ear | International Musician

Vertigo is a tilting, spinning sensation of being off-balance. You may feel like the world is spinning around you even when you are standing perfectly still. Vertigo symptoms are caused by a disturbance to equilibrium, and may be accompanied by nausea and headache. More than 2 million people visit their doctors each year complaining of dizziness or vertigo, and while it’s generally a harmless symptom, you can imagine how it could be debilitating and stop a performer in her tracks.

To better understand the cause of vertigo you need to look at the anatomy and function of the ear. Sound waves travel through the outer ear canal until they reach the eardrum. There, sound is turned into vibrations, which are transmitted through the inner ear via three small bones (the incus, malleus, and stapes) to the cochlea, and finally to the vestibular nerve, which carries the signal to the brain. A collection of semicircular canals (canalis) positioned at right angles to each other inside the inner ear act like a gyroscope for the body. These canals, combined with sensitive hair cells within the canals, provide us feedback regarding our position in space. When there is a disturbance in this system, it can cause vertigo.

Common Types and Causes of Vertigo

Benign paroxysmal positional vertigo (BPPV): This type of vertigo is caused by tiny calcium particles (canaliths) that clump in the canals of the inner ear, which sends signals to the brain about movements relative to gravity to keep your balance. This type of vertigo is most commonly felt when tilting the head or climbing in and out of bed.
Meniere’s disease: This inner ear disorder is thought to be caused by a buildup of fluid, which alters the pressure in the ear. Along with vertigo, symptoms can include ringing in the ear (tinnitus) and hearing loss.
Vestibular neuritis or labyrinthitis: This inner ear problem is caused by an infection (usually viral). The infection inflames the inner ear around the nerves that are important for helping the body sense its balance.

Less frequent causes of vertigo include head or neck injury, brain problems (stroke or tumor), certain medications, and migraine headaches. In many cases vertigo will go away with no treatment. When necessary, what treatment is used depends on the cause of the vertigo.

Common Treatments

Canalith repositioning maneuvers: Performing a series of specific head and body movements can relieve the symptoms of BPPV by shifting the calcium deposits out of the ear canal and into an inner ear chamber where they can be absorbed by the body. While the movements are safe and effective, you may need a doctor or physical therapist to teach you the techniques. Also, if you are uncertain which ear is affected your doctor can let you know.

—Epley maneuver is the most common, and provides relief to 90% of BPPV sufferers.

1) Sit on the side of your bed. Turn your head 45 degrees to the side of the affected ear (not as far as your shoulder).

2) Quickly lie down on your back, with your head on the bed (still at a 45-degree angle). Place a pillow under you so it rests between your shoulders rather than under your head. Wait 30 seconds.

3) Turn your head halfway 90 degrees in the opposite direction without raising it. Wait 30 seconds.

4) Turn your head and body on its side in the same direction, so you are looking at the floor. Wait 30 seconds.

5) Sit up slowly but remain on the bed for a few minutes.

6) Repeat before going to bed each night until you’ve gone 24 hours without dizziness.

—Half somersault or Foster maneuver

1) Kneel down and look up at the ceiling for a few seconds.

2) Touch the floor with your head, tucking your chin so your head goes toward your knees. Wait about 30 seconds or until any vertigo stops.

3) Turn your head toward the affected ear. Wait 30 seconds.

4) Quickly raise your head so it’s level with your back while you’re on all fours. Keep your head at that 45-degree angle. Wait 30 seconds.

5) Quickly raise your head so its fully upright, but keep your head turned to the shoulder of the side you’re working on. Then slowly stand up.

6) Repeat this a few times for relief, resting for 15 minutes in between.

Vestibular rehabilitation: This physical therapy may be recommended by your physician if you have recurring vertigo. It is aimed at helping to strengthen the vestibular system and its function in sending signals to the brain about head and body movements relative to gravity.
Medication: In cases where vertigo is caused by an infection or inflammation, antibiotics or steroids may reduce swelling and cure the infection. For Meniere’s disease, diuretics may be prescribed to reduce fluid build-up pressure. In some cases, medications are taken to relieve the nausea associated with vertigo.

Occasionally vertigo can be a symptom of a more serious problem. It’s always advisable to visit your physician when you are experiencing any medical condition.

In a loud stage environment, musicians become accustomed to hearing their monitor mix at high volume. Some use in-ear monitoring systems (IEMs) to reduce the impact, but if the volume on the device is not regulated and lowered, it’s no solution. IMEs are only considered protective devices if they are used at safe levels.

IEMs are in demand because they isolate the ear from ambient noise and artists can hear the intended signal clearly, at a much lower volume. Critical to the equation, though, says Michael Santucci, Au.D., a researcher and expert who specializes in hearing conservation, is much lower volume. It requires modifying user behavior and listening patterns.

Look no further than the iPod. Studies have shown, in case after case (especially with teenagers), that there was irreversible damage because of volume and prolonged listening. Do most musicians use ear protection? “No,” says Santucci, “Are attitudes changing? Absolutely.”

