Portuguese Version

Year:  2002  Vol. 68   Ed. 5 - (18º)

Artigo Original

Pages: 714 to 720

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Hearing evaluation in frevo and maracatu's musicians

Author(s): Ana I.A. Andrade 1,
Iêda C.P. Russo 2,
Maria L.L.T. Lima 3,
Luiz C.S. Oliveira 4

Keywords: audiometry, hearing loss, noise induced music, musicians

Abstract:
Objective: The present study aimed at measuring the sound pressure levels to which carnival musicians are exposed, especially those who play frevo and maracatu rhythms. We also investigated musicians' minimum auditory levels, learned their complaints, habits and hearing difficulties and compared the results between frevo and maracatu groups in order to gather data for the implementation of a Hearing Conservation Program directed to counsel professions about auditory risks of exposure to music. Study design: Clinical prospective randomized. Material and method: Our sample consisted of 19 frevo's group musicians and 31 maracatu's group musicians, aged between 12 and 71 years. We used a questionnaire to learn about musicians' correlated complaints and habits. The minimum auditory levels were measured. Results: The main complaints were dizziness and tinnitus, and the most frequent habits were going out to discos and wearing walkman. Audiometric configuration in frevo group showed 42.10% of audiometric curves suggesting NIHL, whereas in maracatu group the frequency was 16.13%. In frevo group, age, time span of the career and time of exposure to music influenced the occurrence of auditory abnormalities. Conclusions: We concluded that it is necessary to implement a Hearing Conservation Program for this population of musicians, owing mainly to their poor awareness of risks associated with onset of hearing loss as a result of exposure to music at high sound pressure levels.

INTRODUCTION

Music is the most ancient interaction element among humankind1, it has been present in people's daily life since the oldest days and has taken an important role in communication between them. Music is seen as an agreeable sound and upon hearing it, we associate important facts in our life and from the past but if used too continuously, it may become a hindrance in people's life.

In the 60's, the key period for the transformation music went through in Brazil, owing to the onset of rock-and-roll, there was a general concern among authors about the incidence of noise induced hearing loss (NIHL) caused by excessively amplified sounds in leisure activities2, 3, 4, 5, 6, 7, 8, 9. Among such activities, we can include going to the disco3, the use of walkman10 and exposure to music produced by trios eletricos5 8,6.

Carnival is part of the popular celebrations in Brazil and it is an important leisure activity. Music produced by trio eletrico is common during Carnival feasts, different celebrations and popular holidays throughout the year.

In Pernambuco, Carnival parties are very influenced by the local culture. The musical scenario in Pernambuco has inherited rhythms and music from African slaves, such as frevo and maracatu6. In the cities of Recife and Olinda, in Pernambuco state, we can see the complete culture and origin of the people in such festivities. Carnival music in Pernambuco comprises mainly non-amplified sound, using frevo and maracatu.

The definition of sound levels to which people in the streets and musicians are exposed would help us to define, from a hearing perspective, the healthiest limits to such exposure. In Brazil, studies with musicians have been conducted in various states - Pernambuco, São Paulo, Bahia and Ceara, and all of them pointed out the importance of creating and implementing Hearing Conservation Programs for people exposed to electronically amplified and non-amplified music in different leisure facilities4, 6, 7, 8. Subjects exposed to the same amounts of noise can present different responses11.

In addition to sound pressure levels (SPL) and duration of exposure, the occurrence of hearing loss can be associated with other reported factors, as a result of exposure: tinnitus, dizziness, ear fullness, cardiological abnormalities, gastric and muscular affections, changes in mood, stress and irritability12.

It is considered that high SPL can be harmful to hearing1, 13, 14 and, therefore, periodical audiometry should be made15, in order to observe susceptibility and application of preventive measures before the onset of NIHL 9, 16, 17. Some authors detected low incidence rates of hearing loss16, 18, 29, whereas others found 43% to 40.6% of NIHL in musicians8, 20. Even though results are controversial, it is believed that age and duration of exposure to music contribute to the increased risk of hearing loss 20.

This study intends to check the sound pressure levels to which musicians of Carnival parties from the city of Olinda are exposed, especially those who play frevo and maracatu; we wanted to learn about hearing habits and correlated complaints between the groups of frevo and maracatu and to detect minimal levels of hearing in musicians.

