Music to your ears?

Employers
have a duty to protect staff from harm at work, including loud noises. But what
if that is part and parcel of what they do? A BBC OH manager talks about the
dilemma OH faces with its orchestra members, by Susanna Everton

The BBC has five orchestras and is probably one of the largest employers of
orchestral musicians in Europe. There is a duty of care to protect them from
being harmed while at work by exposure to loud sounds – but in the case of
musical noise, that is precisely what they are employed to produce. There lies
the dilemma.

In 1989, the Noise at Work Regulations were introduced to give a legal
definition to the obligations of employers to prevent damage to the hearing of
workers from excessive noise at work.1 The premise of any control of noise in
the workplace should be that every employer should reduce this risk of damage
to the lowest level reasonably practicable.

In 2006, the European Directive 2003/10/EC on the minimum health and safety
requirements regarding the exposure of workers to the risks arising from
Physical Agents (Noise) will have to be incorporated into UK law.2

The emphasis of the directive is in the prevention of noise exposure through
incorporating measures at the design stage, in the selection of equipment,
procedures and work methods and, finally, in individual protection.

The exposure level standard will continue to be ISO 1999:1990,3 and the
reduction in sound levels before action is required has been reduced by 5dB
(see Table 1). Those in the entertainment industry have been given an extra
two-year implementation period in recognition of the difficulties there will be
in producing enforceable practices.

Excessive noise as a cause of hearing damage has been known for centuries,
and was first described as an occupational hazard by Ramazzini in 1713.4 The
first UK study of occupational noise-induced hearing loss by Barr was published
in 1886, but it was only in the 1960s that studies on musicians started to show
associations between their hearing and noise exposure.5

So, what is noise?

Noise is often described as unwanted sound, but is that true of music? It is
also subjective – we all hear sound differently, so how can it be measured?
Sound is a vibration that sets off a pressure wave formation in the air that,
depending on what is around, can be absorbed or bounced back. Sound is measured
in loudness (amplitude) and distance (frequency).

Loudness in musical terms:

– Pianissimo (ppp) – 40-50 dB spl

– Fortissimo (fff) – 90-110 dB spl6

Loudness depends on the conductor, the musicians and the general quality of
the instruments, the acoustics of the venue, the piece being played, the seating
arrangements of the players and their own perception of what they hear. You are
probably familiar with loud pieces of orchestral music – for instance,
Tchaikovsky’s 1812, complete with cannon fire, as well as the quiet pieces such
as Handel’s Water Music – both at opposite ends of the spectrum.

What are the consequences?

If repeated exposure to noise is experienced, the individual develops a loss
of sensitivity to sound at 4 KHz – which shows as a dip in an audiogram.

With continued exposure, the loss can spread into neighbouring frequencies
and produce a chronic hearing deficit, which is irreversible. Associated
symptoms can include tinnitus, a sensation of noise (whistling, ringing,
humming) arising in the individual’s head, and hyperacusis, a sensitivity to
noise that can cause an individual to feel pain. It is also an industrial
disease entitling the individual to disablement benefit.7

So how do we demonstrate the management of the risk of hearing damage from
exposure to noise in orchestral musicians?

One of the roles of OH is to assist management in identifying potential
causes of ill-health arising from work and advising on control measures to
prevent new cases from occurring, as well as monitoring the ill health effects
of work activity in an employee (or worker). This can be done by adopting a
planned approach – the who, when, where, how process.

– Who is at risk? All sorts of people may be affected by noise, but
it depends for how long, what the levels are and how frequent the exposure is –
musicians, conductors, performers, vocalists, audio engineers, lighting
technicians, orchestra managers, roadies, venue staff, and the audience are all
affected.

There is no specific legislation that sets limits for audience exposure to
noise. However, the requirements of the Health and Safety at Work Act 1974 and
civil law duties place a responsibility on protecting audiences and levels not
exceeding 107 dB(A) should be set.8

Finally, consider the risks for anyone visiting the site who may not be prepared
for the activity within.

– When are they at risk? During practice, rehearsal and performance;
when commuting in cars or trains; when exposed outside work in teaching,
gardening or DIY; during sporting activities or when visiting the theatre or
cinema. Hearing loss is a cumulative condition.

– Where are the risks? Most members of an orchestra are likely to be
subjected to noise levels at or above the first action level 85dB (A), or even
second action level 90 dB (A) over an eight-hour working day or 140 dB (A)
peak.

My own dosimetry of musicians within our orchestras has revealed levels of
94 dB (A) in the brass and woodwind sections during certain pieces.

These situations may arise from their own instrument, other players in
adjacent areas or the piece they are playing; whether there is a public address
system in use or amplification; whether they are in a large auditorium or
recording studio.

Small theatre pits, where players are packed in tight under a low ceiling,
require them to play louder to get the sound out, which increases their noise
exposure risk.

– How to control risks? We need information on the hazard and this
can be achieved through collecting data of the sound levels. Then by using a
risk assessment process, we can review the activity.

