Singing and Tinnitus

Many people experience tinnitus, sometimes called ‘ringing in your ears’. For some it is a temporary disruption, but for others it is a long-term (chronic) condition which can be very stressful. In this article we explain what it is, common causes, how it might affect music making and support available.

How do we hear sound?

We hear sounds because our eardrum responds to physical disturbances in the air (soundwaves). Acoustic musical instruments create this movement in different ways – for example, vibrations being caused by plucking a string, breathing over a saxophone reed or hitting a drum. When we sing, our vocal chords create these vibrations. Soundwaves are conducted from the ear drum, or tympanic membrane, through tiny bones in the middle ear to the inner ear, or cochlea. There, up to 30,000 tiny hair cells convert the vibrations into nervous impulses, or electrical signals, which are then transmitted through nerves to the brain, where they are decoded into sound.[1] See the short animation below.

What is tinnitus?

Some people hear sounds in their brain that have not been created by physical sound waves tickling their eardrums, sometimes called ‘phantom sounds’. Tinnitus sensations usually have an unformed acoustic characteristic such as a buzz, hiss, whooshing or ringing sound, and can be experienced at a range of different frequencies. The character of the sound experienced is very personal to each individual person and the cause of the tinnitus, and can vary over time, becoming worse when the sufferer is tired, anxious or stressed. There are some rare instances of tinnitus linked to vascular conditions, for example tinnitus sensations that appear to pulse with the heartbeat (heartbeat- synchronous pulsatile tinnitus) and ‘typewriter tinnitus’ caused by vascular compression of the auditory nerve.[3]

What causes tinnitus?

There are several known causes. It can be triggered by a very loud noise such as an explosion, which damages the tiny hair cells in the inner ear. The effect is more often temporary in this case, but for a small number of people, the resulting tinnitus sounds are permanent. It can also be caused by repeated exposure to lower level noise, for example in a noisy workplace, which is why wearing ear protection is so important if your job involves repeated exposure noise. Some medical conditions such as a middle ear infection, head injury or reaction to medication can also lead to tinnitus.

Some people become aware of noises in their ears when they have a cold, an ear infection or wax blocking the ear, or following a stressful event, and once they’re aware of it, seem to notice it more and more. This usually fades over time. However, some people continue to notice it once their ear infection has cleared up.[8] It is more common in people who already have hearing loss or other hearing problems, but is also experienced by people with normal hearing.[5, 8]

Musicians and tinnitus

Several famous musicians report suffering from tinnitus, including Chris Martin from Coldplay, Eric Clapton and Pete Townsend.[7] KT Tunstall has previously reported suffering with tinnitus and recently had to cancel tour dates due to fears that she is losing her hearing. “I still have the tinnitus, even in a deaf ear…I’ve adapted really well and can still perform and record, but if I could do it all again, I would definitely make sure I was going for regular hearing checks from a young age.” BBC News Online 28/8/21 [10]

Opinion is mixed on whether musicians generally suffer from more hearing loss and tinnitus than workers in other industries [2, 3]. However, it is clear that repeated exposed to loud noise can lead to tinnitus and hearing damage, so it is a good idea to wear ear protection at loud concerts, or if you routinely play in a loud musical ensemble or section. See here for examples of the type of protection available.

Musicians generally look for ear defenders offering a flat frequency response, where the overall noise level is reduced as evenly as possible across all frequencies. They can be custom made to fit discretely inside your ear and filter all noise effectively. The Musicians’ Union website has lots of information on hearing protection and work-related hearing problems. Their Musician’s Hearing Health Scheme provides subsidised access to specialist hearing assessment and fitted hearing protection, in partnership with Help Musicians UK and Musicians Hearing Services.

It isn’t just professional musicians who are vulnerable to music related hearing damage. A report by the World Health Organisation Make Listening Safe[9] reports that, amongst teenagers and young adults aged 12–35 years in middle- and high-income countries:

• Nearly 50% are exposed to unsafe levels of sound from the use of personal audio devices, listening with headphones or earbuds.
• Around 40% are exposed to potentially damaging sound levels at clubs, discotheques and bars.

The good news is that noise-induced hearing loss can be prevented by following safe listening practices such as monitoring the volume on listening devices and making sure that it isn’t too high, and taking short listening breaks. There is lot information available from the World Health Organisation site Make Listening Safe here.

Living with tinnitus

Depending on the severity, tinnitus can cause significant frustration for sufferers, for example disrupting sleep which can in itself be very disruptive and significantly affect quality of life. In about 85% of all cases of chronic tinnitus, the tinnitus sound is perceived constantly but because the causes and type of sound varies so much from person to person, it has been difficult to study. For the same reasons it is difficult to treat. Studies have been carried out on the use of sound therapy and cognitive behavioural therapy to ‘retrain’ the brain but there is not yet strong evidence supporting the effectiveness of these treatments.[4–6] Advances in neuroimaging have advanced our knowledge, revealing structural and functional changes of different brain areas but our understanding of phantom-sound perception is still far from complete.[4]

Support for managing tinnitus

While there isn’t currently a cure, there are several ways that the condition can be managed to reduce the associated stress and impact on sleep. The British Tinnitus Association (BTA) are a UK charity and their website has lots of useful information and details of their confidential tinnitus helpline. They recommend some simple things:

• A lot of people find that background sound helps – this can be a radio, music, or natural sounds. This masks the tinnitus and makes it less noticeable.
• Following on from the last recommendation, soft natural sounds such as waves or rainfall can also help some people with tinnitus to improve their sleep.
• Sharing your experience with other people who have tinnitus can significantly reduce the anxiety that sufferers often feel. The BTA provides details of  Tinnitus Support Groups around the country.

