Excerpted from Anatomy of Drumming: Move

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Hearing loss

Fun Fact!
Drummers tend to lose hearing
in the left ear more than the right..

Being a
professional
musician quadruples your risk to suffer noise-induced
hearing loss and increases the risk for tinnitus by more than
half. Drummers have more hearing loss than any other instrumentalist. A 2006
study at the Percussive Arts Society found that 57.6% of professional drummers
and 44.2% of amateurs have tinnitus - ringing in the ears. Just 14-17% of nonmusicians have tinnitus.
This sounds like a lot - but the problem is even worse. Playing music actually
improves your hearing, so the true amount of hearing loss is even higher. It is a
big problem. Heres what you need to
know about the mechanics of sound
and the ear to understand both how
hearing loss works and what to do
about it.

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This photograph is of Inner ear
hair cell in a frog.

How The Ear Works

The ear is essentially a specialized form
of touch. It feels the air outside and
responds to a special kind of changes in
air pressure - sound waves.

Most of the ear works like a drum. In this
metaphor, the thing actually making the sound
(raindrops hitting the roof, for example) is the
batter head. When the sound waves reach the
ear itself, the outer ear and the auditory canal
resonate and amplify the sound waves - like the shell of
the drum. The ear drum works like the resonant head.
The ear drum moves 3 tiny auditory bones that work like
a preamp; further amplifying the sound and transmitting
it into the cochlea. The cochlea is a coiled tube filled with fluid and a strip of
sensory cells running in a line from end to end. The strip is called the Organ of
Corti and it houses the sensory cells, a.k.a. the ear hair cells, and their support
cells. The auditory nerve connects the Organ of Corti
directly to the brain.
As the sound waves travel through the cochlea, they
knock over hairs, flipping a switch and turning sound
from a mechanical signal - the moving fluid - into an
electrical signal that travels to the auditory cortex of
the brain. The signal from each part of the cochlea has
a particular part of the brain that matches it. From
there, the signals are sliced apart, analyzed and put back
together, and finally combined with vision and other
sensory information into the final picture of what we
perceive as sound.

Fun Fact!
The worlds record for single strokes in 1
minute is approximately 20 Hz. If we get any
faster, the pitch will begin humming with a
pitch. Another fun fact: The lowest note on a
grand piano is 32.7 Hz.

The Organ of Corti

is where the ears
sensory cells are.

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Sensory cells in the Organ of Corti

are lined up like a graphic equalizer.
The farther away from the ear drum
the hair cells are, the higher the pitch
is that they respond to.

This strip of sensory cells works a lot like a graphic

equalizer. Each section of the cochlea is finely tuned to
respond only to a very narrow band of frequencies and
ignore the others. The thick end responds to lowest pitches
while the tiny end in the middle of the coil responds to the
pitches.

The faster those waves are moving up and down, the higher the
pitch. Pitch is measured in Hertz (Hz), the number of times per
second something happens. For instance, if you spin around in
circles fast enough to get dizzy, you are probably spinning at 2-4
Hz. Humans will hear a pitch in any sound that is vibrating between
20 Hz and 20,000 Hz. The ear is tuned to hear the human voice - so
pitches between 500 Hz and 2,000 Hz are louder to our ears than they really are.

If you think of sound waves as ocean waves, then volume is how high the wave
is. The difference between water waves and air waves is that water doesnt
compress. When pushed, water stacks up - making water waves literally higher. Air
compresses, so when pushes air makes pressure waves. Big sound waves move a
lot of air, and that creates bigger changes in air pressure. The higher the pressure,
the higher the volume (a.k.a. SPL or Sound Pressure Level.) If you
ever hear a sound tech talk about speakers that move a lot of air,
hes really just saying that they are loud. The main reason that bass
tones shake your chest is that they need a lot more volume to be
heard. Bass tones are outside of the range of the human voice, and
The reason there is a +/- 3 dB
so the ear isnt very good at hearing them. This means that in order
switch on many amps and
for them to seem like they are the same volume to us, they need a
mixers is because adding 3 dB
lot more air to move. This extra power is often enough to shake our
approximately doubles the energy
bodies.