It’s like sun exposure, he explains: it’s both how strong it is and how long you’re exposed. In music, it’s personal susceptibility, how loud, and how many hours you’re in it. “We do pit crews for Broadway plays. Is it terribly loud? Not always, but they’re doing it six hours a day.” Nowadays, Santucci frequently works with orchestras because they are featuring more pop stars. The added decibel (dB) quotient can be deafening to orchestra members. Santucci says, “Risk goes up with volume and length of exposure.”

A recent study out of Vanderbilt University showed that, regardless of whether they used floor wedges or IEMs, subjects turned them up to their usual listening level. Everybody had three days of in-ear and three days of floor wedges at different times and in different venues. Every musician turned to exactly the same loudness every day.

“If you’ve been practicing guitar for years at 110 dB with wedges, the natural tendency will be to turn your IEMs to 110 dB, even if it’s not needed,” Santucci says. “And until the audiologist says you need to turn it down to here, their brains tell them to go back to the level they’re used to.”

The good news is that the second part of the study showed that musicians can recalibrate their brains to listen at a lower level. After a couple of weeks, it becomes the norm. Santucci says, “It’s habit—like the timbre of your instrument, pitch—it’s all because you’ve done it a million times. Loudness goes right along with it.”

Adding Ambient Sound

Some musicians say they feel disconnected from the band and the crowd with IEMs. This can be addressed in a few ways. The trick, Santucci says, is to do so without compromising the isolation of the IEM system. A simple remedy is for the sound engineer to set up audience mikes to add to the monitor mix so the artist can get a feel for the room. “Some musicians take out one IEM, which is very damaging to hearing. They end up turning up the side with the ear monitor even louder, plus they have an open ear not protected by anything.”

For a natural, but more robust, method of adding ambient sound into the IEM mix, Santucci recommends 3D active ambient IEM systems that allow the musicians to control how much ambient sound is heard. “What I do not recommend is porting the earphone to let ambient sound leak. Porting effectively eliminates the benefits of isolation and cannot be controlled, it has the potential for the user to turn up the volume of the system to unsafe levels.”

Safe Listening

For hearing conservation benefits of in-ear monitors, refer to OSHA and NOISH guidelines to determine exposure times for safe use. Shows of less than one or two hours are less of a problem. For a club band, whose shows may go on for several sets of three or more hours, volume levels must be much lower and should average no more than 95 to 97 dB.

The problem is being able to accurately determine the decibel level coming from the in-ear monitors. Currently, the only method to measure these levels is with ear-probe microphone technology used during rehearsals or sound checks by an audiologist. From these readings, a volume level can be recommended based on the length of a show.

Tinnitus and Hearing Loss

If your ears ring or if you have trouble hearing after a concert, you are definitely in danger of noise induced hearing loss (NIHL). Santucci cautions, “Even if your ears don’t ring, if you think it’s safe, you’re wrong. Research shows that, of those suffering from NIHL, only 30% experienced ‘ringing’ as a warning sign. In other words, if your ears ring after a performance, you’re too loud. But if they don’t ring, there’s a 70% chance you may still be damaging your ears, if levels exceed OSHA safe exposure limits.”

For additional information, visit the websites: www.osha.gov/SLTC/noisehearingconservation or www.cdc.gov/niosh.

Other Hearing Protection Tips:

Invest in superior hearing protection,
custommade ear molds with dampening filters.
Preferably use musicians’ earplugs, which offer flat attenuation vs. traditional earplugs, which tend to filter sound from higher frequencies, resulting in a muffled sound.
Protect your ears consistently every time you may be exposed to loud music and/or sounds, not just when you are performing.
Better yet, avoid noise as much as possible when you are not performing.
Invest in high-quality in-ear monitors and train your ears to use the lowest level that’s feasible.
Drummers should use dampening pads when possible.
Sound travels in a straight line so it’s louder directly in front of or behind a speaker. Spread out so you are not being blasted by the musician next to you. Move away from on-stage monitors and amplifiers.
If moving away is not an option, look into using baffles to protect yourself.
Take breaks of 15 minutes in between sets of music or rehearsals to give ears a rest. During rest periods go outside or somewhere quiet.
Whenever possible, practice at lower volume
or play your electrified instrument unplugged.
Use smaller amps when possible.
Avoid ear buds and other direct-injection earphones for recreational listening, especially in loud environments.
Have your hearing tested frequently by an audiologist.
If it’s not possible to have regular professional sound-level assessments, at least use a sound meter app to check your exposure level.
Avoid signing up for repeated live gigs at loud clubs. If possible, give your ears some recovery time in between.

Michael Santucci, Au.D. works with the Audio Engineering Society (AES), where he is vice chair of the Technical Committee on Hearing and Hearing Loss Prevention. He operates a Musicians Hearing Clinic and works on hearing conservation through Sensaphonics: In-Ear Monitoring Systems.

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When Vertigo Rocks Your World