To You and Your Students’ Good Health: Q & A Column

Compliments of the CMS Committee on Musicians’ Health 

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The Musicians’ Health Committee, comprised of medical professionals and music faculty, all strong advocates for musicians’ health, is happy to bring you a Q & A column for this month's CMS Newsletter.  If you like this idea, please send us your musicians’ health-related questions which we will direct to our committee members, or other professionals with whom we have contact, to be answered in future newsletters. Gail Berenson and Linda Cockey, Committee Co-Chairs.

 

A: “This is the time of year when students are already stressed as many are preparing for juries and/or recitals.” Consider including:

Finally, remember that it is normal to experience stress and anxiety related to exams, juries, recitals—anything in which a performance will be evaluated by an expert. Think of these as learning experiences that will make the next performance better.

A: “Whether you’re trekking across town to perform in an under-heated cathedral, marching outside with the band, leading The National Anthem for a football game, or joining in festive caroling, this is the time of year when musicians are coping with less than ideal weather conditions.” 

  • Stay indoors and warm as much as possible before performing.
  • Warm up the entire body to prepare tissues for stretching
  • When tissues are warmed up, stretching exercises should begin
  • Warm up your instrument
    • Critically important, especially for wooden instruments (e.g., oboe)
    • May take up to 30 minutes for large wind instrument to regain pitch
    • Blow air steadily and gently through instrument.  
    • Swab before playing to remove water vapor which has condensed inside during warmup 
  • Trap the body’s warmth. Exposed skin = heat loss. Avoid a shivery sound and optimize performance capabilities by dressing beautifully and strategically for the cold. 
    • Can you incorporate a stylish, colorful hat with a small wool cap underneath? 
    • Layer shape-enhancing Spanx® with three pairs of tights or nylons…or even long black Smartwools®.  
    • Consider ditching the idea of the perfect suit or slinky dress and invest instead in a gorgeous long wool or velvety coat with a plush scarf, chic hat, and sleek, perhaps fingerless, gloves or a [fake] fur collar around your neck and wrists. 
    • Lastly, sporting well-trimmed facial hair and wearing long hair down will only add comfort to an outside performance. 
  • Singers, keep your voice warm. The voice box, or larynx, is lined with ultra-sensitive tissue that triggers a cough when it senses anything foreign to its natural environment; this includes cold air! 
    • Breath through your nose. While not ideal for singing, nose breathing is a good crutch when singing outside as it warms, filters and moistens inhaled air before it reaches your vocal box. 
    • After warming up your voice, humming and replying “mmmhmmm” can help keep the cold out and the voice warmed. 
    • Help maintain warmth by sipping a warm, non-caffeinated and non-phlegm-inducing drink such as weak broth or water with honey and a little lemon.
  • Singers, keep your vocal folds hydrated. Outside air in winter tends to be dry - as does the inside air once the central heat is turned on. A dehydrated voice loses flexibility, elasticity for high pitches, and stamina. 
    • Drink sufficient water consistently month-to-month prior to the performance to reach optimal hydration levels inside your voice’s many layers. 
    • Inhaling air with at least 35-45% humidity will help you maintain your voice’s slick outer layer. Keep a regularly sanitized vaporizer or humidifier running at night in your bedroom, and tote a personal steamer. – see Gates, Rachael, et.al. The Owner's Manual to the Voice. (Oxford, 2013), pp. 37-38, 49
    • Trigger your mouth and throat to secrete saliva by adding a little lemon to your water and temporarily trap the beneficial moisture via a little honey, aloe vera, pectin or glycerin. Some singers stick a tiny piece of a lozenge under the tongue or in the cheek to keep the juices flowing (e.g. Grether’s Pastilles, Luden’s® Throat Drops). – see Gates, Rachael, et.al. The Owner's Manual to the Voice. (Oxford, 2013), p. 53

A: “The production of sound (the act of being a musician) typically starts with the ability to hear. The auditory system, one of our most delicate and intricate senses, connects musicians to the world around them, and it is a delicate and intricate system. Interested readers can view this video for a more detailed look into the anatomy and physiology of auditory transduction. The ear can be thought of as a part of the musician’s instrument and, as such, should be cared for regularly!”

