Management of Hearing Loss Prevention in Live Entertainment

Editor’s Note: This text course is an edited transcript of a live webinar. Download supplemental course materials.

Dr. Robert Ghent: Today I’m going to discuss management of hearing loss prevention in live entertainment. I’ll cover why this area has not been more recognized and what opportunities are available for audiologists. I’ll also talk about what management of hearing loss means in the live entertainment industry. Live entertainment includes sporting events, racing events, and concerts of all types, not just rock and roll, but the primary focus today is on music events.

I work for Honeywell Safety Products. Many of the pictures in your handout are of Honeywell products because I have easy access to those images, but there are other products that are included as well. The use of these images does not constitute an endorsement any of these products. I would also like to take this opportunity to acknowledge Mr. Nick Mayne of the Canterbury City Council in Kent, England, for providing me with some data from a study that I’ll be discussing. Additionally, portions of this presentation were previously presented at the 47^th Conference of the Audio Engineering Society (AES), on Music-Induced Hearing Loss in 2012, as well as at the 38^th Annual National Hearing Conservation Association (NHCA) Conference in 2013.

Background

In 1964, the Beatles came to the United States and performed at Shea Stadium. Few fans could hear them, and the Beatles could not hear themselves well because the audience was so loud. There was a problem with getting sound distributed over a crowd of screaming people that large. In the ensuing 10 years, we significantly advanced the technology of concert sound reinforcement.

When I was a senior in high school, I got a job at Tycobrahe Sound Company. They were contracted to provide the sound for a large festival show, second only to Woodstock at the time. So, in 1974, we did The California Jam. A magazine article covering this show touted 54,000 watts of audio power. We generated 105 dB SPL a mile away, and we were awed by such a great achievement. Can you imagine how loud it had to be in front of the speaker tower in order to measure 105 dB SPL at one mile down wind?  This is how I started my career.

Problem Statement

Hearing conservation has never been a part of the live entertainment culture, despite knowledge of the problems and risks. The entertainment industry knows there are some regulations, but those typically apply to brick-and-mortar industries, and entertainment does not know how to apply them in their own industry. Fortunately, we see this starting to change, and this is a good opportunity for audiologists to do something to help this industry.

A “duty holder” is the person who manages live shows. This person could be a concert promoter, a club owner, or the general manager of a football or basketball team. They often see any regulation that comes from outside their industry as a threat to the viability of their product or entertainment value.

Part of the problem is that they do not have a work environment that is in any way similar to the type of environment that you find in brick-and-mortar industries. Duty holders need to see what has been done in other places to accommodate regulations for their own policing of this issue. While the risks and implications are understood, industrial-style regulations cannot be forced on the entertainment industry.

Industry Differences: Labor

In a traditional industry, there is a worker with a supervisor. There is a health and safety manager. There might be an industrial or occupational audiologist. There is often an industrial hygienist or occupational nurse. Someone on this team is responsible for health and safety in these traditional industries. They report to upper management, and upper management controls the site. At the top, there might be an executive overseer and corporate officers.

In live entertainment, the labor structure is very different. It is generally composed of talent. There are musicians, dancers, and actors. Then there is the production crew, which is broken down into two groups: stage crew and technical crew. Both groups report to their own management, which is different management than for the talent. There is also the venue staff, which has nothing to do with the production companies or the artists themselves. Large productions may have safety officers for high-risk operations, like pyrotechnics or stunts, and there will often be medical staff for, say, a movie shoot, but this is not always the case in smaller productions. In any case, hearing loss prevention can be easily overlooked.

Labor Differences: Management

In a traditional industry, there is typically one work site and one safety lead at that work site. This lead could be an occupational health nurse or a safety director who is responsible for all safety issues including hearing conservation and noise hazards. They report in a vertical hierarchy, and the work site is fixed and stable. Process equipment is in one place and makes the same amount of noise every day.

