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New Orleans Musician's Clinic: Protecting the Sound of Jazz
111 Plays1 year ago
We shine our spotlight on the New Orleans Musician's Clinic, the only low or no-cost medical clinic in the United State dedicated to caring for performing artists. They have been a founding member of Athletes and the Arts since our launch 10 years ago, and their outreach includes preventing noise-induced hearing loss. Joining Yasi and Steven on the show are Taylor Cohen, Public Health Director, Kalie Falls, Community Outreach, Ngoma Numu Jordan, New Orleans musician, and Dr. Marshall Chasin, director of research and chief audiologist of the Musicians' Clinics of Canada.
For more information on the clinic, go to https://neworleansmusiciansclinic.org
For Dr Chasin's clinic, go to https://marshallchasinassociates.ca/index.htm
For Athletes and the Arts, go to https://www.athletesandthearts.com
To listen to Ngoma's 2021 album, "Ngoma Numu", go to https://music.apple.com/us/album/ngoma-numu/1578706106
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Transcript
Podcast Introduction
00:00:06
Speaker
Welcome to the Athletes in the Arts podcast, hosted by Steven Karaginas and Yasi Ansari.
00:00:19
Speaker
Hello, everyone. Welcome to the Athletes and the Arts podcast. I'm Stephen Karaginas, along with Yossi Ansari. And thank you for making time to listen to our show. If you like what you hear, feel free to leave a review or tell some friends. Our show is proudly brought to you by School Health, a national full service provider of health supplies and services to professionals in educational settings from preschool to college. To learn more, go to schoolhealth.com.
00:00:45
Speaker
or you can visit www.athletesandthearts.com to learn more about school health or get other resources for performing arts medicine. There's lots to find there at athletesandthearts.com.
New Orleans Musicians Clinic Overview
00:00:58
Speaker
Okay, so today we spend our time focusing on the New Orleans Musicians Clinic.
00:01:04
Speaker
This is a clinic that was started in 1998 to service the needs of musicians in New Orleans and it's a one of a kind place. They are part of the athletes in the arts initiative. In fact, they were there right in the very beginning when we launched 10 years ago. They are the only low or no cost comprehensive medical clinic specifically dedicated to performing artists in the United States. They have a special mission to help prevent hearing loss and try to raise awareness to musicians about the potential for hearing loss throughout their career.
00:01:34
Speaker
So, we invited a few of the folks to come on to our show and talk more about it. On the show today are Taylor Cohen, Public Health Director, Kaylee Falls, Community Outreach Director, Musician N'Goma Numu-Jordan, and Dr. Marshall Chason, Director of Research and Chief Audiologist of the Musician's Clinics of Canada.
00:01:57
Speaker
We have a full house here tonight, which is so exciting. Thank you all for being here with us. Let's start with Taylor and Kaylee. Can you guys tell us a little bit about the New Orleans Musicians Clinic?
Clinic Services and Outreach
00:02:09
Speaker
Yeah, sure. Well, first off, thanks for having us. My name's Taylor. I'll say that since folks can't see that it's me. We work for the New Orleans Musicians Clinic.
00:02:24
Speaker
Foundation, which is a full comprehensive medical center that provides health care to musicians, artists, culture bearers of all kinds. So in New Orleans, that could look really different. It could be a Mardi Gras Indian, it could be a dancer, it could be a singer, it could be a drummer. It could be a server. There are a lot of performers of all different kinds in
00:02:52
Speaker
New Orleans that wear many hats and contribute to the culture. So we're just trying to keep them alive and thus preserving the culture of the city and the art that it has. So we have the clinic, Burke and Mortar Comprehensive Medical Center, and then we kind of have the Assistance Foundation side of things, which is more a nonprofit side, community outreach programming, prevention efforts,
00:03:21
Speaker
So I'm the public health director and I try and prevent people from having to go to the clinic through outreach. One of those things being hearing loss prevention, which we're here to talk about today, which is super important. And Kaylee, I'm so grateful to recently have Kaylee's help with that program.
00:03:43
Speaker
So how does your clinic work as far as musicians wanting to get health care? How do you raise money? How does a musician get into your clinic to be treated? That's a great question. It's really complex. I've been working for the clinic for seven years now. It used to be I would bring out paperwork sometimes, start off with a clipboard, you know, and I would just get people's contact information, connect them with Megan, our social worker.
00:04:14
Speaker
Um, she would help them apply for Medicaid if they were eligible. Snap all the government assistance, if they're eligible and, um, work with really the onboarding and the initial intake. Um, but yeah, financially, I guess it's, it's everything it's private donations. It's, um, us being written into people's wills. Um, it's.
00:04:43
Speaker
grants, a lot of grant money. We recently got a grant from Gilead to work focus on breast cancer prevention. So yeah. So if a musician needs care and they just have like down on their luck, no money, no gigs at this moment, you're able to take care of them. You have a bill, you have financial support and social support to help take care of them.
