Aural Diversity, presented at the Equality, Diversity and inclusion in Music Higher Education one-day conference https://www.city.ac.uk/events/2020/january/equality-diversity-and-inclusion-in-music-higher-education
2. HEARING CONDITIONS
• Central deafness: ear-brain connection damaged or absent
• Sensorineural hearing loss: withering of the hair cells in the inner ear
due to age (presbycusis) or disease, noise-induced (NIHL), or
medications (ototoxicity)
• Conductive hearing loss: the result of obstructions in the outer or
middle ear (e.g. wax, infection, growths, tumours etc).
• Mixed hearing loss: a combination of sensorineural and conductive
hearing loss
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3. AUDITORY PROCESSING DISORDERS
• Hyperacusis (heightened sensitivity to everyday sounds)
• Misophonia (sounds trigger unwelcome emotional or
physiological responses)
• Tinnitus (ringing, buzzing, hissing or other sounds in the
ear when no external sound is present)
• Diplacusis (inter-aural pitch difference, in which two
pitches are heard in either ear)
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4. “NORMAL” HEARING
ISO 226:2003 Acoustics
Normal equal-loudness-level contours
“This International Standard specifies
combinations of sound pressure levels
and frequencies of pure continuous
tones which are perceived as equally loud
by human listeners […]
The listeners are otologically normal persons
in the age range from 18 years to 25 years.”
5. 5
Presbycusis (age-related HL) Sensorineural (e.g. NIHL) Conductive
“By 2013, 1.1 billion people were affected by hearing loss globally”. Lancet. 386 (9995): 743–800.
7. AUDITORY PROCESSING DISORDERS
Tinnitus
• Tinnitus is understood to be a neurological
condition, usually caused by hearing damage
(BTA, 2019)
• Musicians are more than twice as likely to
experience tinnitus (Couth et al. 2019)
• Tinnitus affects classical musicians just as much
as rock/pop musicians (Luders et al 2014)
• Tinnitus can result from prolonged exposure to
intense sounds (Chasin 1995)
Diplacusis
• Professional musicians have a
considerably higher risk of
developing diplacusis (Di Stadio et al.
2018)
• 100% of Ménière’s musicians
surveyed have diplacusis (Hugill
2019)
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12. MUSICIANS AND AURAL DIVERSITY
• I went for an audition to sing. I was put in a room and I sang. I sang okay, and then he gave me ear tests. One
of the tests he gave me was, he said: “I'm going to sing now various notes and I want you to pitch them at a
third above and vary as I vary the pitch very slightly”. Well of course I couldn't hear him so I couldn't do it. It was
just absolutely hopeless. I couldn't follow it, so obviously I failed.
• I don't really hear very much below, I'd say G below middle C and very poorly a c below middle C [...] The effect
is strong if I have to sing. My singing range is that octave below middle C but I'm very aware of the fact that my
pitch is very poor down there. And what I instinctively do is just to sing everything up the octave.
• I was playing this Bach cantata and I had to finish out the week. We were doing rehearsals and then two
concerts. I was just in agony.
• I would play a chord on the guitar and it just didn't make any sense. That’s when I was really frustrated, cause
at this point I was I was working full-time in music. I had to stop. It was the end of my career.
• I don't have the confidence to just dive in with the harmony so much like I used to, so listening to stuff is harder
to to find the spot, to find the key. So, you know how you just jam, you just hear a song and you feel like I'm just
going to sing this harmony and join along with it. Even that's harder.
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13. AURAL DIVERSITY
• The Aural Diversity project has three main aims:
• to create a platform and a set of conventions for staging concerts in which aurally
diverse musicians perform to an aurally diverse audience
• to offer people new ways of approaching the listening experience that shows
awareness of different needs and opens up rich experiences for diverse listening
profiles
• to undertake research into aural diversity that will influence policy and future work in
fields such as music, audiology, sound studies, environmental design, and hearing aid
manufacture
• http://auraldiversity.org
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My theme is Aural Diversity, that is to say: differences in hearing. In EDI terms, that normally falls under the heading of ‘disability’, which is itself all too often the poor relation to other themes. Yet I would say that it is of fundamental importance to music in higher education. It is surprising to me that it is so little acknowledged or discussed.
I would also say that ‘disability’ is only part of the picture. I broadly support the social model, which suggests that it is often society that disables people. This is not to deny the disabling effects of hearing loss, for example, but I would like to point out that my hearing is different to yours, and that is an example of diversity. But first, let me clear what I am talking about…
The sheer range and complexity of hearing conditions is what gives rise to aural diversity. Hearing loss or impairment is categorized into four types. In central deafness the ear-brain connection is damaged or absent. In sensorineural hearing loss there is withering of the hair cells in the inner ear due to age (presbycusis) or disease, noise-induced (NIHL), or medications (ototoxicity). Conductive hearing loss is the result of obstructions in the outer or middle ear (e.g. wax, infection, growths, tumours etc). Mixed hearing loss is a combination of sensorineural and conductive hearing loss. But hearing loss is not the only kind of difference…
Auditory processing disorders include Hyperacusis (heightened sensitivity to everyday sounds); Misophonia (a disorder in which sounds trigger unwelcome emotional or physiological responses); Tinnitus (ringing, buzzing, hissing or other sounds in the ear when no external sound is present); Diplacusis (inter-aural pitch difference). As the slide suggests, these have a neurological origin and their connection to damage in the physical mechanism is either unclear or non-existent.