Managing tinnitus and making music – a personal reflection

I am a passionate amateur musician and have sung and played in lots of different choirs, groups and bands, across classical, jazz and rock and pop genres. I was formally diagnosed with hearing loss in 2009. The event that led to the diagnosis of the underlying problem (a mosquito sting in my ear, which led to a perforated ear drum) also caused tinnitus. I subconsciously knew something wasn’t quite right with my hearing before diagnosis, but it was hard to accept hearing loss as a relatively young person, and a busy musician, so I had avoided getting advice.

At the time of the diagnosis I was devastated, having just made a major life change to embark on training as a sound engineer (I had previously had a career in finance). My hearing is normal up until around 1,000Hz but then drops sharply by around 75%, which means that I can’t hear high frequency sounds until they are much louder than for a normal hearing profile. The cause is thought to be neurological rather than music related. I can hear the fundamental frequency of most musical notes, but much less of the harmonics stacked above them that give sounds their character, and I lose vital parts of speech (you can read more about this in my blog post The Lark Lost). I also have a side effect called hyperacusis, which means that I find some very loud high pitched noises uncomfortable. Feedback from the sound system on stage when I was performing as a singer, or a passing ambulance with a loud siren makes me temporarily feel very distressed.

Through some helpful counselling from a very good audiologist (who now works with the Musicians’ Union on Hearing Protection) and a lot of trial and error, I have learnt to manage my condition and can do nearly everything I could do previously. If I spend an evening rehearsing in a small space with a noisy band, my tinnitus is always worse the next day. Waking up with a ringing head after an evening in front of a drum kit or trumpet section couldn’t continue; with hindsight this was no bad thing, I need to protect the hearing I still have. I now prioritise playing in bands that rehearse in larger spaces with a good acoustic. When this isn’t possible, I wear moulded in ear defenders that reduce the volume evenly across the frequency spectrum (normal ear plugs you can pick up from the chemist tend to absorb high frequencies, which are the ones I already struggle to hear).

It took a while before I wore hearing aids openly at rehearsals. I can’t play saxophone with them in as the sound reverberates uncomfortably in my head, and I don’t want to amplify the noisy sections around me, but I can’t hear speech that makes up the rest of rehearsals without them. I was struggling to cope, but I was so sure people would no longer believe I could function as a musician that I hid my condition for many years. The reaction was so much better than I had anticipated. I have learned to share my condition with my band colleagues so that they know I need time to transfer from ear defenders to hearing aids between takes, or they can point at the section the conductor would like us to play from in the score (‘M’ and ‘N’ sound identical to me, for example, as I can’t hear consonants without my hearing aids – leading to some stressful rehearsals in the early days!).

I am a ‘dep’ musician – often jumping into a rehearsal when the permanent seat holder can’t make it at short notice. It has been remarked that I am particularly suited to this, perhaps because I am more used to looking for visual cues all around the group, such as where other singers or musicians are looking at their music, not just the notes on my page. From the early days of hiding my hearing loss I developed a lot of strategies to know what was going on if I had been unable to hear the musical director’s directions.

Practising sax at home, or singing in a choir, does make my tinnitus worse. The sound resonates in my head, so ear defenders don’t help, however I find using natural sounds to mask the tinnitus afterwards very effective. There are several free apps providing natural sounds that include a sleep timer, reducing the volume gradually to help you fall asleep. ‘Rain on Tent’ from Rain Rain is my favourite  (available for Apple or Android phones, there are several other similar apps available). It reminds me of being tucked up nice and cosy in my small tent in gentle summer rain, and reminds me of being at a music festival.

Explore and find the sound that works for you – it could be wildlife in a woodland forest, waves or even just white noise. When I am writing and need quiet to concentrate, I have found certain composers and artists that mask my tinnitus, and support concentration rather than distracting me from my work. Protecting your hearing from very loud sounds, or repeated noise exposure, is vital. This will reduce the likelihood of developing problems. However having hearing loss or tinnitus doesn’t mean you can no longer participate in music making, it just means you need to adapt – learn strategies to cope and trust your musical colleagues.  

Author: Dr. Sam Duffy

References

[1]      Alberti, P.W. 2001. The Anatomy and Physiology of the Ear and Hearing. Occupational exposure to noise: evaluation, prevention and control. B. Goelzer et al., eds. World Health Organisation. 53–62.

[2]      Couth, S. et al. 2019. Hearing Difficulties and Tinnitus in Construction, Agricultural, Music, and Finance Industries: Contributions of Demographic, Health, and Lifestyle Factors. Trends in Hearing. 23, (2019), 1–15.

[3]      Couth, S. et al. 2020. Investigating the effects of noise exposure on self-report, behavioral and electrophysiological indices of hearing damage in musicians with normal audiometric thresholds. Hearing Research. 395, (Sep. 2020), 108021. DOI:https://doi.org/10.1016/j.heares.2020.108021.

[4]      Elgoyhen, A.B. et al. 2015. Tinnitus: Perspectives from human neuroimaging. Nature Reviews Neuroscience. 16, 10 (Oct. 2015), 632–642.

[5]      Langguth, B. et al. 2013. Tinnitus: Causes and clinical management. The Lancet Neurology. 12, 9 (Sep. 2013), 920–930.

[6]      Searchfield, G.D. et al. 2017. A state-of-the-art review: Personalization of tinnitus sound therapy. Frontiers in Psychology. 8, SEP (Sep. 2017), 1599.

[7]      Ten Celebrities with Tinnitus: 2020

[8]      What Causes Tinnitus? 2021

[9]      World Health Organisation Report Make Listening Safe 2020

[10]     KT Tunstall scraps tour dates over hearing problems Mark Savage 28/7/21 BBC News Online