00:05:07
Speaker
I mean, we certainly don't have an endless supply of money to pay everyone's rent all the time, you know? But we do have an emergency fund for our patients, for emergencies. And yeah, I mean, we don't turn anyone away from our clinic if they need medical assistance, regardless of insurance status, ability to pay, race, ethnicity, gender, whatever.
Hearing Loss Prevention Efforts
00:05:30
Speaker
So with Save Miller Sounds, how long has it been going? Sure.
00:05:36
Speaker
a lot of different community programs. Save and All It Sounds is just one of the many. But we've been focusing on hearing loss prevention in a lot of different ways for a while. So for example, I helped start You Got This, which is our mental health and suicide prevention program. And
00:05:57
Speaker
uh, tinnitus or tinnitus is a real big issue that a lot of our patients face where constantly there's sounds that aren't necessarily there. And it really impacts your overall wellbeing, which impacts your mental health, of course. And a lot of these issues that we, um, talk about with artists involve mental health, but then
00:06:23
Speaker
sometimes they branch outward and there's overlap in all of these topics and different intersections, which is why it's so interesting, but why it's so complex as well to approach. So we decided it needs its own program and started Safe Sounds, which was our hearing loss prevention program, first one, first round, Safe Sounds 1.0, and then
00:06:51
Speaker
Basically, we got in trouble with the noise ordinance at the city. It wasn't really we got in trouble, but basically, we were giving everyone our statistics and raising hell, you know, civil disobedience, we were saying, people need to hear about about this topic. Because it's not only affecting the artists, it's affecting the servers, it's affecting
00:07:17
Speaker
Like you said, the dancers, the front of house, back of house, people all around, choreographers. It's impacting a lot of folks and people don't think about it. Don't wear ear protection.
00:07:30
Speaker
And they basically took our stats and turned it on us and then filed a noise ordinance with the city and basically said, okay, then don't play loud music and try to close music. And we're like, music isn't necessarily noise. There's a difference between allowing artists to make money and gig and fund their career and have standards, public health prevention standards when it comes to hearing loss in venues.
00:08:00
Speaker
I'll shut it off. So are there different stages to hearing loss? I mean, this is not my area of expertise. So I'll be coming in, asking a variety of questions where it feels like it could be obvious what it may not be. But are there different levels of hearing loss? When does someone as a musician know that they need help and support? Is it just the ringing in the ear? What's the first sign that I need some extra support when it comes to my hearing?
00:08:30
Speaker
I honestly feel like I'm not necessarily the best person to ask. I was gonna pass it to Dr. Jason, but I was gonna say, I hope that you don't get there. Like, I want prevention. I want people to wear ear protection so they don't have to get to that point, but where they're saying what what every second. But yeah, please take it away, Marshall.
00:08:53
Speaker
Thank you, Taylor. Hearing loss is a very slow, gradual process. It takes many, many years to show up. Usually you can go to a gig or go to a loud concert. Your ears may be ringing for
00:09:08
Speaker
you know, 18, 20 hours after, but that's a temporary issue. Enough of those and it does over time become permanent, but it's actually incredible how poor humans are at discerning what is damaging versus what is not damaging. We're great as mammals, all mammals,
00:09:30
Speaker
are great, we can discern differences in frequency or pitch. We know when something is sharp or something is flat, but we really are lousy at loudness.
Decibels and Sound Exposure
00:09:41
Speaker
So for example, we know that anything over 85 decibels, decibel being the unit that we can measure with a sound meter, anything over 85 decibels, if you listen to it long enough, can eventually cause some hearing difficulty.
00:09:56
Speaker
But 85 decibels is not loud. A dial tone on a telephone for those that have landlines is 85 decibels. Another example of, let's say you're not feeling very well and you're vomiting in a toilet and you go to flush the toilet, that's 85 decibels. Now, that may sound loud because you're not feeling very well, but you don't run away in horror at 85 decibels. It happens every day around us.
00:10:24
Speaker
But it's prolonged exposure to the 85. So it's not just the sound level in decibels, but how long you're exposed to the sound. So it's much like a radiation dose. Nothing wrong with getting an x-ray. Just don't get an x-ray every moment of the day and every day of the week and every week of the month. It's the dosage that counts.
00:10:44
Speaker
So it turns out that we can be exposed to 85 decibels, not that loud, for 40 hours a week. After about a year, we might be able to measure a hearing loss. But that's the very same thing for 88 decibels, 40, 20 hours a week. In other words, a slightly higher level, up to 91 now, for only maybe 10 hours a week.
00:11:04
Speaker
94 for five hours a week. So it's not only how loud something is, but it's the dose, how long we're exposed to it. And so we want to keep below 100% of the dose. Music, of course, is one of them, but going home in a noisy convertible, let's say, and people honking their horns and mowing the lawn and listening to our own music, all of these things together can contribute to the dose.