– Conduct a noise assessment

– Is there a noise hazard?

– Who is exposed?

– Evaluate risks from hazard

– Record the findings

– Create a noise action plan

– Review, and revise

– Look at the work schedule for the individual/group

– Start a health surveillance programme for those at risk

– Look at ways of reducing their exposure

– Hold education sessions and seminars on hearing health and protection

– Provide and fit suitable personal protective equipment designed for
musicians

– Monitor compliance

– Audit.

In noise reduction for orchestras, it would be unacceptable to remove the
source of the noise or substitute it.

Audiences would not welcome being enclosed, but it is possible to reduce exposure
through alterations in heights of stages and platforms; increasing the distance
between players; using baffle screens and acoustic absorbent materials in
furnishings; monitoring the time and level of exposure; restricting the
schedules of players in rehearsal, performance and practice with rests in
between; reducing extra-curricular exposure to music and other high sound
levels; and reviewing the repertoire.

Health surveillance is a method that should be used by managers to fulfil
their responsibilities where a member of staff is exposed to a hazard that may
cause harm. There are valid, reasonable techniques to detect early signs of
harm, and early detection of harm can benefit the individual.

In a case of noise exposure, the health surveillance procedure should be
carried out by a competent occupational health nurse (OHN). Tests should
include a hearing questionnaire with relevant medical, hearing and occupational
history, examination of both ears and an audiometric test from 500 Hz to 8,000
Hz.

Palin suggests that a detailed history of ear pathology, family history,
noise exposure, occupational history and leisure activities is invaluable in a
proper assessment of an individual’s hearing health.9

It is vitally important for the employer, the individual and for the
validity of the results that a standardised test procedure is in place. There
may be legal liability based on a hearing test result, which therefore needs to
be accurate and valid. Guidance for conducting audiometric testing is available
from the HSE.10

Personal protective equipment is difficult for musicians, as they have to be
able to hear themselves and their colleagues when playing. Industrial hearing
protection is not appropriate, so much work has been done on achieving a plug
that can reduce the damaging sound frequencies but still allow the musician to
hear clearly.

There are now plugs on the market that are differently attenuated to suit
the needs of violinists through to percussionists, based on the Elmer Carlson
plug, commonly known as the ER Range.11 However, many ‘blowing’ musicians
cannot blow with ear plugs in the canals. It may be that musicians can be
persuaded to use hearing protection in all noisy activities except for the
actual performance, and thus reduce their exposure.

Musicians can be exposed to very loud sound levels that increase their risk
of developing an irreversible noise-induced hearing loss or associated
symptoms, but the employer has a legal duty to prevent this and needs to
demonstrate its assessment of risk, control measures and its methods of
monitoring the situation. Musicians have a legal duty to comply with these
measures.

Orchestras will continue to play loud music and audiences will still want to
attend concerts where loud music is played. Our duty is to make this happen in
a healthy and safe way.

References

1. Reducing noise at work. Guidance on the Noise at Work Regulations – HSE,
1989, L108,HSE Books

2. Directive 2003/10/EEC of the European Parliament and of the Council –
Official Journal of European Union, 15.02.2003, L 42 /38-44

3. Acoustics – determination of noise exposure and estimation of
noise-induced hearing impairment – International Organization for
Standardization, Geneva Switzerland, ISO 1999 (1990)

4. Noise – Bell A, 1966, WHO Geneva, Switzerland

5. Hearing in classical musicians – Axelsson A and Lundgren F, 1981,
Acta-Oto-Laryngologica supp 377 3-74

6. Musicians and the prevention of hearing loss – Chasin M, 1996, Singular
Publishing,San Diego

7. Ill or disabled because of a disease or deafness caused by work – SD6,
2001, Benefits Agency, Leeds, DWP Communications

8. The Event Safety Guide – HSE, 2001, HSG195 Sudbury, HSE Books

9. Does classical music damage the hearing of musicians? A review of the
literature – Palin S, 1994, Occupational Medicine 44:130-136

10. MS26 – A guide to audiometric testing programmes – HSE, 1998, Sudbury
HSE Books

11. Improved audibility earplug – Killon MC et al, 1992, US Patent 5 113,967
in Chasin (1996)

Susanna Everton RGN OHN MSc MIOSH, manager divisional support, BBC
occupational health, safety and security, susanna.everton@bbc.co.uk

For more information

– Reducing Noise at Work, HSE Books,
1998, ISBN 07 17615111

– Noise at Work – guidance on regulations, HMSO, 1989, ISBN 0
11 885512 3

– Health Surveillance in Noisy Industries, HSE books, 1995,
ISBN 0 7176 09332

– Sound Solutions, HSE books, 1995,ISBN 0 7176 07917

– HSE website www.hse.gov.uk

– RNID publications, PO Box 16464, London EC1Y 8TT

– A Sound Ear, Alison Wright Reid, ABO, 2001, ISBN
9536789 3 8

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