Fun Fact!

(but not the perceived volume).

The SPL is measured in decibels (dB). The perceived volume of a

sound doubles for every 10 dB, but the actual energy of the wave
increases by a factor of 10 for the same change. A dishwasher in the
next room is half the volume of a normal conversation, but the energy of the sound
wave is only 1/10th. A nightclub or orchestra pit is 32 times as loud, and the waves
are 100,000 times larger or more!

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Sound waves are pressure waves. The object creating the sound vibrates, pushing the air away
from it with each vibration. The waveform at the right measures SPL. The higher the spike is,
the higher the pressure.

Noise Induced Hearing Loss

Drummers have more hearing damage than any other musician. This damage
isnt random. It is because our instrument is the loudest of all the acoustic
instruments and unlike the amplified instruments; it isnt easy to just turn it
down. Luckily, noise induced hearing loss - the technical term for what we suffer
from - is largely preventable if you know what to do.

Bang!

Noise induced hearing loss can come from a single very loud event or from
the slow accumulation of wear and tear on the ears. Damage from a single
loud sound is kind of like breaking a bone. The structures inside the ear
physically rupture causing permanent damage. Consider that a symphonic
orchestra peaks at 120 decibels to 137 decibels and a full-throttle rock
concert tops 150 decibels, and you can see the problem.

Fun Fact!
A single snare strike can
reach up to 137 dB

The Decibel Scale

Threshold of Hearing

0 dB

Cant hear anything

Breadcast Studio Interior

10 dB

1/32nd as loud as conversation

Quiet House Interior

20 dB

1/16th as loud

Watch Ticking

30 dB

1/8th as loud

Humming Refridgerator

40 dB

1/4th as loud

Dishwasher in the Next Room

50 dB

1/2 as loud

Normal Conversation

60 dB

Vacuum Cleaner at 3m

70 dB

Twice as loud

Passing Car at 3m

80 dB

4 times as loud

Average Volume of High School Band Room

90 dB

8 times as loud

Gas Lawn Mower at 1m

100 dB

16 times as loud

Night Club with Live Band

110 dB

32 times as loud

Sirens, Threshold of Pain

120 dB

64 times as loud

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Because louder sounds have more energy, they are more likely to damage the ear.
This much is obvious. What isnt obvious is that the energy in a sound increases
a lot faster than it seems to. As the dB level of a sound rises by 10, we think the
volume doubles (2x), but the actual power in the sound increases by 10x. If the
volume increases by 20 dB, we think the volume quadrupled, but the actual
energy raised by 100x.

Accumulated Damage

Fun Fact!
Dont be offended - Im not trying to make
a subtle drummer joke. Noise induced
hearing loss is a technical term. Noise is
a general scientific term for sound, so any
noise - music included - counts.

Damage from wear and tear is more like the rapid aging of
the ear. When you hear too-loud sounds for too long, the
repair processes of the ear cant keep up with the rate of
damage. This kind of damage is calculated as an average
volume over time. There is a lot of variation from personto-person, but in general hearing loss starts with long or
repeated exposures to sounds at or above 85 decibels.

The slow accumulation of damage is not noticed until it

becomes significant. The first sign is usually difficulty distinguishing between
voices in a group conversation or on the phone.
Once it sneaks up on you, there isnt much you can do about it. Remember, the
actual energy level has to go up by 10x for the sound to seem like it doubles to us.
Warning Signs
The good news is that there is a lot you can do to prevent it. The first thing to
know is what the warning signs are:

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Your ears hurt from the noise.

Your ears feel full or stuffed.
You find that you have to raise your voice to speak to someone standing next
to you.
Your ears start buzzing or ringing, even temporarily.
You dont hear as well anymore.
Your ears get tired, and you dont want to listen to any sounds anymore.
If you find any of these to be true, it will be worth your time to do something
about it. Your ears will thank you.

