Evaluation of the Hearing Function in the Orchestra Professional Musicians of the Teatro alla Scala in Milan
Main Article Content
Keywords
Opera; Music; Orchestral Professional Musicians; Musicians Hearing Threshold; Hypoacusis; Hearing Disorders; Occupational Workers; Noise-Induced Hearing Loss
Abstract
Background: This study was conducted to determine whether occupational exposure to high sound levels, typical of an opera orchestra, can cause hearing loss. Methods: The orchestra professors at Teatro alla Scala in Milan underwent ear examinations, pure-tone audiometry, and other audiological tests. The hearing thresholds of these musicians were compared with those of populations not exposed to occupational noise and with populations exposed to industrial noise. Noise exposure levels were estimated through a phonometric survey conducted at our theater in 2011, which largely confirmed the exposure levels outlined in European guidelines. Results: The average audiometric thresholds of the orchestra musicians were slightly worse than the median thresholds of a healthy, non-noise-exposed population. In three subjects (2.8%), bilateral hearing impairment (PTA 0.5, 1, 2, 3, 4 kHz > 25 dB HL) was observed; in four violinists (3.7%) left unilateral hearing impairment was found. This rate is lower than the expected risk from similar industrial noise exposures. Comparing these audiometries with those from about ten years earlier shows that the hearing threshold decline in the study group is comparable to that caused by presbycusis. Conclusions: The risk of noise-induced hearing loss among professional orchestra musicians appears lower than predicted by the UNI ISO 1999:2015 standard. A few cases of hearing loss due to chronic acoustic trauma were noted, particularly among violinists who demonstrated a higher incidence of left unilateral hearing loss. The high levels of sound exposure and the presence of some hearing loss cases highlight the need for targeted preventative measures in this work activity.
References
2. Hutchinson KM, Alessio HM, Hoppes S, et al. Effects of Cardiovascular Fitness and Muscle Strength on Hearing Sensitivity. J Strength Cond Res. 2000;14(3):302-309. Doi: 10.1519/00124278-200008000-00010
3. Zhang X, Ni Y, Liu Y, et al. Screening of noise-induced hearing loss (NIHL)-associated SNPs and the assessment of its genetic susceptibility. Environ Health. 2019;18(1):30. Published 2019 Apr 4. Doi: 10.1186/s12940-019-0471-9
4. Hake R, Kreutz G, Frischen U, et al. A Survey on Hearing Health of Musicians in Professional and Amateur Orchestras. Trends Hear. 2024;28:23312165241293762. Doi: 10.1177/23312165241293762
5. European Commission - Directorate General for Employment, Social Affairs and Equal Opportunities - Unit F4 . Chapter 8: The music and entertainment sectors" In: Non-binding guide of good practice for the application of Directive 2003/10/EC [Article in Italian] Luxembourg, 2009 ISBN 978-92-79-11342-0. Doi: 10.2767/21285
6. Permanent Advisory Commission for Occupational Safety and Health “Guidelines for the music and leisure sector, pursuant to Article 198 of Legislative Decree 81/2008, as amended – approved at the meeting of 7 March 2012”. [Article in Italian] https://www.lavoro.gov.it/sites/default/files/archivio-doc-pregressi/SicurezzaLavoro/LG_art_198_musica_articolato.pdf
7. Morata TC. Young people: their noise and music exposures and the risk of hearing loss. Int J Audiol. 2007;46(3):111-112. Doi: 10.1080/14992020601103079
8. Moore BCJ, Lowe DA, Cox G. Guidelines for Diagnosing and Quantifying Noise-Induced Hearing Loss. Trends Hear. 2022;26:23312165221093156. Doi: 10.1177/23312165221093156
9. Qian CL, Behar A, Wong W. Noise exposure of musicians of a ballet orchestra. Noise Health. 2011;13(50):59-63. Doi: 10.4103/1463-1741.74002
10. Axelsson A, Lindgren F. Hearing in classical musicians. Acta Otolaryngol Suppl. 1981;377:3-74.
11. Westmore GA, Eversden ID. Noise-induced hearing loss and orchestral musicians. Arch Otolaryngol. 1981;107(12):761-764. Doi: 10.1001/archotol.1981.00790480037010
12. Phillips SL, Mace S. Sound level measurements in music practice rooms. Music Performance Research. 2008 Jan;2(1):36-47.