The slide shows a normal hearing audiogram. The red circles represent the right ear and the blue crosses the left. The X axis gives frequency measured in hertz and the Y axis gives intensity measured in decibels. The classifications of hearing loss are given on the left hand side.
Audiologists measure hearing using a pure tone generator or audiometer. They typically test for the limits of hearing.
The International Organisation for Standardisation (ISO) sets the standard for “otologically normal persons”, giving the typical age range within which such hearing is encountered. After this age, or often somewhat earlier, there is invariably some deterioration, normally at the high frequency end.
Audiograms are extensively used, but they only represent a fraction of the range of human hearing, which is generally reckoned to be 20Hz – 20,000 Hz (i.e. 20kHz). The frequency range of a piano is 27.5 Hz (A0) to 4186 Hz (C8). An audiogram begins around the C two octaves below middle C.
Roughly one sixth of the world’s population is affected by some kind of hearing condition which degrades “normal” hearing,.
Presbycusis is age-related loss and affects everyone to some degree. Notice the even decline across the two ears, with the characteristic loss of high frequency perception. Hearing aids would normally be recommended to counter this.
Noise-induced hearing loss shows a notch. This could also be caused by drugs or some other cause.
The third audiogram shows the difference between air conduction and bone conduction, represented by the blue triangles.
Hearing loss may also be asymmetrical. This is my own audiogram from 2017, showing a clear difference between left and right ear. I have a condition called Ménière’s Disease. Notice how the low end of the frequency range is down – this is very typical of Ménière’s.
But I also have a lot of tinnitus, hyperacusis and diplacusis. All this makes listening to music extremely difficult. Which brings us on to those auditory processing disorders that cannot be depicted in audiograms and rely much more on verbal descriptions by patients and clinicians.
Tinnitus is so prevalent now that it almost needs no introduction. It is in fact a neurological condition, but is usually caused by hearing damage. The preponderance of in-ear speakers and long loud concerts means that most people have experienced temporary tinnitus at some time or other. Musicians are more than twice as likely to have permanent tinnitus. Tinnitus affects classical musicians just as much as rock/pop musicians
Diplacusis is rarer but nevertheless quite common among musicians. All Meniere’s musicians have diplacusis.
Hyperacusis affects many musicians. Notice here the very high occurrence within classical music. Hyperacusis and misophonia are also sensory issues in autism and other similar conditions.
Hearing aids come in a range of types as shown. Bone Anchored Hearing Systems are indicated for conductive hearing loss, mixed hearing loss, or single-sided deafness. Cochlear Implants are for severe to profound sensorineural hearing loss.
In both cases, music is transformed by the use of these technologies. Many musicians really dislike hearing aids and try to work without them. This is because HA are mostly engineered for speech and so compress and distort sound in its favour. Many of the more recent aids include a ‘Music’ setting which generally has a wider frequency response.
A large number of musicians have found cochlear implants able to give them back some aspects of their hearing, often leading to renewed musical activity. But CI do not work for everybody and they do not reproduce normal hearing. The frequency bands are limited, so the ability to listen to music must be learned anew.
Of course, technologies are only part of the picture when it comes to music. BSL interpretation is fairly common at concerts these days.
There are many more solutions for deaf and hard of hearing people, such as vibrating floors and various haptic devices, video and text interpretation, and a number of other experimental listening technologies.
Aural Diversity impacts on musicians in many different ways. However, musicians are also often secretive about their hearing loss, usually for professional reasons.
People with hearing differences often find themselves excluded. Here are some examples from a research project I undertook recently…
Music in Higher Education typically assumes that everybody hears the same. Music departments show little awareness of audiological issues. I never encountered any discussion of the hearing mechanism when I studied, and only limited discussion even of listening.
Now there are of course some famous examples of deaf musicians who have successfully progressed to international careers. It is by no means unheard of for people with cochlear implants and hearing aids to be able to function in musical situations. However, they only do so in a way that ignores or rises above their hearing conditions. They must be able to function in the same way as people with normal hearing to be regarded as good musicians. The message is: we must adapt to music, rather than music adapting to us. Which is strange, because music is immensely fluid and flexible, or should be.
Wouldn’t it be better if we acknowledged aural diversity and made reasonable adjustments for it? This could transform the ways in which music is taught and experienced. Notional ‘gold standards’ expressed through things like aural tests, would need to be revised. The benefits of doing so would be to open music HE up to a much wider range of people. I believe you do not have to be ‘otologically normal’ to be able to study music at a higher level.
The word "auraldiversity" was coined by John Levack Drever. The Aural Diversity project began last year and is co-directed by him and me. We have staged two concerts by aurally diverse musicians for aurally diverse audiences. In November we staged the first conference which was well attended by academics and artists from around the world. Full details are given on our website. We are in the process of creating a research network and would invite anybody who is interested to join us.
In terms of EDI, my main purpose in this presentation is to raise awareness of the importance of this type of diversity. I think it is barely considered, and yet for musicians it is surely very important that we take account of diversities of hearing. I think the academic curriculum, with its normalizing standards needs to do more to include aurally diverse people.