Monitors - Michigan Audiology Coalition

Who we are…
What we do…
• Sensaphonics isn’t just a manufacturer--it’s a clinic!
• We also mentor, teach, and conduct research and product development
• We work with an unregulated industry at risk for hearing loss……MUSICIANS!
AFFILIATIONS
• PRESIDENT SENSAPHONICS HEARING WELLNESS
• HEARING HEALTH SCIENCE
• NATIONAL HEARING CONSERVATION ASSOCIATION ( NHCA)
• AMERICAN ACADEMY OF AUDIOLOGY (AAA)
• ILLINOIS ACADEMY OF AUDIOLOGY (ILAA)
• NATIONAL ASSOCIATION OF MUSIC MERCHANTS (NAMM)
• RECORDING ACADEMY / MUSICARES ( GRAMMY AWARDS)
• AUDIO ENGINEERING SOCIETY (AES)
THE RECORDING ACADEMY AND MUSICARES
HEARING DAMAGE CAN BE AN UNFORTUNATE BY-PRODUCT OF WORKING IN THE
MUSIC INDUSTRY, AND FOR MANY YEARS THE RECORDING ACADEMY’S MUSICARES®
CHARITY HAS TAKEN STEPS TO ADDRESS THIS CONCERN BY PROVIDING OUTREACH
AND SCREENINGS FOR MUSIC PEOPLE IN NEED. AS THE DEMAND FOR THIS TYPE OF
CARE HAS INCREASED, WE’VE PROACTIVELY RESPONDED BY EXPANDING OUR
HEARING CLINICS, OFFERING THEM ACROSS THE COUNTRY THROUGHOUT THE YEAR TO
PROVIDE ASSESSMENT AND TREATMENT FOR MUSICIANS AND INDUSTRY
PROFESSIONALS. IN ADDITION, THE RECORDING ACADEMY WILL BE LAUNCHING THE
GRAMMY® HEARING HEALTH CAMPAIGN IN EARLY 2016 TO FURTHER ADDRESS ISSUES
OF AUDITORY WELL-BEING IN OUR MUSIC COMMUNITY.
NEIL PORTNOW
PRESIDENT/CEO
THE RECORDING ACADEMY AND MUSICARES
Is the music industry at risk?
Brashears-Morlet, Santucci, Morlet (2006)
887 musicians screened for:
• Me infections
• Genetic loss
• Non-music noise exposures
• Oto-toxicity
All completed audiometry, tympanometry, and case history / lifestyle survey
Conclusions: Musicians had poorer thresholds, especially at 3, 4 and 6K hz than the
ISO standard.
Comparison of men in their 20s
250
-5
0
5
10
15
20
25
30
500
1000
2000
3000
4000
6000
8000
Musician
s RE
Musician
s LE
ISO AU
Comparison of men in their 30s
250
-5
0
5
10
15
20
25
30
500
1000
2000
3000
4000
6000
8000
Musician
s RE
Musician
s LE
ISO AU
Comparison of men in their 40s
250
-5
0
5
10
15
20
25
30
500
1000
2000
3000
4000
6000
8000
Musician
s RE
Musician
s LE
ISO AU
Why don’t they protect themselves?
1.
2.
3.
4.
5.
6.
7.
8.
Perception that there will be too much compromise to music sound quality and
it will affect job performance
Unaware of viable HLP tools or where to get them
Don’t want to listen at lower levels
Don’t feel they’re at risk to damage hearing
Think it’s too late
Think gear and appointment will be too expensive
Inconvenient to see audiologist during normal business hours
Don’t care that much about their hearing
Want to work with musicians?
• Regulated
• Educated
• Tested
• Unregulated
• Uneducated
• Untested
• Is his hearing less important?
• Is his hearing more important?
If he came to see you for earplugs or in-ear
monitors…would you treat him differently?
No regulations, but principles are the
same…
• Education and motivation
• Case HX
• Engineering and administrative controls
• Audiometric monitoring
• Sound level measurements
• Molding and fitting of the protective device
• Detective work for the individual musician
Most effective
EDUCATION & MOTIVATION
Effects of MIHL/MIHD
• Temporary and permanent loss of frequency resolution
• Tinnitus (ringing)
• Hypersensitivity (decreased sound tolerance
• Distortion
• Diplacusis (inability to find pitch)
Research bits
•74% of musicians report a hearing disorder or a combination of symptoms (Kahari
2003)
•70% of the audiograms for violinists in the CSO showed a 4khz notch in their left
ear (Royster 1996)
• In quiet, only 6% listen to i-pod at risky levels, in noise 80% exceed NIOSH
guidelines (Portnuff 2006)
Case hx
• What are your hearing concerns?