MATERIAL AND METHOD

We conducted a retrospective study with musicians of frevo and maracatu in the city of Olinda-PE, Brazil.

The musician subjects signed a letter containing information and the free informed consent term.
The SPL to which musicians were exposed during the rehearsals or performances were measured in the compensation circuit A and slow response time using the meter Realistic II (USA).

The participating musicians were characterized according to musical style, age, gender, time in the job, types of instruments played, number of hours of work in a day, number of days of work every week, hearing habits and correlated complaints. The questionnaire was adapted from that by Marques21.

Before the audiometric assessment, we asked musicians to have 14 hours of acoustic rest, according to the Technical Standard No. 19 of the Ministry of Labor and Work Safety Department, dated April 22, 199814. We performed visual inspection of the external acoustic canal to exclude obstructions. Cases with abnormalities were referred to the ambulatory of Otorhinolaryngology, Hospital das Clinicas, Federal University of Pernambuco (HC-UFPE).

To perform audiometric tests in the office of the groups, we chose a silent room without acoustic treatment, in an environment whose noise level varied 55-60dB HL, as defined by the Technical Standard No. 3214, of Ministry of Labor and Work Safety Department22. We used a portable audiometer Maico MA 41, calibrated according to ANSI standard S3.6 (1989)23 and conducted biological calibration in order to control acoustic abnormalities of the audiometer. The procedure consisted of checking the minimal level of response for frequencies 0.5 kHz, 1 kHz, 2 kHz, 3 kHz, 4 kHz, 6 kHz and 8 kHz, for pure tone air conduction and if necessary, 0.5 kHz, 1 kHz, 2 kHz, 3 kHz, 4 kHz for bone conduction.

For the classification of auditory thresholds in musicians we used the audiometric abnormality criteria proposed by Fiorini 12.

As to statistical analysis, we employed the quantitative variables represented by mean, standard deviation, median and minimum and maximum values. Qualitative variables were represented by absolute and relative frequency. In order to test the association between NIHL, notch, level of loss and all qualitative factors of interest, we employed the chi-square test (x2). We adopted significance level of 0.05%. Descriptive levels (p) below this value were considered significant and represented by an asterisk (*).

RESULTS

Out of 50 assessed musicians, 19 were with the group of frevo and 31 musicians were with the group of maracatu.

The measurements of maximum sound pressure levels generated during rehearsals and performances for the frevo group were 117dB HL and for maracatu, 119dB HL.

Nineteen musicians (100%) of the frevo group were male, aged 16 to 71 years (mean age 36.47 years). In the maracatu group, 27 musicians (87%) were male and four (13%) were female artists. The age of maracatu musicians ranged from 12 to 46 years (mean of 21.80 years).

The mean age of frevo group was statistically significantly greater than the mean age of the maracatu group, as shown in Graph 1. We noticed heterogeneity of ages from the musicians, especially in the frevo group.

As to duration in the job, we divided them into intervals of 0-5 years, 6-10 years, 11 - 20 years and 21-50 years.

For the frevo group, most of the musicians (78.95%) had worked for over 5 years with music, whereas for the maracatu group, the greatest concentration was in the range between 0 and 5 years (77.41%) (Graph 2).

In the frevo group, we noticed greater exposure to music, with statistically significant difference as compared to the maracatu group.

In the frevo group, 84.21% of the workers used woodwind instruments (sax, trumpet, clarinet, tenor horn and French horn), and 16.79% used percussion (conga drums, drums). In the maracatu group, all instruments used were percussion, typical in Brazilian rhythms (Graph 3).

Upon the analysis of the variable number of work hours per day for the two groups of musicians, we observed that 73.69% of the musicians in the frevo group and 77.42% in the maracatu group were exposed to music between one and five daily hours (Graph 4).

By evaluating the number of work days per week, we observed that 52.63% of the frevo musicians played from 5 to 7 days a week, whereas 83.87% of the maracatu musicians played between one and four days a week. The group of frevo presented more work days in a week compared to the maracatu group (Graph 5).
The most common complaints in both studied groups were dizziness and tinnitus, which presented statistically significant differences when compared to other complaints (Graph 6).