Live entertainment is very different. Each trade within the music industry, for example, has their own management structure. They may have their own safety procedures; they may not have any. Their line of authority is short and takes short parallel paths to each level of management. Sometimes those paths are not defined very well.

Furthermore, this work site can be a moving target. For example, an arena may host a basketball game one day, Ice Capades the next, and then a concert. Given this management structure, who is responsible for the workers’ safety in live entertainment? 

Regulatory Environment: United States vs. Europe

As we go through this, think about how your role as an audiologist can fit in. Let’s look at some of the regulatory differences between the United States and Europe. The European Union (EU) has successfully had entertainment under their regulatory purview for some time. The regulatory environment in the United States is very hands-off. The Occupational Safety and Health Administration (OSHA), which is in charge of this regulatory activity, has little understanding of the entertainment industry. It has focused on traditional industries, which are different even among themselves. For instance, mining is very different than manufacturing. The realization of such differences prompted the formation of MSHA, the Mine Safety and Health Administration. There are special requirements for construction and for the railroads, too, because those industries differ from a traditional manufacturing industry.

OSHA tends to be very reactive instead of proactive. It tends to audit an industry or company after an incident occurs. It follows a default template when they do this, and it is very difficult to change. At this point in time, OSHA relies on the live entertainment industry to police itself. As such, the entertainment industry needs to do a better job.

By contrast, the safety and health administrations in Europe seem to be genuinely concerned for the safety and wellbeing of the individual worker. They are also concerned about the impact their activities will have on the operations of the businesses they serve. They do not want to do any economic damage or damage the quality of any product, whether it be physical goods or a service. Their approach is to prevent injury in the first place, and in order to do this, they have developed a special guide—the Event Safety Guide--in collaboration with other stakeholders. We also now have an Event Safety Guide in the U.S., which we will talk about later.

Impact on Industry

We want to look now at the difference of the impact these regulations have on the live entertainment industry versus traditional industries. In the U.S., live entertainment is lumped in with all the other industries that put workers at risk. The self-employed, however, are not currently part of OSHA’s purview.

The Environmental Protection Agency (EPA) is another U.S. regulatory agency. I mention it here because the Noise Reduction Rating (NRR) for hearing protection devices is defined by the EPA. Hearing protectors need to be tested according to an American National Standards Institute (ANSI) test standard. I want to make it clear that the test standard from ANSI is not the law. It is merely a testing method, but the EPA requires manufacturers to use that standard. The EPA code published in the Federal Register is the law and carries legislative force. A measurement or function needs to be in compliance with the law, which is OSHA’s regulations, the EPA’s regulations, or both.

When the Europeans drafted their laws for noise exposure for workers, they included live entertainment. They drafted the Noise-at-Work regulations in 2005, promulgated to go into effect in 2006. They gave the live entertainment industry an extra two years to develop the means to comply with this regulation. This allowance was for the entertainment industry to find ways to comply that had the least impact on their product and on the economics of their industry because EU lawmakers recognized the unique issues in this industry. They also covered the self-employed under those same rules.

When the European Union (EU) develops a directive like this, they expect each member country to enforce it. The directive is nothing more than a minimum set of requirements. The laws that each country puts into effect have to be at least as rigorous as the directive from the EU commission.

The European ISO/EN standards, like the ANSI standards, are not law. The EU does not have an EPA mandating testing a certain way. Instead, they rely on the hearing protection product manufacturers to meet the ISO testing standards by having their product testing done at independent accredited laboratories. This keeps competition lively because they know that everyone is on the same level playing field.

Noise Standards

Noise exposure standards are different also. Europe is successful in implementing noise exposure standards in the entertainment industry even though their standards are more stringent than the U.S. standards. For instance, the action level in the U.S., under OSHA, is 85 dBA.  At this level, an industry needs to provide hearing protection to their employees; they do not have to make them wear it, just provide it. For the maximum exposure level—90 dBA for 8 hours—protection is required, as this exposure level equates to a 100% noise dose. Workers are not allowed to be exposed at 90 dBA for more than 8 hours, 115 dBA for 15 minutes, or 140 dB peak at all. Those are violations of OSHA regulations.