00:11:29
Speaker
But I think that Taylor and Kaylee are quite right in the sense that we want to make sure that they can hear 30 years from now, not just prevent what's happening today. So prevention really is the cue, the important element.
00:11:46
Speaker
In GOMA, you're a musician performing in these environments all
Awareness of Hearing Protection
00:11:51
Speaker
the time. From your perspective, how concerned are your fellow musicians about hearing loss and how difficult is it to avoid these exposures? A lot of them aren't. I don't think a lot of them are really aware like that.
00:12:13
Speaker
I see a lot of musicians who don't wear any earplugs or anything like that. I mean, I would love to bring more awareness to them. But some guys, they're just like, oh, it's fine. Others are like, yeah, I know I need to wear something, but they still don't. And then you have some guys that's like me, and then they walk around with their earplugs on their key chains and stuff.
00:12:45
Speaker
Is it an attitude sometimes where sometimes it's just like, I'm tough, I'm cool, I'm a musician, I'm rocking out, I'm playing all the time. I don't need protection. I'm young. Is it more like the attitude? Yeah, with some guys, some guys are just, they just play. They don't even really think about that part with their ears and stuff like that.
00:13:10
Speaker
I just play even at even at cuz I you know, I like going to concerts and if I can like be backstage and stand on stage for the show. And even being a spectator on the stage is still loud, you know, and yeah, you know, especially drummers, they're like, man, it's fine. I like that attack. Like I like hearing, you know, hearing that natural sound and that rough sound of the stage is that which I do too. But
00:13:38
Speaker
Yo, it's loud. You know, we got drums and stuff on stage. But even some guys that now, you know, now we have the in-ear monitors that guys are wearing now.
00:13:55
Speaker
But the thing is, even with in-ear monitors, some guys have their headphones blasting even with the in-ear monitors in. It kind of defeats the purpose of you having in-ear monitors if you're going to have it just blasting in here. Right. 105 decibels blasting in your ear? Yeah.
00:14:17
Speaker
Yeah, I plugged in or put on in some guys lines and I'm just like, how, why? You might as well not wear these if you're good. Right. In Goma, did you always wear like a
00:14:31
Speaker
Like an aid in the, I don't even know what, what do we do? No, what did it take for you to realize that it was important? And how old were you when you were like, were you a young, like were you in your teens when you were like, I need to start wearing a monitor in my ear?
00:14:50
Speaker
No, so all right. So, you know, so I was in the marching band in high school. Okay. You know, and I played snare drum and you know, and it's just the drum itself is this loud. So we got from there and then up to I started playing drums professionally at 18 from there. So sometimes even now I sometimes I won't wear ear protection, especially if
00:15:18
Speaker
just something like if it's just me in the room and I just need to just express myself and get it in. Sometimes I won't wear ear protection, although I know I need to. But yeah, going up through through high school being in the band, I didn't wear any protection all five years that I marched in the band. It wasn't until
00:15:42
Speaker
I don't know, I just got to a certain point where I just started looking for better ear protection because after a while I started wearing earplugs, you know, the ones you got to do all this to and stick deep in your ears. But the thing was that will block out too much noise.
00:15:59
Speaker
So I was always constantly looking for something to use until one day I went to Ray Francis' drum center. And I forgot the name of these earplugs that they had, but they had them. And when I was talking to the guys, you know, Frank and Woody and
00:16:17
Speaker
And Ray, you know, they were telling me that Woody was telling me that he uses them on his gigs. And what it does, it actually just drops the music or the stage level down a few decibels. So it doesn't completely like wipe it out.
00:16:31
Speaker
And that's what I started using. And from then, I was like, yo, this is perfect. I feel like I still have my hearing after I finish playing. And I feel like it doesn't really take away because you can still feel the music. You know, I could still feel myself hitting the cymbal and hear it, but it takes away that initial attack on my... Hit against your eardrum. Yeah, I hit against your eardrum. It takes that away. So, as you say, that's like how I got to it, you know.
00:17:01
Speaker
And even going to concerts too. I realized that going to concerts because I love going to concerts and shows, you know, even being in the audience and then I get home and it's in the crowd.
00:17:18
Speaker
Marshall? I think Nagoma has outlined or underlined or underscored a very important point in that more is not necessarily better.
Ear Protection for Musicians
00:17:29
Speaker
Hearing protection that just takes the edge off music that is the same for the bass notes, the treble notes as well, so equal throughout the whole piano range, that's the ideal. In fact, in 1988, the first pair came, maybe the ones that you're referring to, called the ER-15.
00:17:48
Speaker
named manufactured by a company called Etymotic Research, hence the name ER. And the 15 decibel reduction means that if you like math, you could be exposed 32 times as long before the same damage occurs without the hearing protection.