All musicians should know the following 5 aspects of hearing loss prevention:

  1. Have your hearing tested by an audiologist. Above all, this is the best thing you can do for your hearing. This will not only be the window into your invisible instrument (your hearing) but alert you to any changes in your hearing that you might not notice. Fortunately, and unfortunately, musicians can “ear train” to discrete changes in hearing over time which can render those changes unnoticeable until they become severe. Beyond that, an annual hearing test is your way to:
    • Verify that your hearing protection is working
    • Provide a regularly updated baseline to which any sudden changes in hearing can be compared
    • Give you an opportunity to have an audiologist look in your ears and remove any occlusive earwax

  2. Know when your hearing is at risk. Hearing loss occurs when sound is too loud (amplitude), for too long (duration). Fortunately, there are some guidelines that help predict when we are at risk for hearing loss (these do not predict our risk for music-induced hearing disorders such as tinnitus or ringing in the ears). Generally, when sound is lowered by 3 decibels (dB), you can double your exposure time. Steps for knowing when to pop in earplugs:
    1. Download the NIOSH SLM app on your iPhone. This is the only sound level meter app validated to be accurate.
    2. Measure the sound levels during rehearsal and if you can, performance. Refer to this chart to know if you are at risk for hearing loss due to loud sound (click and scroll down to “Average Sound Exposure Levels Needed to Reach the Maximum Allowable Daily Dose of 100%”).
    3. Choose an earplug that reduces the sound to a level that will not cause hearing loss. For example, if you measure sound levels of 100 dB and your rehearsal is 2 hours long, an earplug with 9 dB of attenuation will be sufficient. If your rehearsal is 4 hours long, you may want to consider an earplug that reduces sound by 15 dB.

  3. Find earplugs that work for you. Most musicians begin with over-the-counter, universal fit earplugs and are often unhappy with the results. Most earplugs you can purchase off- the- shelf, do not provide the sound quality a musician requires. Technically, musicians can “ear train” to any form of hearing protection given enough time and effort, but most musicians are simply not able to take the time to ear train get used to foam earplugs. Additionally, some over-the-counter hearing protection actually blocks MORE sound than needed. More effective earplug options for musicians are:
    • Universal-fit: Etymotic ER20s
    • Custom-fit: Made by multiple companies
    • Active hearing protection: Etymotic MusicPro, ASI Audio 3DME

    Earplug choice should always begin with a full hearing evaluation and consultation with an audiologist and appropriate expectations of hearing protection. No earplug will sound exactly like your open ear canal, but with practice, your ears will become “bilingual” and you will be able to communicate musically both without and with the earplugs.

  4. Be a wise consumer of marketing. There are heaps of companies claiming to sell “musician” earplugs, however just labeling a product “musician” or “high fidelity” does not mean they actually are. One tip is to look at the company’s published specifications for their earplugs. Did they include a frequency response curve? If so, a rule of thumb is to choose an earplug that has a flat frequency response. In other words, the earplug that shows the flattest line across the frequency response graph. Some companies publish an NRR (Noise Reduction Rating) which shows the estimated attenuation the hearing protection achieves if fit and worn properly. However, there are no two ears alike on earth, so a wise consumer will be aware that the NRR is not necessarily a real-world estimation.

  5. When earplugs are not enough. Wearing a true, high fidelity, musician earplug is still a compromise on sound quality. If you find that earplugs are not working for you, even after considerable ear training efforts, consider an in-ear monitor system or a self-tunable earplug. This can be especially helpful for vocalists and reed and wind instrument players. For more information on hearing loss prevention strategies and types of hearing protection, contact Dr. Heather Malyuk () or Dr. Laura Sinnott ().