Furthermore, the jump from the action level at 85 dBA at 50% dose to 90 dBA, which is 100% dose, is 5 dB. We call this the exchange rate. For every doubling of sound energy, we ordinarily would cut exposure time in half. A doubling of sound energy equates to a 3 dB increase in sound intensity, but we allow 5 dB in the U.S. which is significantly more than double the energy. This was a compromise in the law as a result of lobbying by the regulated industries.

The permissible exposure level in the U.S. is based on a time-weighted average of eight hours daily, or a typical work shift. Again, a 100% daily noise dose is 90 dBA for 8 hours. In Europe, instead of 85 dBA, the lower exposure action value, where hearing protection must be provided, is 80 dBA, and the upper level, where hearing protection must be worn, is 85 dBA. Their peak exposure levels are lower as well.

While European requirements are more stringent, they are also based on science. For instance, they use a 3-dB exchange rate. This makes sense because twice the energy amounts to a 3 dB increase in intensity. They also know that noise exposure damage is cumulative. Rather than simply limit exposure to eight hours per day, they have a weekly exposure criterion as well. There may be a worker who works a 10-hour day but is not exposed to 85 dBA for those 10 hours. However, over the week, that daily exposure can accumulate to put him or her at risk for a hearing loss. Europe does not generally use the concept of a 100% daily dose, but they look at the level of exposure averaged over the week as well as the day.

Corrective Actions

Corrective actions in the U.S. are different than European corrective actions. When a worker’s 100% noise dose has been exceeded, the U.S. takes no drastic action. Only at each annual audiogram is it determined if there has been a threshold shift during the year. If there is, it must be reported to OSHA. OSHA may come in and do an audit. They may sanction a company that has threshold shifts that are not under control. The problem with doing it this way is that the damage is already done. Annual audiograms are not leading indicators; they are lagging indicators.

It seems that OSHA will tolerate the injury, but then reprimand the violation after the damage is done. Europe looks at the measured noise exposure values and requires a reduction in exposure before damage is done.

Implementation

What is the difference in how the EU applies these regulations in live entertainment versus the U.S.?  Europe adopted a collaborative model. They asked, “What can we learn from the entertainment industry that we do not know?” and “What can the industry learn from us?”  In the U.K., in order to study that, they put together collaborative working groups. At the outset, they were not trying to force companies to comply with the rules; they were trying to understand each other. In Europe, worker safety has more to do with preventing injury than compliance with regulations.

When OSHA does finally react, it has been viewed by U.S. industries as being heavy-handed. Many of their sanctions have resulted in extraordinary economic and administrative burdens for some companies. It would crush the live entertainment industry if these actions were administrated in the same way as in other industries.

OSHA in the United States

The Assistant Secretary of Labor and the director of OSHA, Dr. David Michaels, has been quoted as saying that OSHA fines are too small and are not an adequate deterrent to violations. He would like to see an increase in fines and impose jail time. This viewpoint, as we will see, suggests that OSHA does not put a significant value on an injury or a life (and their penalty structure supports this observation), but attaches value to lack of compliance or violations.

To avoid the perception of a confrontational approach, OSHA has started to change the way they interact with the industries they serve. They have been trying to take a more European approach and talk about zero at-risk behaviors, as opposed to zero injuries. In other words, they want to change industry’s culture before there is an accident—a culture of safety instead of a culture of compliance. The companies that have been subject to OSHA regulation are looking for some hand-holding to accomplish these things. The entertainment industry really needs to first understanding what the expectations are.

The entertainment industry needs this kind of approach because the management structure is so different. Anyone who has ever worked in entertainment will tell you that the talent is the top dog. This is one of the reasons that OSHA does not understand how the entertainment industry is put together. They look at it from an industrial point of view, or as a multi-employer work site. They need to find out and understand who is in charge. Maybe the management structure in the entertainment industry needs to change as well, but that is going to require another culture shift.