00:18:06
Speaker
And it's incredible how quiet, how minimal, I guess is a better way of saying it, a 15 decibel reduction. So it's the way I'm talking right now, AB versus the way I'm talking right now. It's noticeable.
00:18:22
Speaker
but it doesn't take away the subtleties of what you need to hear. The last thing we want to do, especially with the drummer, is fit them with the full shell industrial strength air plugs because the drummer is going to lose his monitoring ability, start hitting the rimshot really loud because he can't hear it, and then come into the clinic with wrist and arm problems.
00:18:43
Speaker
And so we want to have that beautiful balance between proper monitoring as well as hearing protection. And that's what the people at the New Orleans Clinic and also other musicians clinics such as mine in Canada, the Musicians Clinics of Canada, wanted to do. We don't want too much hearing protection, but we don't want too little hearing protection either.
00:19:05
Speaker
Yeah, so some of those ear earplugs I see in the market, high fidelity earplugs, those are the kind of things you're talking about, like heroes and like vibes. So where they use basically lower decibels, but keep the high frequencies coming through. Yeah, there's another company. Sorry, go on.
00:19:24
Speaker
Well, I said there's another company called Eargasm. Ah, okay. And they have, I mean, you can pick from an array of it. They have earplugs for people who go to concerts, earplugs for musicians, like it's, you know, they have specific ones for specific things and what you're doing with that particular company.
00:19:48
Speaker
Many manufacturers, though, do market an air plug that they market to musicians, but they're not for musicians, and so you have to be very careful. Such as Heroes, for example, they have a large air hole going through them. Essentially, they allow the lower bass notes to get through unaffected, but they lessen or attenuate the whole right-hand side of the piano keyboard.
00:20:10
Speaker
and for something like a drummer that can be useful to attenuate or lessen the irritation of the cymbal in the hi-hat and the rim shot. But most high fidelity earplugs are intended to be flat or uniform, whether it has the same effect on the left hand side of the piano keyboard as it does on the right hand side of the piano keyboard. So you have to be very careful about that.
00:20:36
Speaker
Then on the one end, you have those kinds of earplugs that are like $15, $20, $25. At the other end of the spectrum, you have ones that are custom-molded for performers too, right? For the average gigging musician, are those feasible to afford? How expensive do those go?
00:20:56
Speaker
The one size fits all size, you can get some very nice air plugs for like $15 or $20, such as the, again, for Metamod research as an example, the ER20XS, which is a very good one.
00:21:12
Speaker
There's another one that's come out recently called the Minuendo, which is a little bit more expensive. But when you get up into the custom-made mold, where you visit an audiologist, an impression is taken of the ears, and after a week they actually get the earplug, such as the ER-15, for example.
00:21:29
Speaker
you're looking at about $300 out of pocket for that but that should last you 20 or 30 years. I got my pair made in 1992 and that's over 30 years and I'm still using that same pair that I put out for in 1992. So yes it is an expenditure but I think it's well worth it.
00:21:51
Speaker
Yeah, I would agree. And something that I always love to tell people that I'm really proud of is our patients at the Musicians Clinic can request a referral from our primary care physician for custom-molded earplugs. And all they have to pay, I think it's between $10 and $20 copay to get a pair of custom-molded earplugs through the New Orleans Speech and Hearing Center.
00:22:16
Speaker
I think that really also highlights the importance of partnerships with other organizations and efforts that are working towards hearing loss prevention. Kaylee, how challenging is it to spread the word about hearing loss? I would have to say it's been hit or miss. I feel like a lot of the older musicians feel as though, oh, I've already lost my hearing, or they feel
00:22:46
Speaker
anxious or scared to share that with fellow bed members at a risk of losing their gig or their opportunities. I have been receiving a lot of positive feedback about this initiative from DJs and sound gums in particular, which actually surprised me, but it makes a lot of sense. So a part of what we want to do is we want to set up workshops
00:23:16
Speaker
kind of geared towards like a general musician one, one for composers, one specifically for like brass bands, you know, and then we want to do one for DJs and sound guys. And the goal really is to just empower the artist, especially some artists who might not be well versed in the technical side of like sound production. And so I'm hoping that these workshops really educate
00:23:45
Speaker
and empower the artists that come.
00:23:50
Speaker
Yeah, it almost sounds like more DJs and musicians like they just like the people who are in the center of it all need to share their own experiences and how using these resources are helping them protect their hearing health. I feel like that's really it almost like that's the only way one of the biggest ways at least is like someone who's in it to express how important it is to protect your ears, right? Exactly. Because
00:24:20
Speaker
At the end of the day, like me going to a concert or the consumers, they can be their right choice. You know, for the musicians, it's their occupation, it's their job. And so it can become a hazard to them. So the goal is to really empower them, you know, with preventative methods, educate them on like the right language to use when speaking to a sound guide. If you say, this is what I want this to sound, I would like to hear. And I think once we have that, you would really start to see
00:24:50
Speaker
a change happening overall. Hopefully that will then transition to venue owners to get proper sound systems and to hire sound guys who know what they're doing and knowing what your venue can
00:25:09
Speaker
what your venue can hold. This place is good for a singer-songwriter. This place has a sound system equipped for more of a club style. This sound place is good for brass bands. I think all of that is important. We'll be right back after a word from our sponsor.