• When was your last hearing test and what were the results?
• How long is your typical performance time?
• Do you wear hearing protection when you play and what type?
• How loud are your stage monitors or personal monitors?
• What about non-musical over-exposures?
• When were last exposed?
• Also patient draws sound sources on stage
Education--more than just sound exposure!
• Genetics
• Disease
• Injury (ototoxic / head trauma)
• Vascular function
• Loud sound
Sound level measurements
• If possible, get sound level readings to determine risk and recommend
appropriate hearing protection
• If sound level readings aren't available, look at exposure time and estimate
probable db level
Baseline & repeat testing
• Without regulations, hearing
testing and re-testing
becomes one of the only
ways to determine the
effectiveness of the hearing
conservation program
• Capability to test 10khz and
above a plus
Methods of protection
• Traditional ear plugs / muffs / napkins / cigarette butts …
• Hi fidelity earplugs ( custom and generic)
• Active earplugs
• Etymotic’s Music-Pro, 3D system
• Personal in-ear monitors ( reduction of on-stage loud speakers)
• Acoustic modifications to the work environment
How to choose a filter
Good impressions are critical!
Technique…….Closed jaw or bite block?
Closed vs. Open Jaw (Lerner, NHCA 2015)
• The study completed probe mic testing with earplugs from open jaw and closed
jaw impression as well as low viscosity and high viscosity impression material
• Significantly more attenuation with high viscosity impression material
• Slightly more attenuation with open mouth impressions (average of 1 dB)
PA systems
• A means of amplifying on-stage sound sources in order to reach
listeners
• Listeners include audience AND performers
They come in all shapes and sizes
Aren’t bands loud enough already??
•
•
•
•
Microphones on each amp, each drum, each vocalist
Microphones then feed into the mixing boards where the sound is “mixed”
Acoustic instruments often go “direct” into the mixer and have no amp on stage
The mixed signal feeds into power amps which deliver an amplified signal to the
loud speakers
Live performance sound systems (pro)
Two separate systems
•
Mains or “front of house”
•
•
•
Monitors
Help the audience hear
•
Front of house engineer – one mix
Monitor engineer – many mixes!
Can interfere with performers
Help performers hear!
What does the monitor engineer do?
He makes a mix for the performers!
A mix is a blend of instruments catered to each performer’s needs
• Like baking a cake
• Better ingredients & more experienced baker= better taste and design
• Better performers & more experienced engineer= better sound and
experience
A good room is like a good oven
Monitors
Wedges
• At feet of performer
•
•
facing up
Provide individual
mixes for each band
member
Gain before
feedback issues
Signal-to-noise: Loudest Wars!
SPL of the snare drum alone can reach and often exceed 105 dba.
• Drummer’s monitor system (to hear rest of band) needs to be at least 6 db louder
than the snare drum.
• Electric guitarists, keyboardists and bassists have a similar problem in that, if the
drum kit is loud (it is naturally); then their monitors needs to be louder to be heard.
• This is simply so the instrumentalists can perform properly in the presence of a
drummer.
Gain before feedback (GBF)
• A loudspeaker system can be challenged to provide feedback-free sound
reproduction for a vocal microphone less than 6 feet away.
• Loudspeakers in close proximity to microphones can lead to feedback loops as
well as instable or undesirable resonant frequencies
• Due to the spectral content of the microphones and the acoustic behavior of the
loudspeakers in the space where they are interacting.
Volume war…
Competitive monitoring
Musicians’ need on stage
amplification
Guitar and bass amps
Drums
Vocals and acoustic
instruments
SPL exceeding 110 dBA on stage
OSHA says ½ hour
NIOSH says not safe!
