Are My Earplugs Good Enough for Music Rehearsals?

Dear Dr. Nagler,

First, thank you so much for your time. I’ve been dealing with tinnitus for the last 8 weeks. I can hear it all day long, aside from the shower. I’m a band director and musician for almost 20 years. I have a very small dip in hearing around the 4 kHz mark. I’m guessing this is where the tinnitus is coming from, but it’s a guess really. I’m told my hearing is excellent by several ENTs and audiologists. I’ve purchased molded ear protection in an effort to not make the tinnitus any worse. I’ve been using them almost since the onset of my lovely ring/hiss/electric static/etc.

Here’s my first question - my rehearsals are typically fluctuating between 60 and 85 decibels. They don’t often get into the 80s, but it does happen briefly. My ear plugs are supposed to cut out 25 decibels. Is this satisfactory? I ask because my right ear (which was the louder ear) was gradually coming down in volume, but now my left ear has jumped, which till now wasn’t as prevalent. Am I still damaging my ears, or is this typical within the first months of tinnitus?

My second question - how do I habituate when I’m constantly wearing ear protection at work? It brings my attention to the tinnitus... even more.

Teaching music is how I make a living-please help.

Very best
Tom

 

Hello @MusicTeacher. Thank you for your question. I sense some urgency on your part, and I just wanted you to know that you haven't fallen off my radar. I am pretty well covered up today - but I will try to respond as soon as I am able. Please check back.

Regards -

Stephen M. Nagler, M.D.

 

OK @MusicTeacher Tom. I'm going to at least get started with my response and see how far I get.

You wrote:

So if you are normal, that means you are about to get overwhelmed, if you are not there already. You are wondering (1) how the hell did this happen to you? (2) will it ever go away? (3) if it doesn't go away, what will your life be like? Stuff like that.

Please do not be alarmed! (It happens to all of us.)

It's great that you can get some peace and quiet. Plus, likely you are the cleanest fellow in your neighborhood!

Hard to say. Often the tinnitus frequency is near the edge of the dip on the audiogram - the so-called "edge effect" - but even that phenomenon is inconsistent. Regardless, it has no diagnostic, therapeutic, or prognostic implications.

Reminds me of the writing on a coffee mug I saw the other day: "I may not be perfect, but parts of me are excellent."

So here it gets a little tricky. Molded ear protection is designed to protect you from auditory damage, which is very important. But it has little or nothing to do with tinnitus. You can have a lot of auditory damage and not have any appreciable tinnitus. You can have a normal audiogram and have screaming tinnitus 24/7. And you can have all sorts of combinations and permutations in between. Moreover, just because your tinnitus is louder, that does not necessarily mean it is worse. There are folks with soft tinnitus who are largely incapacitated by it. There are folks with loud tinnitus who are hardly affected at all. Importantly, there are folks with loud tinnitus who used to be largely incapacitated by it and who now are hardly affected at all even though their tinnitus has not changed a whit! And, again, you can have all sorts of combinations and permutations in between.

I'm not sure I would use earplugs unless the ambient sound were of such an intensity that it could potentially damage your hair cells. Overprotecting can predispose to hyperacusis and can make your tinnitus sound louder as your auditory system, upon not being able to readily access normal environmental sounds, "turns up the gain" in order to hear, which, after all, is its raison d'être! You have not caused yourself any sort of damage by overprotecting, but I do believe some guidelines are in order.

More to follow, Tom. Please check back.

Stephen M. Nagler, M.D.

 

So, @MusicTeacher Tom, to pick up where I left off yesterday ...

The simplest guideline for when and when not to use ear protection would be the one devised by Dr. Jack Vernon (1922-2010). Dr. Vernon suggested that if you have to raise your own voice in order to be heard by a person standing next to you, then the room is too loud for you and everybody else, whether or not he or she has tinnitus. So either use ear protection, or leave the room. Moreover, if the loudness in the room does not meet that threshold, then you should not use ear protection. I doubt highly that the volume in your rehearsal hall is that loud, which means you have no need for ear protection at all; indeed, as I mentioned in my post above, the disadvantages of overprotection outweigh the advantages.

Another way to look at it would be the criteria of the Occupational Safety and Health Administration, which state that a worker can safely be in an environment where the ambient level is 90dB for 8 hours a day daily. According to your post, the volume you are exposed to in your work as a music teacher rarely gets into the 80s, and even if were to reach 90dB, the exposure would be relatively brief. Since auditory damage is a function both of noise level and length of time of exposure, I would say that the best place for your ear plugs would be your pocket; and keep them there until you are using your leaf blower in your front yard!

I know, I know. Your main concern is to avoid aggravating your tinnitus; that's why you are wearing earplugs all day long. And the point I want you to take from all this is that you cannot possibly live your life with an eye towards trying to avoid situations that might aggravate your tinnitus unless those situations also represent the possibility of causing permanent auditory damage - because there is simply no way you can "outsmart" your tinnitus. In general, your tinnitus is going to do exactly what it wants to do - and the more you let your tinnitus dictate where you go (and what you eat, etc.), the more power you give it, power your tinnitus simply does not deserve. (The "where you go" part of it includes wearing ear plugs in environments the do not represent a threat to auditory damage.) Is it possible that you might be an exception to the above general principle? Sure, I guess so. But in my opinion, it would be highly unlikely.

Your other question had to do with whether or not your wearing earplugs all day long somehow interferes with habituation. Well, first of all I have suggested that you consider discontinuing the use of earplugs at work (because, as I state again for emphasis, the disadvantages of wearing them all day long when the ambient sound levels to not represent a threat to hair cell health outweigh the advantages), but even if you did have to wear them for whatever reason, habituation is all about reaction to tinnitus regardless of what the volume of that tinnitus might be at any given point in time. Perhaps consider it like habituating to the concept of tinnitus rather than to any particular loudness, pitch, or timbre.

I am attaching my "Tinnitus 101 for Newbies" article in case you have not yet come across it. "Message Number Four" in the article addresses ear protection.

Hope this helps.

All the best -

Stephen M. Nagler, M.D.