A story from my dad: I remember hearing Commander Cody and

the Lost Planet Airmen back in the late 1960s at the Armadillo World
Headquarters in Austin. I was there to drink beer and observe, as a fellow
musician, how they did sound check. I clearly remember them telling the
sound tech to put 90 dB in the mains and 120 dB in the monitors. An
invitation to catastrophic old age hearing loss.

Listening to headphones at loud volumes

for long periods of time doesnt give your
ears the time they need to rest and repair
the damage that has been done to them.
photo credit: Toby Bateson

Fun Fact!
To avoid damage:
Reduce Volume at the Source: Turn down the volume knob a
notch. Use practice pads. Fix that noisy muffler. Put up some
baffles to absorb some of the sound so there isnt as much noise
in the air. It isnt always possible, but when it is, it is the easiest
way to reduce noise induced hearing damage.

Some people are more resistant to

hearing loss than others. It is unknown
why, but resistance seems to have a
strong genetic component. However,
like aging, there is no escaping it
eventually. Even if you are one of the
lucky few, it will still be worth your
time to protect your hearing so that
you can hear better, longer.

Move away. The power of sound decreases exponentially with distance. If you
double the distance from a sound source, you reduce the volume by 6 dB. It
doesnt sound like much, but extra distance reduces the energy to of what it
was. This is important to understand when you are deciding where to set up your
drums on stage, and also when fixing something on the fly. Ever try to adjust
your snare stand or bass drum pedal while playing? Leaning over places your
head near the snare, exponentially increasing the volume and the risk. It is safer
just to skip the backbeat until you get the adjustment made.
Limit exposure. Reducing the total exposure at one time makes a big difference.
Give yourself a break from the sound when you can. Shorter rehearsals,
walking outside on the set breaks, anything to keep that noise damage from
accumulating.
Ear plugs. Ear plugs are one of the simplest and most effective ways to prevent
noise induced hearing loss. See ear plug guide on page 164.

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Hearing Loss in T- ...

Sound Level

NIOSH Standards (1998)

OSHA Standards (2009)

85 db

8 hours

16 hours

88 db

4 hours

10.6 hours

91 db

2 hours

7 hours

94 db

1 hour

4.6 hours

97 db

30 minutes

3 hours

100 db

15 minutes

2 hours

110 db

2 minutes

30 minutes

115 db

28 seconds

15 minutes

These are the guidelines for allowable for on-the-job volume and duration from
the Occupational Safety and Health Administration (OSHA) and the National
Institute for Occupational Safety and Health (NIOSH), a branch of the Center for
Disease Control and Prevention (CDC). Anything more than this is considered to
be dangerous by these organizations. The durations listed are not at one sitting
maximus - they are daily maximums. Youll notice that the OSHA standards are
much longer than the NIOSH standards. OSHA standards go by the assumption
that the energy level of the sound doubles every 5 dB. It doesnt. It doubles every 3
dB - which is reflected in the NIOSH standards.

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162

IEMs. In Ear Monitors, or IEMs, are a great way to reduce the amount of gear you
have to carry around and give you some direct control over your stage volume.
Any kind of headphones can block some external sound. Just make sure they
arent part of the problem.
Rest. Your ears get tired, and after a loud concert, it is safer to allow them a
period of complete silence - or at least as close as you can get. I will often sleep
with earplugs in after a show to give my ears a little extra edge in recuperating,
and my ears are much happier for it.
Take Antioxidants. There is some research that taking antioxidants before you
are exposed to loud sounds has some protective effect. Your ear using them
to repair damage, and making more available while the ear is dealing with the
damage helps the ear do a better job. This includes easy-to-find Vitamin E, but
is especially true for glutathione. Glutathione is used directly by the ear to fight
damage from noise and studies show that taking some immediately before or
after exposure to loud noises can help prevent permanent damage. Glutathione
is available online.

