to how you speak every day. Even performers who have good singing habits can cause damage when they speak. Many skilled singers don't continue their healthy habits when they speak; indeed, "many people—including singers—should have much more breath flow when they speak."
• Don't clear your throat too often. When you clear your throat, it's like slamming your vocal cords together. Doing it too much can injure them and make you hoarse. Try a sip of water or swallow to quench the urge to clear. If you feel like you have to clear your throat a lot, get checked by a doctor for such things as acid reflux disease, or allergy and sinus conditions.
• When you're sick, spare your voice. Don't talk when you're hoarse due to a cold or infection. Listen to what your voice is telling you.
• When you have to speak publicly, to large groups or outdoors, think about using amplification to avoid straining your voice.
• Humidify your home and work areas. Remember, moist is good for the voice.

Other suggestions for vocal health:

• Maintain good general health. Get adequate rest to minimize fatigue. If you do become ill, avoid "talking over your laryngitis" - see your physician and rest your voice.
• Exercise regularly.
• Eat a balanced diet. Including vegetables, fruit and whole grains.
• Maintain body hydration; drink two quarts of water daily.
• Speak in phrases rather than in paragraphs. Breathe slightly before each phrase.
• Vocal athletes must treat their musculoskeletal system as do other types of athletes; therefore, vocal warm ups should always be used prior to singing. Vocal cool-downs are also essential to keep the singing voice healthy.

Resources

• http://www.dukehealth.org/services/voice_care_center/care_guides/voice_hygiene/tips_for_performers
• http://www.singershealth.com/dimensions/pvarticles.html
• http://www.ncvs.org/products_health.html
• http://www.voiceteacher.com/mathis.html
• http://www.texasvoicecenter.com/

Instrumental musicians are particularly at risk for repetitive motion injuries. Many instrumentalists commonly develop physical problems related to playing their instruments, and if they are also computer users, their risks are compounded.

Instrumental injuries often include carpal tunnel syndrome, tendinitis, and bursitis. Incorrect posture, non-ergonomic technique, excessive force, overuse, stress, and insufficient rest can also contribute to chronic injuries that can cause great pain and, in extreme cases, career-ending disability.

Recommendations for preventing injury:

• Evaluate your technique. Reduce force, keep joints in the middle of their range of motion, use large muscle groups whenever possible, and avoid fixed, tense positions.
• Always warm up. As an athlete would not begin a vigorous physical activity without warming up, a musician must warm up carefully before practice or performance.
• Take breaks to stretch and relax. Take short breaks every few minutes and longer breaks each hour. Two or more shorter rehearsals each day are more productive than marathon single sessions. Even in performance, find those opportunities to relax a hand, arm, or embouchure to restore circulation.
• Pace yourself. No pain, no gain is a potentially catastrophic philosophy for a musician. Know when enough is enough, and learn to say 'no' to certain performances or lengths of performing that might result in injury.
• Check out your instrument. Does your instrument place undue stress on your body? Is your instrument set up optimally for you to relieve pressure on hands, joints, etc.? Is there a strap, carrier, or stand available to relieve the stress?
• Evaluate other activities. Pains and injuries affecting your music making could be caused by other activities in your daily life. Computer use is notorious for causing afflictions including carpal tunnel syndrome and tendinitis.
• Pay attention to your body. Pain is the mechanism by which your body tells you that something is wrong. Listen to your body; if it hurts, stop what you are doing.
• Maintain good general health. Get adequate rest to minimize fatigue.
• Exercise regularly.
• Eat a balanced diet.
• Maintain body hydration; drink two quarts of water daily.
• Get medical attention if you are injured. Do not delay in seeing a doctor. A physician may prescribe a minor adjustment or, in worst-case scenarios, stipulate not performing for a period of time. As drastic as this may sound, a few months of rest is better than suffering a permanent, career ending injury.

Resources

• What Every Musician Needs to Know About the Body; Barbara Conable, GIA Publications
• What Every Pianist Needs to Know About the Body; Thomas Carson Mark, Plural Publishing
• What Every Singer Needs to Know About the Body; Melissa Malde, MaryJean Allen, Kurt-Alexander Zeller, GIA Publications
• The Musician's Way: A Guide to Practice, Performance, and Wellness; Gerald Klickstein, Oxford
• The Musician's Survival Manual; Richard N. Norris, International Conference of Symphony and Opera Musicians
• http://www.artsmed.org/ (Performing Arts Medicine Association (PAMA), an organization comprised of dedicated medical professionals, artists, educators, and administrators with the common goal of improving the health care of the performing artist.
• http://www.repetitive-strain.com/Articles1/carpal-tunnel-syndrome-in-musicians.html

As with other items we use in the course of our daily lives, musical instruments must be cared for properly and cleaned regularly. This is important not only for the “health” of the instrument itself but for the musician’s wellness. Proper care of shared instruments (for instance, those used in methods classes or checked out from the department) is a particularly important wellness practice.