In the frevo group, 10 musicians (52.63%) presented dizziness and tinnitus, and in the maracatu group, 21 (67.74%) and 13 (41.93%) of the musicians reported these complaints, respectively.

The most commonly referred habits were going to discos and using the walkman. In Graph 7 we can see that 42.10% of the musicians in the frevo group and 80.64% of the musicians in the maracatu group had the habit of going to discos, parties and shows, and 31.58% in the frevo group and 67.74% in the maracatu group liked individual amplified music from the walkman. We detected that these habits were more frequent in the maracatu group. There was statistically significant difference between the groups, since we detected more frequently the habits in the maracatu group.

Another important habit in the frevo group was the use of drilling and grinding machines, with no statistically significant difference, and this fact was explained by the older age of subjects in the frevo group, which would favor their work in other jobs besides music.

The auditory minimum level of musicians was abnormal in 47.37% of the frevo group and in 16.13% of the maracatu group.

The minimum hearing levels in the frevo group were as follows: 10 musicians (52.63%) presented normal hearing thresholds, and 8 (42.10%) presented audiometry suggestive of NIHL in at least one ear and one (5.26%) did not present a curve suggestive of NIHL. In the maracatu group, 26 musicians (83.87%) presented normal audiometric responses and five (16.13%) presented audiometric curves suggestive of NIHL in at least one ear. These results can be seen in Graph 8.

The results of minimum hearing levels for both groups of musicians suggested that the presence of NIHL was predominant in the frevo group (42.10%), whereas in the maracatu group, we found only 16.13% of NIHL in the audiometry of musicians.

Graph 9 shows the assessment of minimum hearing levels that were within the normal hearing thresholds for the subjects in the frevo and maracatu groups, but subdivided in order to highlight the notches. We observed that in the frevo group nine (47.37%) of the musicians presented bilateral normal results and one (5.26%) presented unilateral notch; in the maracatu group, 11 (35.48%) presented normal results, nine (29.03%) presented unilateral notches and six (19.35%) presented bilateral notches. A greater number of notches (35.48%) was observed in the maracatu group, resulting in statistically significant difference.

Graph 1. Distribution of musicians assessed in the group of frevo (n=19) and maracatu (n= 31), according to age range.



Graph 2. Distribution of musicians of frevo and maracatu groups according to duration of exposure to music in years.



Graph 3. Distribution of instruments by class of instruments used by musicians of frevo and maracatu groups.



Graph 4. Distribution of hours of work per day for musicians in the frevo and maracatu groups.



Graph 5. Distribution of number of work days per week for musicians of frevo and maracatu groups.



Graph 6. Distribution of frequency and percentage of complaints related to musicians of frevo and maracatu groups, which could be related to exposure to music.



Graph 7. Distribution of frequency and percentage of hearing habits reported by musicians of the frevo and maracatu groups.



Graph 8. Distribution of results of tests according to variations of minimum levels of hearing detected in frevo and maracatu group musicians.



Graph 9. Distribution of results of tests that had minumum hearing levels within normal range, according to presence of notch in frevo and maracatu groups of musicians.

DISCUSSION

The SPL generated by the musicians of the frevo and maracatu groups ranged from 107 to 177dB HL and 107 to 119 dB HL, respectively. The results indicated that these musicians were exposed to music at loud SPL. However, in other studies that assessed SPL generated by music, similar results were observed5, 16. The musical style was not a limiting factor to generate high sound pressure levels as noticed with rock musicians13 and symphonic orchestra musicians4, with SPL that ranged from 100 to 130 dBHL. As to electronically amplified music, in findings from two studies with musicians of trio eletrico, the authors measured SPL that ranged from 104 to 114dB HL6 and 91.5 to 111dB HL7. There are few reports about electronically non-amplified music with SPL below 85.8dB9.

In Brazil, there are no guidelines by the Brazilian Association of Norms and Standards (ABNT) about control of noise in leisure activities, that is, there is no pre-defined limit for sound pressure level exposure during the performance of frevo and maracatu groups2.