Fun Fact!
The energy from sound only truly decreases exponentially if you are skydiving. Otherwise the sound
reflects off of nearby surfaces and back to you, giving you a double or triple dose of the sound. If you
are playing a room with a low ceiling and concrete walls, the sound bounces back and forth, hitting
your ears each time.

Volume Limiter: While not as practical on stage, using a volume limiter on your
MP3, metronome, studio etc can help to avoid damage.
Lighter Sticks. Force = Mass x Acceleration. One of the simplest things you can
do to reduce volume is to switch your sticks to something that weighs less. Sticks
that weigh half as much result in half the power - and volume.
Better Technique. Lets face it: Most drummers really do play too loudly. I have
been called the loudest drummer in the world on more than one occasion
myself. It is fun to play loudly. However, it isnt always appropriate - especially
on the cymbals. Becoming proficient with finger technique is a great way to

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lower the volume on the cymbals - and enable some really fancy playing to boot.
Besides, it is musical. The bass drum and the snare are more important for most
musical styles, and deserve to be louder.
Get tested! Knowledge is power. If you dont know how loud the stage is, you
arent going to know the best course of action. Sound level meters are easy to
come by these days - you can download an app for free on a smart phone that
can tell you.
Tell Your friends/family/bandmates. If they dont know, they cant help.
Eat Well. The damage from sound will happen. Give your ears a fighting chance
by eating well so they can be at their best to repair as much of the damage as
possible. Eating well and drinking enough water has been shown to reduce noise
induced hearing loss.
Dont Smoke. One of the ears responses to loud sound is to increase blood flow
to the damaged areas. Nicotine prevents this. Turns out that smokers are 70%
more likely to develop noise induced hearing loss than nonsmokers.
Watch out for ototoxic drugs. Every over the counter pain reliever available and
over 100 classes of drugs can make the ears sensitive to noise induced hearing
loss. See page 166.

Ear plugs
Fun Fact!

Ear plugs do more than simply stop up the ears. The ear canal amplifies
sound much like the shell of a drum, and filling it up with
something reduces volume and significantly changes the
tone. The shape of the ear canal makes the sound at around
2700 Hz about 17dB louder. Filling the ear canal with an ear

According to research, two thirds of

drummers never wear ear plugs.

Custom molded
earplugs aprovide the
highest fidelity.

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plug changes that resonance, and thus changes how we hear the sound.
This is why we love and hate ear plugs. We love them because they are the first
line of defense protecting our ears during shows and practices. We hate them
because they change the characteristics of the sound we hear. Because the
ear plugs fundamentally change the nature of the sound before it gets to the
cochlea, there isnt any way to really get high fidelity in ear plugs. Every ear
canal is shaped differently, so an off-the-shelf ear plug wont be able to give you
the exact right fit. Even with custom molded plugs, there is constant movement
- especially from singing - that keeps the ear plugs shifting subtly within the ear.
Once you get used to wearing ear plugs, your brain will do a pretty good job of
making up for the difference, though. Like waiting for your eyes to adjust to the
dark, it takes a little bit of time to attenuate the signal from the ears. Popping
ear plugs in right before you play doesnt give your brain enough time to make
the change. You might consider putting your ear plugs in before you need them.
This has the added bonus of keeping the accumulated damage from loud sounds
even lower.

Tinnitus
Tinnitus is a ringing, hissing or buzzing in the ear that isnt really there.
Tinnitus isnt a cause - it is a symptom of other problems and almost always
accompanies hearing loss. Drummers suffer tinnitus
at 3-4 times the rate of non-musicians.
Tinnitus is a little different in everyone. For some it
is a ringing, for others a buzzing, roaring, hissing or
whistling. No matter the sound, it essentially prevents
the sufferer from experiencing quiet. If it is severe
enough, tinnitus can impede normal hearing, keep you
from getting to sleep, break your concentration and/or
come with a raft of negative emotions.