00:25:29
Speaker
Founded in 1957, School Health Corporation has been dedicated to helping school-based health professionals keep their students healthy for athletic performance. As a national school service provider of health supplies and services, school health's comprehensive offerings include hydration supplies to prevent heat illnesses, sports medicine, recovery and rehabilitation equipment, and school safety infographics for our athletes and the arts community.
00:25:56
Speaker
School Health provides more than just products and resources for performing artists and musicians. They also offer training, advisory services, and exceptional customer care for those supporting performers on school campuses. For more information, please visit www.schoolhealth.com. And now back to our show. So in Goma, how long have you been playing drums?
00:26:26
Speaker
three or four years old, for like 30 years. So then can you tell that you have a loss of sensitivity at all with listening to music? Do you find yourself noticing differences in how you hear? Yeah, now my ears are very sensitive.
00:26:45
Speaker
So I have, for example, like I have a friend of mine and he'll come in the car, he'll hop in the car and he'll be like, yo, check out this music I just put on and he'll crank the music and I'll be like, yo, man, don't eat the music that loud and hear the song. Even simple as like I was just in New York and just stuff as simple as like the, you know, the ambulance and like those type of sounds, I have to like close my ears when the ambulance is coming by. Yeah.
00:27:15
Speaker
Yeah, my ears are very sensitive now. So there's a number of sounds a number of times, even if I don't have my ear blood on me, I have to do that to protect my ears.
00:27:33
Speaker
What are the first signs of hearing loss is not so much ringing in the ears, not so much not being able to hear the consonant sounds, but the reduced tolerance, the increased sensitivity. So when hearing loss occurs, not only do sounds have to be a little bit louder before you can hear them,
00:27:56
Speaker
But also the loudest sound that you could hear or tolerate becomes reduced. So sounds that would not bother them 10 or 15 years ago, those same sounds are more bothersome. So that's one of the earlier signs of auditory or hearing related problems. But that's not to say you have a hearing loss per se, but I'm glad that you're wearing the hearing protection, that's for sure. Yeah, so go ahead.
00:28:24
Speaker
Marshall, I was going to ask for the average person. Are there any hearing sensitivity tests out there? Is there an app for this? There are a number of them, actually, which are very good.
00:28:40
Speaker
It's funny, the Food and Drug Administration in the United States recently approved a new type of hearing aid that could be sold called an over-the-counter hearing aid, or OTC for short, and that's for people with very mild hearing losses.
00:28:57
Speaker
Once the hearing loss gets a little bit more than mild, they better see an audiologist. But as part of the people accessing OTC, a lot of apps have sprung up in the marketplace to test hearing, to give some estimate of hearing. Some of them actually are fairly good, maybe not for the very, very low base notes because the room sometimes is a little bit noisy and that would cover or alter. But in the mid and higher frequencies, they're fairly accurate.
00:29:26
Speaker
Many people can just type in OTC or over-the-counter hearing aids, and they can actually do a self-test through that manufacturer. Some of the manufacturers are very large, Sony, Bose, these are large audio industry people that are now involved in the over-the-counter hearing aid market, and they've developed hearing testing apps that are fairly close to what you'd get in an audiology clinic.
00:29:55
Speaker
So that's a good screening test that they could use.
Auditory Rest and Key Prevention Tips
00:30:00
Speaker
So Doc, let's talk about then like treatment and handling this. So like acutely, and Goma goes and does a gig. He's buzzing afterward, goes to the concert, buzzing afterwards. Are there things you can do acutely after you're exposed to a large amount of decibels per hour that you can, does it help to like,
00:30:23
Speaker
protect your ears for 24 to 48 hours. Can you recover a little bit from that? What should folks do? Because one of the things that I worry about is our kids that go to like four day in a row concerts or six day in a row dance conventions where they're exposed to sound for hours and hours every single day. So there's a benefit someone to have auditory rest after a loud exposure.
00:30:45
Speaker
And something I want to add to that is these days, everyone has AirPods in their ears, like everyone's walking around with earphones all the time. That's true. Including myself sometimes, I like want to walk with music playing at all the times, right? But I don't think that's necessarily the healthiest.
00:31:02
Speaker
Well, built into these questions are the answers. Of course, moderation is a very important element. If you go to a gig on Friday night, don't mow your lawn on Saturday. We better still get someone else to do it for you.