Recommended practices:

• All musicians or students should have their own instruments if possible.
• All musicians or students should have their own mouthpiece if possible.
• All students and faculty sharing reed instruments MUST have their own individual reeds. Reeds should NEVER be shared.
• If instruments must be shared in class, alcohol wipes or other germicide solution should be available for use between different people. When renting or using a Department-owned musical instrument, each user must understand that regular cleaning of these musical instruments is required in order to practice proper hygiene.
• Mouthpieces
  • The mouthpiece (flute headjoint), English horn and bassoon bocal, and saxophone neck crook) are essential parts of wind instruments. As the only parts of these instruments placed either in or close to the musician's mouth, research has concluded that these parts (and reeds) harbor the greatest quantities of bacteria. Adhering to the following procedures will ensure that these instrumental parts will remain antiseptically clean for the healthy and safe use of our students and faculty.
    • Cleaning the Flute Head Joint
      • Using a cotton swab saturated with denatured, isopropyl alcohol, carefully clean around the embouchure hole.
      • Alcohol wipes can be used on the flute's lip plate to kill germs if the flute shared by several players.
      • Using a soft, lint-free silk cloth inserted into the cleaning rod, clean the inside of the headjoint.
      • Do not run the headjoint under water as it may saturate and eventually shrink the headjoint cork.
    • Cleaning Bocals
      • Bocals should be cleaned every month with a bocal brush, mild soap solution, and running water.
      • English Horn bocals can be cleaned with a pipe cleaner, mild soap solution, and running water. Be careful not to scratch the inside of the bocal with the exposed wire ends of the pipe cleaner.
    • Cleaning Hard Rubber (Ebony) Mouthpieces
      • Mouthpieces should be swabbed after each playing and cleaned weekly.
      • Select a small (to use less liquid) container that will accommodate the mouthpiece and place the mouthpiece tip down in the container.
      • Fill the container to where the ligature would begin with a solution of half water and half white vinegar (50% water and 50% hydrogen peroxide works too). Protect clarinet mouthpiece corked tenons from moisture.
      • After a short time, use an appropriately sized mouthpiece brush to remove any calcium deposits or other residue from inside and outside surfaces. This step may need to be repeated if the mouthpiece is excessively dirty.
      • Rinse the mouthpiece thoroughly and then saturate with germicide solution. Place on paper towel and wait one minute.
      • Wipe dry with paper towel.
      • Note: Metal saxophone mouthpieces clean up well with hot water, mild dish soap (not dishwasher detergent), and a mouthpiece brush. Germicide solution is also safe for metal mouthpieces.
    • Cleaning Saxophone Necks (Crooks)
      • Swabs and pad-savers are available to clean the inside of the saxophone neck. However, most saxophonists use a flexible bottlebrush and toothbrush to accomplish the same results.
      • If the instrument is played daily, the saxophone neck should be cleaned weekly (and swabbed out each day after playing).
      • Use the bottlebrush and mild, soapy water to clean the inside of the neck.
      • Rinse under running water.
      • Germicide solution may be used on the inside of the neck at this time, if desired (not necessary). Place on paper towel for one minute.
      • Rinse again under running water, dry, and place in the case.
      • If using pad-savers, do not leave the pad-saver inside the neck when packed away.
    • Cleaning Brass Mouthpieces
      • Mouthpieces should be cleaned monthly.
      • Using a cloth soaked in warm, soapy water, clean the outside of the mouthpiece.
      • Use a mouthpiece brush and warm, soapy water to clean the inside.
      • Rinse the mouthpiece and dry thoroughly.
      • Germicide solution may be used on the mouthpiece at this time. Place on paper towel for one minute.
      • Wipe dry with paper towel.
    • Other Instruments
      • String, percussion, and keyboard instruments present few hygienic issues that cannot be solved simply by the musician washing their hands before and after use.

  Heavy equipment, including but not restricted to choral risers, pianos, etc., should be moved by or under the supervision of CSU facilities management or other authorized personnel. Students who work with or move recording and/or other sound equipment should be trained on and supervised in its use by the appropriate faculty or staff.