Fun Fact!
If your tinnitus is rhythmic or matches
your heartbeat, see your doctor. It could
be a sign of a more serious problem.
She may actually be able to hear
herself through her stethoscope.

Nobodys quite sure why tinnitus happens, but the

prevailing theory is that tinnitus is phantom limb syndrome for the ears. In
phantom limb syndrome, a person feels a limb that has been removed. The cause
is that while the limb is gone, the part of the brain that receives information
isnt. Now left to its own devices, that part of the brain goes a bit haywire. In
phantom limb syndrome the brain thinks the limb still exists in a ghost form,
and in tinnitus people hear phantom sounds.
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Ototoxicity
Noise isnt the only danger to the ears. Many
common drugs can damage your hearing. The
technical term is ototoxic: meaning they damage
the sensory structures in the ear. Research
suggests that ototoxic drugs may attack the ear
hair cells or support cells directly and/or prevent
the cells from healing themselves. Damage can
range from mild tinnitus to profound deafness.

Every over-the-counter
pain reliever can cause
hearing damage.

Over 1000 drugs and chemicals are known to be

ototoxic. This list includes, but is not limited to,
every single over-the-counter pain reliever available;
Advil, Excedrin, Aleve, Motrin, Tylenol. Other widely known drugs with ototoxic
side effects are nicotine, streptomycin, Valium, Paxil, Prozac, Xanax and many,
many more. The the most ototoxic drugs are mostly antibiotics (neomysin,
streptomycin, etc), diuretics, (acetazolamide, etc), salicyclates (aspirin) and
NSAIDs ( ibuprofen, acetominophen, etc). There are several large ongoing
studies, so you can find out more information online about specific drugs.

Early warning signs of ototoxicity

Dizziness
Onset, change in type, or worsening of tinnitus
Pressure in your ears
Hearing gets worse or fluctuates
Vertigo

How Dangerous Is It Really?

Fun Fact!

Nobody really knows exactly how much hearing damage from drugs there really
is. There are dozens of ways that drugs could harm the
ear, and most researchers arent on the lookout for subtle
and slow damage to hearing. With a few drugs, there

Slowly built-up damage can be hard to

detect. Just look at how long it took the NFL
to notice the damage from head trauma.

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may be profound and rapid deafness. Mostly, however, the permanent damage
is hard to see because it builds up slowly over time. The slowness of the damage
also prevents the harmful effects from showing up in clinical trials - and thus on
warning labels or doctors textbooks. When a loss of hearing is noticed, ototoxic
damage is often confused for noise induced hearing loss, old age or associated
with the disease the medicine was prescribed for. Even when ototoxic damage
is noticed and recognized for what it is, according to former FDA commissioner
David Kessler, only about 1% of serious side effects get reported. Other research
suggests this number is much too generous, putting the number closer to zero.
Complicating matters further for researchers is that much of the damage is
temporary. For most of us, if we experience symptoms at all, they reverse when
the drugs fade from our system. This might be great news for you. If you are
regularly taking aspirin or other ototoxic medications, and you are experiencing
hearing loss, the two might be related. You may find your hearing restored a week
or so after you stop taking the medicine. Unfortunately, sometimes a portion of
the damage is permanent.
Further clouding the issue is a lack of clear research standards on ototoxicity.
Some researchers hold that there must be a loss of at least 10 dB in both ears
before a drug can be considered to be ototoxic. Others put that limit at 15 or 20
dB in only one ear. This ought to scare you. Only a massive loss in hearing ability
is counted as a side effect. Small, slowly built up damage sails totally under the
radar and isnt even considered. The slow accumulation of ototoxic damage is
something that is most certainly occurring but generally unknown and unlooked
for. One example of the effect of varying
standards is Cisplatin. Some researchers
find almost no ototoxic effect, and others
is a combination of hyfind it to permanently damage hearing
drocodone and acetaminophen (Tylenol), was
nearly all the time. The difference is how you
not thought to be ototoxic for many years,
define the terms.
but is now known to cause permanent deaf-