The musicians included in the present study are professionals in the areas of frevo and maracatu. Considering the occupational activity, these subjects would be free from hearing damage only if exposed to 85dB SPL not exceeding 8 hours of daily exposure. The exposure to 100 dBSPL is only allowed for one hour a day22. In such observations we detected noise levels over 100dB SPL and there are no definitions concerning maximum exposure, which leads to the conclusion that only few minutes a day would be recommendable. In addition to high SPL, we noticed that the duration of exposure to loud noise was increasing. These two conditions can act in synergy and increase the risk of damage to the hearing of these musicians. In the present study we did not expect to detect such high levels of sound pressure.

In the two musical groups, we observed great amplitude of ages of musicians, agreeing with similar studies 6, 8, 9, 24, 25. However, other studies showed limited age variation13, 18, 26.

The musicians of the study started their working activities at an early age. It can be a harmful factor for these subjects because there may be a cumulative factor over the years exposed to loud music. We emphasize the importance of having a hearing conservation program directed to this population since they are exposed to music for prolonged periods of time. Comparing this professional activity with others, we rarely see people with over 50 years of continuous exposure to noise during work activities with no hearing loss11.

In the analysis of minimum hearing levels for the groups of frevo and maracatu, we noticed a prevalence of hearing problems in frevo musicians. In frevo and maracatu groups, we noticed that sound pressure levels produced by the instruments were higher than expected, suggesting that musicians exposed to instrument sounds could be prone to have hearing loss. In the present study and in other similar ones, it is suggested that there is an association between instruments used by musicians and the occurrence of NIHL. Some authors8, 20 studying musicians that used different classes of instrument concluded that the musicians that play woodwind instruments are more susceptible to hearing losses. However, there are reports of impaired thresholds of musicians that play percussion instruments in rock groups5, 19 and in symphonies4.

In the present study, we observed that work with non-amplified music was not an important factor to reduce the risk of hearing loss. The exposure to music during two hours and a half exceeds the daily safety limits for human hearing27. There are contradictory reports concerning number of hours of exposure and how long it takes to develop a hearing loss. Jerger et al. observed that 33.34% of the musicians that were exposed approximately 15 hours a week during two years developed hearing loss26. However, musicians exposed to 105 dBSPL during 11.4 hours a week throughout 2 years and nine months did not develop hearing loss in 95% of the studied subjects18. In some studies there was no definite association between hearing loss and number of days worked with music13, 16.

Some preventive measures concerning exposure to music have already been suggested8, 15, 16. The safety norms should specify not only the number of work days a week but also the number of hours a day and the SPL produced during each performance.

The presence of tinnitus as the main auditory complaint is present in studies with musicians relating hearing damage and exposure to music, describing the occurrence ranging from 18% to 100%4, 5, 6, 13, 17, 19, 27. Some authors considered the presence of tinnitus and temporary threshold shift (TTS) after performances as important factors to suspect of a likely hearing loss24. The presence of hearing complaints such as tinnitus and intolerance to loud noises have already been reported by musicians with normal audiological tests9, and such findings were not detected in rock musicians when tested with audimetry19.

Upon the analysis of the effect of individual amplified music on the hearing of young people, it was noticed that 64.76% of them are exposed to this type of music10. It was shown that variables such as age, duration of exposure to music, hearing habits such as walkman or shooting could cause harmful effects to hearing24. Even though this fact has been observed in this study (Graph 7), it may be justified by the phenomenon of toughening28.

More advanced age and duration of exposure increase the likelihood of NIHL among musicians24, which confirms the results of the present study.

In the literature, there are associations between hearing loss and the following variables: duration of work with music4, 5, 24, elevated sound pressure level6, age24, and susceptibility to develop hearing impairment29. The increase in hearing loss can be detected as the subject is exposed and it is noticed by a remarkable change in the thresholds detected in frequencies over 2000Hz15.

The results of hearing thresholds among musicians in the groups of frevo and maracatu were not statistically significant. The thresholds of the frevo group were similar to those detected in musicians of symphonic orchestra, concerning percentage of hearing threshold according to age and duration of exposure20. Differently from these observations, there were some cases of long term exposure to high frequencies with 13% of hearing loss19. In the maracatu group, we observed less time of exposure to music with high SPL, a fact that was also noticed in studies of rock groups18. However, exposure to short periods of time is also harmful to hearing, since there are cases of musicians exposed to high frequencies of 30 to 70dB SPL for periods of 2 years who presented hearing loss in at least one ear26.