The big picture
The peace treaty
• Earplugs
Safer, but compromises
• In-ear monitoring (IEM)
Works on any size stage
Easy to individualize mixes
Can protect hearing… when
used properly
Safety is not the main concern for musicians--performance is. The ability to “listen
better” while on stage is promised by IEMs– not plugs
Unlike plugs, personal in-ear monitors
enhance sound quality during live performances
Benefits of IEMs
• Improved sound quality
• Improved pitch perception
• Improved timing
• Consistent sound quality between venues
• Complete mobility with wireless system
• Reduced feedback
• Reduced vocal fatigue
• Lower sound levels for the audience
• And…
…the potential to reduce sound
levels and protect hearing without
compromise to sound quality
THIS
VS THIS
Musicians’ perspective:
…The first concern is
the performance
…Secondary concerns
are sound, comfort,
professionalism, and
safety
To use IEMs, you can be wireless or
hardwired…
Hardwired is ideal for musicians
who don’t need to move around
stage (like drummers)
IEMs
They come in various shapes, sizes, makes, and models…
Universal fit (with custom sleeves)
Acrylic
Silicone
IEM speaker types
• For sound quality, to isolate or not isolate depends on the speaker
• Dynamic drivers (speakers) sound best with a less occluded canal and with open vents
• Balanced armatures sound best with a deep fit and no vents for maximum isolation
Dynamic speakers
• Single
• Round iPod type earbuds
• Vented for free movement of diaphragm
• Designed for open ear canal (2cc volume)
Balance armature speakers
• Square shaped
• Non-vented
• Designed for closed canal (.5cc)
• Enhanced bass with tight seal
• Used as a single or in multiple combinations
Single Balanced Armature
Dual Balanced Armature
Triple Balanced Armature
How many are too many??
• Today, 4, 5, 6 and 8 drivers per ear are very common from many manufacturers
• Sensitivity doubles when doubling the number of drivers making it more difficult to
listen safely
• Lower impedance at low frequencies can cause wireless beltpack to become unstable
Materials, isolation, & sound quality
• Balanced armature speakers sound better with a tight seal and no leaks.
• Seal variables
• Material used for the IEM shell
• Impression techniques
• Softer materials seal better and can be worn comfortably for longer
durations
• Manufacturers offer different grades of softness from semi-soft (thermoplastic) to very soft (silicone).
Materials, isolation, & safety
• The better the seal, the better the bass response and isolation from competing
sound sources.
• High degree of isolation increases s/n ratios in the ear canal
• Better signal-to-noise ratios can decrease the risk that the performer will drive the
monitors at unsafe levels
Isolation can create new problems…
• Too much separation from audience and room
• Unable to communicate with other band members
• Loss of localization / directional cues
• Loss of spatial recognition
Old solutions
1. Take out one earpiece to hear the room
•
•
•
Loses binaural summation
Open ear is at risk from stage volume
Central masking causes increase in volume in monitor ear
2. Vent the Earpiece
BOTH OF THESE OPTIONS SHOULD BE AVOIDED
3. Mic the room
3D Active Ambient
3D AARO
• Active ambient earphones
incorporate tiny, binaural
microphones on the outside
of the custom-fitted
earphones which allow a
performer to dial-in a userselect amount of ambient
sound through the personal
amplification system
Features of 3D AARO
• An active attenuation control offers many options ranging from zero attenuation
(sounds like the user’s ears canals are open) to -24 dB of flat frequency attenuation in
six distinct 4 dB increments.
• A “full” attenuation setting (no ambience) where the bias voltage for the microphones
is interrupted, causing them to mute; resulting in >30 dB of non-linear, occludedsounding, ambient isolation.
• A stereo input connector enabling a personal monitor mix to be introduced into the
wearer’s plugged ears just like any traditional IEM earphone.
Internal/external controls
But are they really safe??
• IEMs provide us with a unique
opportunity to introduce hearing loss
prevention to the musician.
• Manufacturers all claim that used
properly, personal monitors can
protect hearing, but how can you
direct a musician to safe listening
levels from an earphone and, will
they be protected if you can’t?
Vanderbilt study (Federman/Rickets)
• The study compared sound levels, measured in-situ,
between floor monitors and
in-ear monitors during a performance. Subjects were asked to turn both types of
monitors to preferred listening levels (PLLs) and minimum acceptable listening
levels (MALLs)
• PLLs 110.9(floor) 110.1 ( in-ear)
• MALLs 1.8db less (floor) 6db less (in-ear)
Otherwise it’s guesswork
•
In-ear sound level measurements using probe mic technology and an a-weighted
sound level meter is currently the only method to determine safe, time-weighted
levels from a personal monitor
Probe mic measurements
• In-ear sound level measurements can be taken during rehearsal or sound check
• Must have an a-weighted SLM
• Must account for diffuse field inverse (DFI)
• Must be portable
• Band must be available
IEM measurement
• Because speakers within an IEM are inserted into the wearer’s ear canals, a freefield measurement is difficult to accomplish.