Vicodin

Noise Problem

Unfortunately for drummers, there is

another problem: ototoxic drugs amplify the
damage doneto the ears from loud noise.
Ototoxicity messes with the ears ability to
recover from loud noises. Very few of the
guides on ototoxicity mention this, but for
musicians it is critically important. The
volume of our instruments puts us all at risk
for ototoxic effects.

ness if abused. High rates of consumption

(over 20 pills/day) are required to cause such
high levels of damage, but because Vicodin
is addictive, many people end up taking high
dosages. Rush Limbaughs sudden deafness in
2001 was due to his drug addictions. Research
shows that it is the acetaminophen (Tylenol)
in the Vicodin not the hydrocodone - that
causes the hearing damage.
If you are wondering why it took so long to
discover Vicodins ototoxicity, the reason
is simple. It takes a high dose to reach
ototoxicity - much higher than was used by
the FDA in researching side effects. Many
side effects are dosage dependent and others
take a long time to express themselves.167
Ototoxicity is both.

For example, one study looked at workers who were exposed to both noise and
toluene, an ototoxic chemical used widely in paint thinners, paints, feedstock,
etc. The workers who were exposed to noise alone had 4x the hearing loss than
workers who werent exposed to either. Those exposed to the toluene had 5x the
hearing loss, but those exposed to both at the same time had 11x the hearing
loss. Another similar study in Brazil placed this increased damage at over 27x.
Ototoxic drugs can synergize with noise, and they can synergize with each
other, further amplifying the damage to the ear. Because there are so many
ototoxic drugs, it takes extra care to avoid combining them. For example, both
the nicotine in cigarettes and the carbon monoxide can damage the ear by
reducing its ability to recover from auditory trauma. The damage is amplified
if the nicotine and/or carbon monoxide (even second hand smoke from bars) is
combined with other ototoxic drugs or loud sounds.

How Dangerous Is It To Me?

To make a long story very short, it varies from person to person. Like damage
from noise, some people seem to be better protected than others. Also like noise
induced hearing loss, the dosage matters a lot. Low doses arent likely to cause
damage, but the chances go through the roof when you combine ototoxic drugs
with loud sounds and other ototoxic drugs taken at the same time. The only way
to know how you are affected is to find out for yourself.

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What To Do About It
Dont simply stop taking medicine because you hear it is ototoxic. Speak
to your doctor first about your situation to find if there is a better course of
action. There may not be!
Talk to your doctor. Your doctor needs to know your concern about hearing
loss, and should be able to prescribe non-ototoxic drugs. If your doctor is
unaware of or unconcerned about ototoxicity, then you might consider
switching. Be sure to let your doctor know about any existing hearing loss and
that you are a drummer.
Skip a show. If you need to be on that antibiotic, maybe it is better to skip your
show or rehearsal. No matter how much it hurts to give up the gig, the potential
damage to your ears probably isnt worth it. At very least use the most powerful
ear plugs available.
Follow dosages exactly. Dont take over the amount that your doctor or the
drug company prescribes - whichever is smaller.
Watch out for combinations of ototoxic drugs. They can combine their effects
to do extra damage. This is particularly true for loop diuretics, cisplatin, and
aminoglycoside antibiotics. It is even true for nicotine and aspirin. If you
use the same pharmacy, they will be able to better watch out for bad drug
combinations.
Drink plenty of water. Having enough water protects your ears and helps to
moderate the levels of ototoxic drugs in the ears - helping to keep the ears safe.
Eat well and exercise. When your body is healthy, it runs better - and handles
ototoxicity more effectively.
Get checked. If you begin a treatment with an ototoxic drug, get your hearing
checked with a serial high-frequency audiogram before you begin the
treatment, and monitor your hearing regularly as you go along. This will allow
you to detect hearing loss early and stop the treatment - saving your ears. Serial
high-frequency audiogram is important because normal hearing tests wont
catch hearing loss soon enough.

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