From drum roll to tinnitus

Daniela Gut - Many cases of musicians with tinnitus and hearing loss are known from history. Beethoven is probably the best known case. His hearing began to deteriorate at the age of twenty, and this was accompanied by the onset of very disturbing tinnitus. Later, he even lost his hearing completely, but the tinnitus persisted. The cause of this problem in Beethoven's case has not yet been clarified. Otosclerosis, a progressive bony fixation of the stapes, or neurolues, a late form of syphilis, have been discussed. Attempts were made to solve this mystery by exhuming the body. Unfortunately, however, the rock bones (bones containing the auditory apparatus) were missing, so that no new findings came to light.

Musicians are exposed to high levels of noise throughout their professional lives. Be it in the orchestra, during rehearsals or when teaching. The greatest noise exposure is generated by their own instrument.

In the case of noise damage, a distinction is made between acute and chronic noise trauma. In acute noise trauma, there is a brief, strong noise impact - like a gunshot. The typical frequency for this is 6000 Hz. Chronic noise trauma is defined as prolonged exposure to noise with a sound pressure level of over 85 dB.

Both disorders can lead to the development of tinnitus. The latter is defined as any form of ringing in the ears. It can be a tone, but also a hissing, buzzing and so on.

"Tinnitus" is therefore more of a symptom than a diagnosis. The causes are very different and do not even have to originate in the ear. Examples include temporomandibular joint problems, cervical spine problems and vascular problems: both arteries and veins can cause flow noises. Not to be forgotten are medications, above all psychotropic drugs, loop diuretics and high doses of aspirin. With the latter, the tinnitus is reversible. Tinnitus can also occur with psychiatric illnesses - for example, depression or burn-out syndrome.

Tinnitus can be associated with certain ear diseases.

Even a banal ear plug can cause tinnitus. After removal, however, the noise disappears. Tinnitus also usually occurs with inflammation of the ear canal and middle ear. This is also usually reversible once the inflammation has healed. Tubal catarrh, where fluid forms behind the eardrum and leads to hearing loss without pain, is usually accompanied by tinnitus. Tinnitus is often the first symptom of otosclerosis. This disease runs in families. Progressive hearing loss can be significantly improved by surgery.

Then there are diseases of the inner ear, such as sudden deafness and Ménière's disease. The latter consists of a triad of rotary vertigo, tinnitus and hearing loss. This last category also includes acute and chronic noise trauma.

The question now arises as to whether anything can be done to protect the ear. According to studies by Freiburg music physiologists Bernhard Richter and Claudia Spahn, the musician's emotional attitude to a piece has proven to be very important. And, of course, hearing protection measures. These range from emergency solutions such as absorbent cotton to foam earplugs (Oropax) and preformed hearing protectors. The safest and most suitable for musicians are otoplasts (Elacin), which are made to fit the ear canal and offer varying degrees of sound attenuation. In general, all hearing protection measures are not particularly popular with musicians, as on the one hand protection should be provided and on the other hand artistic sound production is altered. It is assumed that only around a sixth of all musicians protect themselves.

In conclusion, I would like to leave you with my favorite quote from Wilhelm Busch: "Music is often not perceived as beautiful, as it is always associated with noise.

Dr. med. Daniela Gut

... is a FMH specialist for ORL with a practice in Zurich