We are going to look at some examples of how this management structure has failed with regard to safety issues. We will see how the EU has applied their regulations to this management structure with some success, and address the culture change that will be needed.

Penalties in the United States

Let’s look at some non-entertainment industry examples. These companies were hit with very severe penalties, not because of a hearing conservation violation, but because someone died or lost a limb. The penalties are over $100,000 for these companies because of extra safety violations, including noise exposure violations that were added after-the-fact. Figure 1 shows some examples of these penalties. One company was fined over $300,000 in penalties for 25 safety violations. OSHA audited this company because one employee got hurt or died, but their audit found 24 additional violations, including exposing workers to excessive noise levels.

Figure 1. Examples of OSHA penalties and fines for safety violations.

An Industry Incident

In 2011, a terrible incident occurred within the entertainment industry that spurred a lot of angst, but also needed attention when it comes to safety. A large gust of wind collapsed the stage roof of an outdoor concert in Indiana, killing 7 people and injuring 58 others. The Indiana Occupational Safety and Health Administration (IOSHA) levied penalties totaling over $80,000 against the International Alliance of Theatrical Stage employees, who was the contractor for building the stage, the Indiana State Fair Commission, who was the concert promoter, and the sound company that provided the sound reinforcement. The sound company did not build the stage, but they hung their loudspeakers from the stage moorings. It was those loudspeakers that came down with the stage roof and killed people. The sound company bore the highest penalty and lost one of their own in the accident.

The promoter, the contractor and the sound company had earlier brought these weather concerns to the attention of the artist—the band—to which all the contracted help looked as the sole authority to unplug the show and shut it down. Every single one of these entities looked to the band for leadership because they understood that the artist is the boss. IOSHA did not see it that way, and the artist was not cited. They did not see how the artist was culpable in this accident. Anyone who has worked in this industry will tell you that is not how it works; the artist has the final say.

OSHA does not understand this management structure. Dr. Michaels of OSHA has said that he is taking the entertainment industry to task, because safety is not often the highest priority. We have not seen him cite any entertainment companies for hearing conservation or noise exposure violations, but we have seen it happen in other industries and in other companies.

We can expect to see this happen in the entertainment industry eventually, but they have to fix their management problems first. For instance, who is responsible for the sound levels at a concert?  Is it the audio guy—the sound engineer?  Remember, different crews all have their own management, but the artist is ultimately the boss. In any case, the sound engineer cannot do anything about the volume of the audience. The sound engineer has to deliver audio to a very large crowd and make sure that they can all hear over their own noise. It is going to be loud.

Other Case Examples

Here’s an actual example: An audio engineer at one of the sound companies for which I worked was told by the lead guitarist of an internationally famous band that if he could not hear the main house sound system while on stage, then it was not loud enough. The audio engineer said that he would not make it that loud. What do you think happened?  That audio engineer lost the job. The sound company lost that contract. The artist is the boss.

The next example is a realistic scenario: In order to comply with community noise ordinances, the owner of a nightclub has installed a device that turns off the sound system when it gets too loud. The neighbors have been happy, but the people working inside the club are still being exposed to hazardous levels of noise. What happens when the owner is blindsided by a Worker’s Compensation claim for a barista’s occupational hearing loss?

In the U.K. they did something about this by forming working groups to address the issue from a common base. The working groups consisted of a wide variety of stakeholders, including audiologists, the British Beer and Pub Association, entertainment management associations, etc. Canada and most of the British Commonwealth have adopted this working group model. The Association of British Orchestras published studies on how the Noise-at-Work regulations were being applied in orchestras. The publications are called A Sound Ear I and II. You can do a Google search to find these documents.