• An in-line sound level analyzer has been developed to measure particular insert
earphones.
dBCheck in-ear sound analyzer
(patented)
• Averages in dBA
• Converts dBA to safe exposure
• Limits displayed in minutes
• Minutes displayed for OSHA and NIOSH
• Serves as SLM with mic function
Converts a known earphone’s input sensitivity
characteristics and a given voltage from a headphone
amp to equivalent SPL measurement in dBA and
minutes of safe use
Damage or safety
• IEMs are likely causing as much, if not more, hearing damage as the loudspeakers
they have replaced on large scale concert stages.
• IEMs can be used safely, as is historically shown; with proper education of the user
about the active device’s potential to damage hearing, real-time measurement of
the active devices in use and repeat hearing screening
Case studies on 2 musicians
• Musicians were educated on dangers of in-ear monitoring
• Personal case histories were discussed
• Pure tone audiograms taken at Sensaphonics
• Dual speaker model (silicone)
• Guidance on safe levels provided by in-ear SLMs
So your patient has hearing loss…
3D AARO can be made as a 3D-CROS, but it can also be used to amplify existing
hearing loss!
3D-ME
• Larry Revit, an audiologist, audio engineer, and performing musician with hearing
impairment, first tried the method now known as 3D-ME
• With his knowledge of engineering, audiology, and music, he was able to take the
output of the 3D AARO microphones, process them for his individual needs as a
musician via EQ and compression, and return them with his monitor input
Why is 3D better for music?
• Revit was dissatisfied with using hearing aids for obvious reasons….
• Note: Hearing aid comparison is approximate
How Revit used it…
“When I tried the monitors… it was
bittersweet. How much of this was I
missing my whole life?”
“I hear myself playing bad notes,
before I wasn’t sure.”
Pure tone air conduction thresholds.
Hearing loss is sensorineural and
genetic
“[Since using 3D-ME] I’ve never
been more elated about my
music.”
Pure tone air conduction thresholds.
Hearing loss is sensorineural
Backstage etiquette and professionalism
You’ll need access
and a pass
Be aware of your surroundings!
• Do not touch the equipment
• Do not lean on it
• Don’t sit on it
• Do not set drinks on it!!!!!
• Don’t get run over during a load-in or load-out
• Don’t walk into a dressing room uninvited, even with an all access pass
• Always respect your contact and referral source--the monitor engineer
Outreach to the local music industry
• Not just local musicians and engineers, but also includes music consumers
(especially younger generations and teens!)
Outreach to younger generations…
• The world health organization states that 1.1 billion teenagers are at risk for
hearing loss from personal music players and loud nightlife
Teens--Are we overprotective?
• Looking at damage-risk criteria from OSHA and NIOSH…is it appropriate for
teens?
• Can we apply the “40 year working lifetime” to them? (Hopefully they’ll be
enjoying music and nightlife for longer than that!)
Reaching teens
• Education, motivation, and access to hearing health—make yourselves available as
audiologists!
• Programs like Dangerous Decibels are great for spreading information to even younger
generations
• Simulations of SNHL are certainly helpful for reaching some
Outreach
So what do we do?
GO TO THEM. Team up with local bands,
local hang out spots—MAKE IT COOL
• OUTREACH & EDUCATION, OUTREACH & EDUCATION,
OUTREACH & EDUCATION…….
Conclusions
• Measurement of SPL is the first step in determining risk level and potential behavioral
changes that can be employed to protect hearing
• Filtered, high fidelity, earplugs can be used when the spectral balance of a loud sound
source must be heard clearly but attenuated at a fixed amount
• IEMs are “earplugs” by nature however; research shows them as “not necessarily
protection devices”
• Musicians deserve guidance on hearing loss prevention strategies and complete care
Musicians and AuDs
•
Needs of a musician are unique from non-musician clients
•
Every musician has specific needs
•
Musicians will feel more comfortable with an audiologist who “gets it” and can
teach them something about hearing conservation in their industry and solutions
that will help them perform
Great sound quality, comfort, safety, & professionalism
= Happy musicians, engineers, and patients!