• Musicians, like everyone else, can feel stressed from time to time. The pressures of a becoming/being a professional musician can sometimes be overwhelming. Many practices that contribute to overall physical and emotional wellness also help alleviate the stress that musicians and music students face:
  • Regular rest and exercise
  • A well-balanced, nutritious diet
  • Regular hydration
  Additionally, developing effective TIME MANAGEMENT SKILLS will help the musician accomplish everything he/she should and, therefore, reduce anxiety:
  • Use a calendar (electronic or paper) to record dates and times of classes, rehearsals, tests and other assignments, deadlines, performances, etc. If you use an electronic calendar, learn to use the alarm/reminder feature to alert you to upcoming important events or tasks.
  • Write down your daily schedule, and make it detailed. Include scheduled classes and rehearsals, practice time, meal times, free/social time. Include “transition” times—the times it takes to drive to campus, to walk from one building to another, etc.
  • Spend time practicing and studying every day. Musical skills are only built successfully by regular, daily practice and drill. Your daily practice and study time should include your applied instrument/voice, theory skills, aural skills, ensemble music, and reading and studying for your other classes.
  • Take frequent breaks away from your cell phone, tablet, or other electronic media that can potentially be time-wasters. It is not necessary to be electronically connected to the world every minute of the day. Turn your cell phone OFF during class, during practice sessions, during mealtimes with friends or family. Set aside specific times of the day (on your written daily schedule) to respond to phone calls, text messages, emails, etc.
  Many musicians occasionally, or even frequently, experience some level of PERFORMANCE ANXIETY. Being the center of attention and having all eyes on you can be stressful. Psychologically, your body reacts to this situation in much the same way as it would if you were being attacked. Your body's "fight-or-flight" mechanism kicks in, which is why symptoms of stage fright are similar to symptoms that occur when you are in real danger. Performance anxiety SYMPTOMS may include:
  • Racing pulse and rapid breathing
  • Dry mouth and tight throat
  • Trembling hands, knees, lips, and voice
  • Sweaty and cold hands
  • Nausea and an uneasy feeling in your stomach
  • Vision changes
  Musicians who have successfully overcome performance anxiety usually report that FREQUENT PERFORMING and THOROUGH PREPARATION are the keys to becoming more comfortable in performance situations. Most successful musicians also acknowledge that a LITTLE anxiety often contributes to their most successful performances—in other words, that a manageable amount of stress keeps them more alert and responsive during the performance. Here are several tips to help you overcome your fears and shine on stage (WebMD):
  • Be prepared: practice, practice, practice.
  • Limit caffeine and sugar intake the day of the performance. Eat a sensible meal a few hours before you are to perform so that you have energy and don't get hungry. A low-fat meal including complex carbohydrates -- whole-grain pasta, pizza, or a bean and rice burrito -- is a good choice.
  • Shift the focus off of yourself and your fear to the enjoyment you are providing to the spectators. Close your eyes and imagine the audience laughing and cheering, and you feeling good.
  • Don't focus on what could go wrong. Instead focus on the positive. Visualize your success.
  • Avoid thoughts that produce self-doubt.
  • Practice controlled breathing, meditation, biofeedback, and other strategies to help you relax and redirect your thoughts when they turn negative. It is best to practice some type of relaxation technique every day, regardless of whether you have a performance, so that the skill is there for you when you need it.
  • Take a walk, jump up and down, shake out your muscles, or do whatever feels right to ease your anxious feelings before the performance.
  • Connect with your audience -- smile, make eye contact, and think of them as friends.
  • Act natural and be yourself.
  • Exercise, eat a healthy diet, get adequate sleep, and live a healthy lifestyle.
  • Keep in mind that stage fright is usually worse before the performance and often goes away once you get started.
  Remember that goal is not necessarily removing performance anxiety altogether, but learning to manage it so that musical performance is an enjoyable and satisfying activity for the musician and for the audience. There are many books and web resources available on this subject, and many musicians have given presentations on performance anxiety at professional music education conferences. Helpful resources include:
  • http://www.webmd.com/anxiety-panic/guide/stage-fright-performance-anxiety
  • http://www.bulletproofmusician.com/
  • http://www.musiciansway.com/performance.shtml
  • A Soprano on Her Head: Right-Side-Up Reflections on Life and Other Performances; Eloise Ristad; Real People Press,
  • The Inner Game of Music; Barry Green, Doubleday
  Understanding the causes of performance anxiety and completing the exercises recommended by these experts can greatly reduce the negative effects of performance anxiety in musicians. The university Counseling and Psychological Center can also be a great resource for overcoming your performance anxiety.