00:31:16
Speaker
There's no given number of how long you should rest. There's a lot of literature on this, and they haven't really come up with a definitive answer. But we do know that after a loud gig, your hearing may be down for 16 to 18 hours after the loud gig. And the ringing or the tinnitus may even last a little bit longer. So as a rule of thumb, 16 to 18 hours seems to be a bare minimum.
00:31:43
Speaker
While we're actually talking about portable noise, like listening to music, our own music, there's something called the 80-90 rule, which also talks about moderation. 80% volume for 90 minutes a day, that will give you one half of your daily dose of noise exposure. So you're listening to your favorite song comes on, turn up the volume, enjoy it thoroughly, just turn it back down below 80% after.
00:32:10
Speaker
If you're listening for more than 90 minutes a day, an hour and a half a day, maybe you shouldn't, and maybe that's anti-social, but you have to be your own measuring stick. So if you're going to be listening to music longer than 90 minutes a day,
00:32:25
Speaker
8 out of 10 volume. You better be very careful that night. You should double up on hearing protection. Maybe you shouldn't go to that rock concert that night. Maybe go the next night. Also, there are some something called chemical ear muffs. How's that for a phrase?
00:32:43
Speaker
and refers to a bunch of medicines or pharmaceuticals you could take, some before, some after, that can mitigate or lessen the effects of music or noise exposure. One of them we've all known, we've all heard the terminology of an antioxidant.
00:33:02
Speaker
Antioxidants can be very important for our body, not just our hearing. But there's one in particular that's actually been demonstrated to be very useful to mitigate the effects of loud music or loud noise on hearing called LNAC, L-N-A-C, and many health food stores take it.
00:33:19
Speaker
sell it rather. The problem with LNAC is that it's not clear on what the dosage should be, and with so many of these antioxidants, dose is very important. The FDA is currently in the process of phase three trials, which is the Plano phase trial to make sure that there's no downside, there's no risk
00:33:41
Speaker
And there's one called epsilon that's been going through the system. And it's been shown that the right dose of epsilon taken either before or after noise exposure can lessen the amount of noise exposure that you generally have.
00:33:56
Speaker
But again, it's the dosage. It's the exact number of milligrams that's so crucial. So if you do hear about these chemical air muffs or pharmaceuticals, your first question will be, what's the dose? And if they can't give you that information, run away. But this stuff is coming through the FDA and through other routes as well. That can be very useful for us, for everyone.
00:34:23
Speaker
It's okay, Lee, what kind of techniques or prevention tips do you give out when you're doing outreach for musicians as far as trying to help with hearing loss? What are the key points that you make every time you present? You know, like just protecting your ears from noisy environments, like Dr. Marshall mentioned, you know, you listen to your favorite song that allows volume, next song, lower it.
00:34:51
Speaker
We do hand out earplugs to encourage artists to protect their ears that way. We have those silicone ones that can hang around your neck. Are there any programs that you work with musicians on who suffer from tinnitus? Well, like I said, we're going to be starting the workshop. So we're in the planning phases of that. So at the moment, I'm working with the audiologist at the New Orleans Speech and Hearing Center.
00:35:21
Speaker
I'm speaking to audio and sound engineers and I'm speaking with local musicians to curate a course. Okay. Then Marshall, what can people do to help with tinnitus? Are there anything you can take supplement wise? What other methods do you have to help people with tinnitus?
Tinnitus Treatments and Stress Management
00:35:46
Speaker
Well, that's a two-pronged answer. There's two flavors of tinnitus or tinnitus when it comes to musicians. There's the tinnitus that you get when you have a significant hearing loss. Maybe you've been drumming for 40 years and you happen to be in your 60s or 70s, and you do have a significant hearing loss.
00:36:08
Speaker
And hearing aids have really improved a lot in terms of helping to mask out the tinnitus. In fact, 56% of people that have tinnitus that also have a significant hearing loss get significant release or at least help partial masking for the tinnitus. So that's one flavor.
00:36:30
Speaker
The other flavor you get with musicians that are younger that have essentially normal or near normal hearing is a whole different animal despite the fact that they may call it tinnitus or tinnitus or noises in the ears. And that actually is more related to stress.
00:36:50
Speaker
Now, stress is not something airy-fairy. I know I remember in the 1960s, I was a kid then, but I certainly remember the headlines in the newspaper. Stress, the big killer. And they were talking about how it can affect your heart and your kidneys and your liver and everything. But actually in 2009, more than a decade ago now, an interesting article came out that delineated the effects of stress. And the short form is that when you're stressed,
00:37:19
Speaker
there's high levels of cortisol that are emitted from your adrenal glands. Cortisol is a very, very interesting molecule. It's one of the very few that can cross from the body into the brain, can cross the blood-brain barrier. What's in the brain that facilitates changes, not directly but indirectly, and it facilitates something called high levels of glutamate.