It is acceptable for a normal subject to go to pop music concerts or discos once or twice a week without the risk of impairing the hearing. However, if exposure to rock concerts is associated with other risks in leisure situations, the risk to have a hearing loss is increased24.

The prevalence of NIHL among musicians ranges from 0% to 40.6%8, 9, 16, 18, 19. In the frevo and maracatu groups the percentages of NIHL were compatible to the findings in the literature. In this study, the observed percentage of hearing loss can be attributed to long exposure to music, detecting higher prevalence in musicians from the frevo group. These musicians had an increased risk of NIHL owing to long hours of exposure to high SPL resultant from work and leisure. The studied musicians were regularly exposed to music for many hours a day during various days a week, associated with various years of work in the job or various moments of leisure. Some people started to work in it as a child and had performed the same activity for over 50 years.

We noticed the musicians were not willing to learn about the risks posed to them, probably because of lack of information and awareness about the risks of developing an irreversible hearing loss.

Based on the result of the present study, it is justifiable to conduct projects that aim at implementing hearing conservation training and counseling programs directed to frevo and maracatu musicians to prevent hearing impairment, despite the small sample and the advanced age range that could explain the high frequency of hearing loss identified in the frevo group. The procedure of repeating audiometry at regular one-year intervals was reported as the most sensitive way to determine individual susceptibility to hearing loss15.

In agreement with Fiorini 12, our results showed that the presence of a notch is a tendency for the development of NIHL.

It is important to point out that the musicians in this study were poorly informed about the risks of having a NIHL, a part of the scenario of lack of information or difficulty to access specialized information. Any audiologist concerned about NIHL prevention can reduce the occurrence of this abnormality simply by providing information about the risks of noise induced hearing loss or the risks of exposure to music at high sound pressure levels. We do hope we can contribute to the area by making audiologists interested in the topic and motivated to conduct Hearing Conservation Programs directed to music professional workers.

CONCLUSIONS

Sound pressure levels generated by musicians of Carnival groups of frevo and maracatu ranged from 107 to 117dB HL and 107 to 119 dB HL, respectively.

The most frequent hearing complaints were dizziness and tinnitus. In the frevo group, ten (52.63%) musicians presented dizziness and tinnitus and in the maracatu group, 21 (67.74%) had dizziness and 13 (41.93%) had tinnitus.

The hearing habits most frequently reported by them were to go to discos and to use walkman. In the frevo group, 8 musicians (42.10%) used to go to discos and six (31.58%) used walkman, whereas in the maracatu group, 25 (80.64%) and 21 (67.74%) musicians presented the habits, respectively. The results were not in agreement, probably because of the toughening phenomenon.

The minimum levels of hearing in musicians showed abnormalities in 47.37% of them in the frevo group and in 16.13% in the maracatu group.

Even though the sample was small and the age range was advanced in the frevo group, which can explain the high frequency of identified hearing losses, these results raise the issues about the implantation of programs to clarify questions and provide guidelines that aim at conserving hearing in musicians.

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1 Master in Speech and Language Pathology and Audiology, Pontifical Catholic University of São Paulo. Professor of Catholic University of Pernambuco. Professor of Integrated Schools of Recife. Audiologist of the Service of Otorhinolaryngology at Federal University of Pernambuco.
2 Faculty Professor, Postgraduate Studies in Speech and Language Pathology and Audiology, Pontifical Catholic University of São Paulo and Member of the National Noise and Hearing Conservation Committee.
3 Audiologist, Master studies in Public Health under course, Fundação Oswaldo Cruz in Pernambuco (FIOCRUZ-PE); Deputy Professor in Speech and Language Pathology and Audiology, UFPE.
4 Clinical Audiologist.

Affiliation: This study is part of the Master Dissertation in Speech and Language Pathology and Audiology, - PUC-SP, São Paulo, Brazil.

Address correspondence to: Ana Isabel Azevedo de Andrade - Rua Dom João de Souza, 117 apto 1301 Madalena - 50.610-070 - Recife PE - Tel/Fax: (55 81) 3228.1819 - E-mail anabelandrade@aol.com

Study presented at the XVI Encontro Internacional de Audiologia Rio de Janeiro, April 5 - 8, 2001.
Financial support: PICDT -Federal University of Pernambuco.

Article submitted on April 16, 2002. Article accepted on August 15, 2002

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