Singers, instrumentalists, actors and performance professionals throughout the arts are understandably worried when they experience hearing problems, and often contact BAPAM with concerns about their ability to perform and work. If you read this article and take one thing away from it, it should be this: Many performers have a successful career and also have hearing loss. Key to this is getting expert assessment and specialist advice.
Hearing loss will need to be assessed by a specialist clinician such as an audiologist or an Ear, Nose and Throat Consultant, and you may need further medical investigation and treatment. If you think you have a hearing problem, the first thing you need to do is visit your NHS GP, even if you are thinking of contacting BAPAM or using an independent specialist audiology service. Check here for detailed information from the NHS.
We asked Paul Checkley, lead audiologist at Musicians Hearing Services, and Mr Declan Costello, a Consultant Ear, Nose and Throat surgeon who specialises in helping professional singers, for their thoughts on musicians and hearing loss:
Paul Checkley
How many musicians would you say have hearing loss?
PC: Studies have shown that between 40% and 50% of musicians report hearing problems (Greasley et al 2018). However, in the same study, almost 20% did not know whether they had a hearing problem, which suggests that this number could be higher.
How does this impact their ability to perform?
PC: The effect that hearing loss has on a musician’s ability to perform is related to the level of the hearing loss and any other related audiological issues. Obviously, the more severe the hearing impairment the greater the impact on the musician’s ability to play. Hearing loss brings with it the obvious problem of a musician hearing their own instrument and pitching confidently, but there are a number of other related issues to be addressed including: monitoring the other instruments in the orchestra to clearly hear all musical cues, hearing instruction from the conductor during rehearsals and overcoming distortion in hearing aids, particularly for higher pitched notes.
Is this a career-ending matter or are there solutions?
PC: No, this is definitely not always a career-ending issue, I have seen many musicians in clinic who have a successful musical career and also have a hearing problem. This does depend on the type and degree of hearing loss and to some extent on individual differences in approach. In many cases, where the hearing loss is mild, there can be little or no effect on their ability to play. As hearing losses become more severe there is a corresponding increase in the challenges faced. It is true that hearing aids are not always efficient at processing music, indeed 67% of hearing aid users in a recent study reported difficulties listening to music. In some cases, there are simple hearing aid adjustments or dedicated music programmes, which can improve the ability to appreciate and therefore perform music. In contrast, there are also some cases where the hearing loss presents such a high level of difficulty, that the individual feels that they are no longer able to continue with their music. Pitching issues and distortion, for example, can present difficulties which the individual feels are insurmountable.
We know people don’t like to admit to hearing loss for fear of it impacting their career, could you give us a sense of the numbers of successful musicians who are continuing a successful career because an audiologist has solved their hearing problem?
PC: It is not possible to estimate numbers but we regularly see many musicians enjoying a successful career while living with hearing loss. There are many effective and discreet technology options available that can allow people with hearing loss to continue with their career. The important thing is to see an audiologist, preferably who has had some experience with musicians. There are a host of professionals available to support all aspects of hearing and lifestyle issues.
Declan Costello
From your perspective as a voice specialist, could you give us an idea about how hearing impacts the ability to sing?
DC: Singing (or indeed any musical endeavour) relies on being able to hear both yourself and your fellow musicians: this will facilitate ensemble, tuning, balance and timbre. Hearing loss can make performing quite stressful, because the performer can start to doubt themselves; for a singer, this in turn can lead to technical issues of muscular tension in the vocal tract, along with issues of intonation.
If you have a patient who presents with both vocal and hearing health problems, what is your approach to getting them back to performing?
DC: It is important to address both in parallel – but addressing the hearing loss is very important initially, as the ability to hear yourself and your colleagues is paramount. The first thing is to acknowledge that there is a problem and to have a detailed hearing test. In fact, there are certain types of hearing loss that can be remedied with medicine (nasal sprays, tablets or even surgery) so it is important to establish whether there is a reversible cause of the hearing loss. If the hearing loss relates to the outer ear, it might be due to ear wax or an infection of the skin of the ear canal (otitis externa). These are both easily treated and the hearing can be improved very rapidly. If the problem relates to the middle ear (for example, glue ear) there are treatments that can resolve this or occasionally surgery is required. Finally, if the problem is within the inner ear (as is usually the case with age-related hearing loss), hearing aid(s) might be needed.
We understand that most people lose hearing as they get older, how can a professional singer manage this?
DC: The first step is to accept that there might be a problem! A hearing test by an experienced audiologist (ideally one with experience in seeing people in the music industry) is very important. This will help to establish the degree and the cause of the hearing loss. If it turns out to be an age-related problem (“presbyacusis”) then hearing aids may be suggested. Again, an audiologist with experience in treating musicians will be able to provide devices that give the best possible performance. Naturally, it is also very important to protect the ears as much as possible – this might involve ear plugs or other performance-related modifications to minimise any further damage to the inner ear.
–
Thanks to Paul Checkley and Declan Costello for their advice on approaches performers with hearing loss can explore.
For another perspective, we recommend reading BAPAM Patron, Dame Evelyn Glennie‘s Hearing Essay on being an ever evolving musician who is also profoundly deaf. “If you want to know about deafness, you should interview an audiologist. My speciality is music”.
Related links:
Musicians’ Hearing Health Scheme from Help Musicians and the Musicians’ Union
Action on Hearing Loss: Protect your Hearing
Don’t Lose the Music: BAPAM Factsheet