00:37:43
Speaker
Now we may not have heard of glutamate before, but it's like dopamine and serotonin. It's the things that make the nerves work. It turns out that high levels of glutamate are toxic to the hearing mechanism. So at the smallest, smallest molecular level,
00:38:00
Speaker
The effects of loud noise or loud music are identical to the effects of high levels of stress. Tinnitus is one of the side effects of that. So stress reduction techniques have been one of the greatest things we could do to mitigate the bothersome effects of ringing or buzzing in the ears for those that have relatively normal or near normal hearing.
00:38:25
Speaker
Also, I'm Canadian. In Canada, marijuana is allowed. Now, marijuana is made up of two elements, the THC, which essentially is what stones you out, and there's no medical benefit to that at all. And then there's the CBD or the cannabinoid, and there is some potential benefit medically for that as well. And it's shown at research at the Musicians' Clinics of Canada,
00:38:52
Speaker
It also presented at organizations like PAMA, the Performing Arts Medical Association, that high levels of cannabinoid, 30 or 40 milligrams a dose, as long as you keep the THC, the bad stuff, the stony stuff, really very low, less than two and a half milligrams per dose, that can actually allow the musician to sleep
00:39:14
Speaker
deeper, longer, and generally become less stressed, which has positive effects on reducing the amount or the annoyance of the tinnitus. So it's a two-pronged element. Are there any supplements in the market that are being used to help with this?
00:39:31
Speaker
To my knowledge, it's only the CBD that's available in Canada. I know you're in the States. L-NAC may be useful for some people, but again, we don't really know the dosage of the L-NAC. Okay. And then what, yeah. I think Cordycep mushrooms also help too.
00:39:56
Speaker
Cordyceps, okay. Yeah, I've tried them before, and I felt that it really helped lower tendonitis and stuff like that, at least in my ears, personally. I don't know if there's actual study or anything out on it like that, but I know cordyceps helped with me, and I've heard it works.
00:40:18
Speaker
Sorry, at the pharmacies here in town, there's pile of flavor noise now that they market towards tinnitus as well. I have no clue if there's any research to support that, but it's actually on the shelves now too. So I'm not sure if you guys have heard about that at all.
00:40:33
Speaker
There is research about flavonoids, but almost all the research is done on men, very little on women. And so some of the young ear, nose, and throat doctors graduating from school now are really on the bandwagon with flavonoids for their male patients.
00:40:49
Speaker
They don't really know how it works, but it does seem to work in some cases. Re-establishing the proper chemistry of the cochlea of the inner ear. But again, all the research has been done with men, very little with women. It's one of those sexist societal oopses that occurred.
00:41:10
Speaker
So we have severe tinnitus, tinnitus. So what can be done at that point? You have some people who have this constant roaring. They're really disabling their life. They have a very difficult time functioning. What kind of more advanced things are clinics doing to help people?
00:41:31
Speaker
There are a series of treatments for people that have significant tinnitus and hearing loss together. They have different names. One of them is called tinnitus retraining therapy or TRT for short.
00:41:49
Speaker
Another form of that is neuromonics, which is the same thing only with shaped noise. So they wear what look like hearing aids, but they're actually maskers. They emit certain sounds in the ear, but the trick is to have what they call a mixing level. That is, the masking noise has to be sufficiently loud
00:42:11
Speaker
but not too loud such that the person in a quiet place can no longer hear the tinnitus. They should hear the tinnitus, but a little bit of basking noise. Over time, the amount of noise that is required as the brain gets used to receiving the input is less and less and less. It's not a cure for the tinnitus, but it is a treatment that reduces it from maybe a very severe level to a more mild level.
00:42:37
Speaker
Usually this is coupled by cognitive therapy, stress reduction techniques, and it's quite debatable whether it's the stress reduction or the masking that's more important. But I think stress reduction is a biggie, and that's one of the first questions I always ask my musician clinics patients that have tinnitus, I say, what do you do for relaxation?
00:43:04
Speaker
And it doesn't have to be push-ups or sit-ups, although that's good, but it could be watching 1940s movies, whatever it is that cranks your chain. So stress reduction is something that we're just looking into, but we do know that it really makes a difference, especially for those musicians that are coming with debilitating tinnitus and sleep deprivation issues.
00:43:29
Speaker
But there is a doctor, Jennifer Ganz in California, that started a mindfulness-based tinnitus stress reduction program. And we actually adopted the curriculum. And one of our patients, musicians, community members,
00:43:48
Speaker
benefited from it so much that he brought it to other folks in New Orleans and has been offering to volunteer to do it. And then like, I try and give him money and he just ends up donating it back to the clinic. So it's, he really cares about this program. And it's, it's been evidently really beneficial to folks. So just wanted to highlight what Marshall was saying. Yes, Jennifer Gans, G-A-N-S. She's, she's a psychologist. She's brilliant.