13. Zelený M, Navrátilová A, Kamýcek Z, Vlk Z. [Relation of hearing disorders to the acoustic composition of the working environment of musicians in a wind orchestra] Vztah poruch sluchu k akustické skladbĕ pracovního prostredí hudebniků v dechovém orchestru. Cesk Otolaryngol. 1975;24(5):295-9. Czech. PMID: 1204072.
14. Laitinen H, Poulsen T. Questionnaire investigation of musicians' use of hearing protectors, self reported hearing disorders, and their experience of their working environment. Int J Audiol. 2008;47(4):160-168. Doi: 10.1080/14992020801886770
15. Behar A, Wong W, Kunov H. Risk of hearing loss in orchestra musicians: Review of the literature. Medical Problems of Performing Artists. 2006; 21(4):164-8. Doi: 10.21091/mppa.2006.4035.
16. Zbysińska M, Lachowska M. Hearing damage caused by noise in classical musicians. Pol Otorhino Rev. 2020;9(2):41-53. Doi: 10.5604/01.3001.0014.1545
17. Behar A, Chasin M, Cheesman M. Noise Control: A Primer. Singular Pub. Group/Thomson Learning. San Diego, 2000 url :lcp:noisecontrolprim0000beha:epub:d3e0e7f9-5d58-4592-b4c5-a5c2e4e74027
18. Chasin M. Musicians and the prevention of hearing loss. Singular Publishing Group Inc. San Diego, CA. (April 1996) ISBN#1565936264.
19. Pyykkö I, Toppila E, Zou J, Erna K. Individual susceptibility to noise-induced hearing loss. Audiol Med. 2007;5(1):41-53 ISSN 1651-386X.
20. Couth S, Prendergast G, Guest H, et al. Investigating the effects of noise exposure on self-report, behavioral and electrophysiological indices of hearing damage in musicians with normal audiometric thresholds. Hear Res. 2020;395:108021. Doi: 10.1016/j.heares.2020.108021
21. Aazh H, Danesh AA, Moore BCJ. Internal Consistency and Convergent Validity of the Inventory of Hyperacusis Symptoms. Ear Hear. 2021;42(4):917-926. Doi: 10.1097/AUD.0000000000000982
22. Couth S, Prendergast G, Guest H, et al. A longitudinal study investigating the effects of noise exposure on behavioural, electrophysiological and self-report measures of hearing in musicians with normal audiometric thresholds. Hear Res. 2024;451:109077.
23. Sataloff RT. Hearing loss in musicians. Am J Otol. 1991;12(2):122-7.
24. DECRETO LEGISLATIVO 9 aprile 2008, n. 81. Attuazione dell'articolo 1 della legge 3 agosto 2007, n. 123, in materia di tutela della salute e della sicurezza nei luoghi di lavoro. Gazzetta Ufficiale della Repubblica Italiana - Serie Generale n. 101; 30 aprile 2008.
25. Pira E, Bosio D, Merluzzi F. (Prevention of noise-induced hearing damage in the workplace - guidelines proposed by the Italian Society of Occupational Medicine and Industrial Hygiene) La prevenzione dei danni uditivi da rumore in ambiente di lavoro-linee guida proposte dalla Società Italiana di Medicina del Lavoro e Igiene Industriale. [in Italian] Ed. PIME 2003. ISBN:8879631500
26. UNI EN ISO 1999:2015 Acoustics - Estimation of noise-induced hearing loss [Article in Italian].
27. Parati L. Risk Assessment to Surveillance Planning in a Lyric Theatre: a Focus on Noise Exposure in Orchestra and Chorus. Practical Aspects, Problems and Peculiarities. Occupational Voice Symposium, UCL London, 2017.