Another example from is from Mr. Nick Mayne, whom I mentioned before. He looked at sound levels in seven nightclubs and five pubs in Kent, England, and found that the owners of these nightclubs—the duty holders—had no knowledge of their noise exposure responsibility to their employees. However, because the regulations were coming and Mr. Mayne’s attitude was to help them to be able to comply with these regulations, his team took sound measurements. Personal noise exposure monitoring measurements on individual employees were well over the allowable limits.

Mr. Mayne looked at why the duty holders or management were not doing anything about this hazardous noise exposure. It was because they had no knowledge of the Noise-at-Work regulations or how loud their businesses were. The local authority did not cite the businesses, but instead educated them in order to help them protect their employees.

As an example, after implementing instructions and protocols, one nightclub saw a significant decrease in noise exposure over 18 months for its five employees. Although their improvements were not perfect and there were still unsafe exposures, the overall improvements were beneficial and continue to improve.

I tried to launch a similar study in San Diego, although the response I got was very defensive. I tried to explain that I was not a legal authority, and I was not going to report their noise exposure levels to any authority. However, because they do not perceive any enforceable regulations in their industry, they do not feel like they have a problem, and they are not going to do anything about it. “If it ain’t broke, don’t fix it.”

How Do We Help?

As hearing healthcare professionals, what can we do to help the live entertainment industry protect their workers’ hearing?  First, we can increase awareness. We have been doing this for some time, but the efforts have not yet resulted in a wide-spread culture shift. We need to help initiate this culture change. Increasing awareness is not enough, but at least we have people’s attention now.

We can help this industry make hearing loss prevention a part of their daily work culture. We have some tools they can use, but we have to teach management why it is important and help them understand the law. We can to get to them through stakeholder working groups.

Tools

Help management take some simple steps, such as including hearing protection in the gig kit so that hearing protection is available at the venues. They must begin to self-regulate their exposures as well. We have to get this culture change started or self-regulation is never going to take place. Much of this has to do with education. If you can get key entertainment industry personnel into your practice for a hearing assessment, you can participate in their education and become the expert in your area for this industry.

One tool for which we can provide education is amplification at venues. There are new loudspeaker systems available that have a curved-line array and are hung very high. In this way, the top of the array can be made louder and the bottom softer so that every member of the audience gets the same level of loudness. People who are closer to the loudspeakers do not have to be blasted just so the people in the back of the hall can hear. We can educate the talent to limit the volume on stage and let the loudspeakers do the work.

Similarly, barriers need to be used. OSHA specifies the use of engineering controls first, like barriers, followed by administrative controls and hearing protection. When it comes to music, we need to have the appropriate hearing protection for the job at hand. For instance, foam earplugs might be appropriate for security or food vendors, but employees working the sound stage need a uniform-attenuation earplug. Musicians and performers may prefer custom-molded musician’s earplugs.

Assessment

Audiologists can also promote assessment products and services. We can monitor sound levels using dosimetry in all performance spaces where employees are working. This is especially important during day-long shows, such as festivals. We also have in-ear dosimetry available for staff to monitor the sound level in the ear canal that is being protected, such as that of the musician. We can fit test earplugs on site. Fit testing an earplug is very similar to how we verify the fitting of a hearing aid using real-ear probe microphone measures. Fit testing can be used to help in the selection of hearing protection devices and train people how to use them.

Musicians and sound engineers, especially those working in film, should have their hearing tested above 8 kHz. High-frequency audiometry and otoacoustic emissions can detect early hearing loss that may not yet show up on a conventional audiogram. This is important for audio professionals who may be exposed to hazardous noise yet require sensitivity to sonic nuances above 8 kHz. Remember, people in this profession are not focused solely on the speech spectrum.

Procedures

There are best practices for procedures as well. This is where you can start to have an impact in the education area, but you have to get your foot in the door, which is the difficult part for most audiologists. Since the Indiana State Fair stage disaster, a new alliance has been formed in the entertainment industry called the Event Safety Alliance (ESA). They have published their own version of the Event Safety Guide, based on the guide from the U.K. You can find this guide at www.eventsafetyalliance.org.