00:44:17
Speaker
So it sounds like the World Health Organization has gotten involved because of how big this issue is around the world, right? Hearing loss affects billions of people around the world. And I guess my main question is for those who, so it sounds like New Orleans Musicians Clinic has resources for people who may
00:44:44
Speaker
not have the funding for support, but it also has mental health resources as well. So Marshall and Ingoma, if you can share a little bit about some of the mental health challenges that come up for people with hearing loss, I assume.
Mental Health and Economic Challenges
00:45:01
Speaker
A lot of it is not being able to hear your music, right? Not being able to follow along. Your day-to-day challenges, it gets stressful for something that's so natural for the body, so it's hard for someone to be able to hear. Are there any other challenges that come up from a mental health perspective? Well, at the moment, I don't really know of.
00:45:29
Speaker
exactly anybody dealing with mental health at the moment but I do have one brother when I talk to him he's like yo man I really I really can't hear like don't stop you know stop laughing you know and I'm like you know he's like I'm not really laughing at you I'm just kind of like you know like smiling like wow
00:45:50
Speaker
You're really deaf, bro? You're a little younger than me. So it's concerning, because this is a person I really consider as my brother. It's very concerning. And then I have another brother who's just in denial about it. You're sitting there talking to him, and he goes, huh? And I'm like, you didn't hear what I said? And he's like, uh-uh. And I'm like, then you go talk to him some more, then it's like, huh?
00:46:20
Speaker
really didn't hear what I, you know, so it was like, you try to talk to him about it, like, hey, bro, I think your hearing is going down, but, you know, you're trying to deny, deny about it. It's like, uh, brother, I was just talking to you. You didn't hear me, you know? So I'm like, were you not paying attention or were you just, you just, just did not hear me at all, you know?
00:46:42
Speaker
So at least that's the two that I can actually at least talk about as far as, at least the closest I know of like 20 mental health, as far as the here at Osco. In both Canada and the United States, they've done surveys for musicians and on musicians. And the average salary of a musician in Canada is $16,000.
00:47:10
Speaker
The poverty level in Canada is $22,000. So gig musicians have a major, major life stress in the sense that they cannot afford to live, especially in a large city where their gigs are. So they have to live in Toronto or Montreal or any of the larger cities. That's where the clubs are.
00:47:33
Speaker
yet the rent takes up 120% of their income in many cases. And couple that with the fact that in North America, our society does not respect musicians. It's incredibly, incredibly difficult to go into music and have a life as a musician. And some handle it very well, but
00:47:58
Speaker
Quite frankly, my son wanted to become a musician. I just about beat him up. I tried to sit on him. I wouldn't let him go out. Now, he is a musician. He's a composer, though. He's on the other side of it. And finally, I said, you got to do what you got to do. And I'm fully in support of him being now. But as a parent, I knew this data and I tried to dissuade him.
00:48:21
Speaker
I say stay in school, become a computer scientist or something. But finally, as a father, I said, you got to follow your passion. And I'm fully in support of him now. But I know that his friends that are other musicians, many of them, they don't sleep. They get in very, very late. Many of them may be imbibed too much alcohol or other drugs. They are not well respected and they can't make rent.
00:48:49
Speaker
half the time and they don't eat well. There's a lot of social stresses on musicians. I think if as a society, we would remunerate them to the extent that they deserve and to appreciate them to the extent that they should be. I think that would significantly reduce the mental stresses that are on musicians. This is predictable that musicians should be stressed.
00:49:19
Speaker
I'm perfectly understandable, but it's really a massive tragedy. It's an awful tragedy. But that's the reality. Musicians are not well paid, not well respected.
00:49:33
Speaker
And it's funny because COVID helped expose that when we have nothing to do and everybody shut down, what do we turn to for our sanity? It's performing arts, music, shows, and the performing artists are, you know, too big industries are on strike right now. Music industry is always fighting for proper payment.
00:49:54
Speaker
very strong point you make, so I really appreciate that. I appreciate the work that the New Orleans Musicians Clinic does. It's amazing work, Taylor. Where can people go to get more resources, more information, how to reach out
Engaging with the Clinic
00:50:07
Speaker
to you? People want to get involved with the Musicians Clinic should definitely go to our website. We're always looking for volunteers, interns, folks to get involved.
00:50:18
Speaker
Well, people can definitely check out more information about Save Nova Sounds on our website. So if you go to New Orleans Musicians Clinic and you click under Programs, we have a web page with a lot of resource information and tools that are available.
00:50:38
Speaker
Well, Kaylee, Dr. Chasen, Ingoma, Taylor, we really appreciate you being on the show today. We spent a lot of time going over a very important issue, and I hope everything goes well for you guys in the future. Thank you so much for being here. Thank you, Stephen. Thank you for having us. Thank you so much for having us. And that wraps up another episode. We'd like to thank our sponsor, School Health, again for supporting the show. And if you like what you hear, please click Subscribe and leave a review. For Yasiyan Sari, I'm Stephen Karaginas, and this has been the Athletes and the Arts Podcast.