28. Roth TN, Hanebuth D, Probst R. Prevalence of age-related hearing loss in Europe: a review. Eur Arch Otorhinolaryngol. 2011;268(8):1101-1107. Doi: 10.1007/s00405-011-1597-8
29. Brunetti B, Menzio P, Morra B. [Juridical and methodological problems in the evaluation of occupational hearing loss.]. Problemi giuridici e metodologici nella valutazione delle ipoacusie professionali. [Article in Italian]. Acta Otorhinolaryngol Ital. 1985;5 Suppl 6 :3-34.
30. Royster JD, Royster LH, Killion MC. Sound exposures and hearing thresholds of symphony orchestra musicians. J Acoust Soc Am. 1991;89(6):2793-2803. Doi: 10.1121/1.400719
31. Schmidt JH, Pedersen ER, Juhl PM, et al. Sound exposure of symphony orchestra musicians. Ann Occup Hyg. 2011;55(8):893-905. Doi: 10.1093/annhyg/mer055
32. Obeling L, Poulsen T. Hearing ability in Danish symphony orchestra musicians. Noise Health. 1999;1(2):43-49.
33. Kähäri KR, Axelsson A, Hellström PA, Zachau G. Hearing development in classical orchestral musicians. A follow-up study. Scand Audiol. 2001;30(3):141-149. Doi: 10.1080/010503901316914511
34. Behar A, Chasin M, Mosher S, Abdoli-Eramaki M, Russo FA. Noise exposure and hearing loss in classical orchestra musicians: A five-year follow-up. Noise Health. 2018;20(93):42-46. Doi: 10.4103/nah.NAH_39_17
35. Eaton S, Gillis H. Review of Orchestra Musicians' Hearing Loss Risks. Canadian Acoust. 2002;30(2):5-12.
36. Johnson DW, Sherman RE, Aldridge J, Lorraine A. Extended high frequency hearing sensitivity. A normative threshold study in musicians. Ann Otol Rhinol Laryngol. 1986;95(2 Pt 1):196-202. Doi: 10.1177/000348948609500219
37. Suen JJ, Betz J, Reed NS, Deal JA, Lin FR, Goman AM. Prevalence of Asymmetric Hearing Among Adults in the United States. Otol Neurotol. 2021;42(2):e111-e113. Doi: 10.1097/MAO.0000000000002931
38. Bidelman GM, Bhagat SP. Right-ear advantage drives the link between olivocochlear efferent 'antimasking' and speech-in-noise listening benefits. Neuroreport. 2015;26(8):483-487. Doi: 10.1097/WNR.0000000000000376
39. Reybrouck M, Podlipniak P, Welch D. Music and Noise: Same or Different? What Our Body Tells Us. Front Psychol. 2019;10:1153. Doi: 10.3389/fpsyg.2019.01153
40. Strasser H, Irle H, Legler R. Temporary hearing threshold shifts and restitution after energy-equivalent exposures to industrial noise and classical music. Noise Health. 2003;5(20):75-84.
41. Perrot X, Collet L. Function and plasticity of the medial olivocochlear system in musicians: a review. Hear Res. 2014;308:27-40. Doi: 10.1016/j.heares.2013.08.010
42. de Boer J, Thornton AR. Neural correlates of perceptual learning in the auditory brainstem: efferent activity predicts and reflects improvement at a speech-in-noise discrimination task. J Neurosci. 2008;28(19):4929-37. Doi: 10.1523/JNEUROSCI.0902-08.2008. PMID: 18463246]
43. Probst R, Lonsbury-Martin BL, Martin GK. (1991). A review of otoacoustic emissions. The Journal of the Acoustical Society of America. 89(5):2027–2067.
44. Moore BCJ, Huss M, Vickers DA, Glasberg BR, AlcántaraJI. A test for the diagnosis of dead regions in the cochlea. British Journal of Audiology. 2000;34(4), 205–224.
45. Tomasina F, González AE, Pisani Biriel MA, et al. Audiometric Database of Academic Musicians in Uruguay. Med Lav. 2025;116(3):16424. Doi: 10.23749/mdl.v116i3.16424
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All Journal's articles are Open Access papers distributed under the terms of the Creative Commons Attribution License CC BY-NC 4.0 Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