Gaining Traction in the United States

The Professional Lighting and Sound Association (PLASA) is a group of entertainment industry professionals who are working on technical certification, vocational training and ANSI standards for the entertainment industry. They have not yet addressed hearing loss prevention, but both the ESA and PLASA are looking for experts in safety areas to join their programs and offer help. The Audio Engineering Society (AES) has taken a big step forward with their conferences on music-induced hearing loss. Additionally, in the past few years, audiology has become a recognized career path for people enrolled in audio technology coursework at trade schools and universities.

We need hearing healthcare experts who also understand the management and business structure of the live entertainment industry and how to accommodate that structure. We also need to accept that music and sound are often going to be loud as an integral part of the entertainment experience. Lastly, we must acknowledge and work with professional organizations on the industry’s unique health and safety goals.

Facilitate Education and Cooperation

We need to have collaboration among the stakeholders, many of which are shown in Figure 2. These are organizations with which you are probably familiar or may have memberships. Some of these have very strong programs devoted to hearing loss prevention in entertainment, such as the National Hearing Conservation Association (NHCA), the Audio Engineering Society (AES), Dangerous Decibels, and the National Association of Music Merchants (NAMM). NAMM offers hearing tests for all attendees of their annual conference and convention. These organizations are at the forefront of the professional trade organizations, and we can link to many of these organizations and pool our resources together.

Figure 2. Examples of professional organizations in the hearing and music industries.

Conclusion

When we look at this problem, we need to ask ourselves, “How can I or my practice benefit this industry, and how does my practice benefit in return?”  Collaboration is still in its infancy, which is why I do not have a lot of concrete methods to give you yet. However, we’ve talked about some tools that you can start using now in your local areas.

Music and live entertainment are not just for the youth. I like listening to music. I like going to concerts. I still play in bands, and I like it loud. I also like to protect my hearing and the hearing of those around me. There are ways to accomplish both. We have seen how it is done in Europe, especially the U.K., and we can implement some of those same things here in the United States, but we need to get organized and be forthcoming with the live entertainment industry about what they can do to get a handle on minimizing hearing damage risk to their employees.

Questions and Answers

Can you tell us more about how weekly exposure is calculated in the EU?

They take an average of daily exposures throughout the week, but you have to remember that you cannot do an arithmetic average with decibels. They do personal exposure monitoring during the day and take an accumulated average for the week, based on an eight-hour exposure rate, but they know that some people are exposed for more or less time than that during the day. They make adjustments to those daily exposure levels to normalize them to eight hours, and then look at the accumulation over the week.

Which organization refuses to promote hearing loss prevention?

That is one of the quiz questions. I don’t think we discussed which one refuses, but I mentioned three that are very involved in promoting hearing loss prevention in the entertainment industry: NHCA, AES, and NAMM. Those three in particular have been very instrumental in increasing hearing loss awareness in the live entertainment industry.

You mentioned great organizations like NHCA that audiologists can join. As this area develops, what resources can audiologists look to for more information in the future? 

Within those groups that I mentioned, especially audiology community groups like NHCA, you will find people we can call a “triple threat.”  Brian Fligor is one example. There are not a lot of us. In entertainment, a triple threat is someone who can sing, dance, and act. In audiology, if you are a performer or understand performance, are an audiologist, and also understand audio technology, which, unfortunately, a lot of audiologists do not, you may be a triple threat. A person who has developed that skill set is at an advantage to be able to become the expert in their area. They have to promote themselves just as they might promote their practice for fitting hearing aids.

You can promote your practice to the audio vendors, sound companies, concert promoters and venues as the go-to person to help with these issues. One of the areas where audiologists can get better background on how safety is being handled in the entertainment industry is to align themselves with the ESA and/or PLASA. You can find these organizations on the Web. These organizations are going to be at the forefront of promoting safety in the live entertainment industry, including hearing loss prevention.