Implementación de opciones de mitigación

hearing. Ear damage can occur from over-exposure to loud sounds and can also be caused by infections and other causes such as diabetes. The person may lose hearing in the low frequency or high frequency range. This is often accompanied by tinnitus (ringing sound in the ear). Those who lose hearing in the low frequency range tend to hear a low, roaring or throbbing tinnitus, and those who lose hearing in the high frequency range tend to hear a high pitched whine. There is no known cure or effective treatments for either hearing loss or tinnitus. Those who are clinically deaf can benefit greatly from cochlea implants.

A damaged ear can more easily suffer additional damage than a healthy ear. Because damage is painful, those with hearing loss are more sensitive to loud sounds -- even moderately loud sounds that do not bother normal people can be painfully loud because they can cause more damage. Therefore, if there is a hearing impaired person in the room, don't make the mistake of turning up the sound thinking that they will hear it better.

That is why hearing aid technology is so difficult – you can't simply amplify all sounds. Soft sounds must be amplified but loud sounds must be attenuated, a process called "compression" in the industry. Compressed sounds, especially music, sound terrible to most people so that patients with even the most expensive hearing aids costing over $10,000.00 do not wear them unless necessary. Those wearing hearing aids for the first time must go through a period of gradual acclimation to the compression; the audiologist gradually increases the compression over a period of weeks or months. Patients with hearing aids wear them in order to understand conversations, not for music which generally sounds better without hearing aids.

The first thing that happens when hearing is impaired is the difficulty of understanding

conversations. The most common reaction, and mistake, is to stop communicating. Lack of communications will quickly cause the "communications part" of the brain to atrophy, which is the main reason for wearing hearing aids — to restore communications and delay the brain atrophy as much as possible. By the time a person needs a hearing aid, the brain usually has atrophied so that the soft background noises, when amplified by the hearing aids, can flood the brain causing brain fatigue. This is very bothersome because the irritating background noise carries no useful information, giving the user another reason for not wearing it. Clearly, today's hearing aids are not good solutions, at any cost. For those with sufficiently severe hearing loss, cochlea implants appear to be a viable solution, but are expensive and prescribed only for patients that are legally deaf.

When purchasing hearing aids, most vendors will provide a 30 day period for testing the devices (look for vendors who provide 60 days because 30 days is too short, and the vendors know it) during which you can return them for a full refund. Test them thoroughly during this period to see if they really help, especially when purchasing the more expensive models costing thousands of dollars. Inexpensive models without adequate compression can hasten hearing loss if the volume is turned up too high.

There is no method for diagnosing tinnitus except from the comments of the patient. The tester provides sample sounds and the patient tells the tester which sound is closest to his tinnitus. For tests and treatments you need to see an ENT (Ear Nose Throat) specialist. For non-pathological cases, ear damage is generally caused by exposure to loud sounds. There is a wide difference in tolerance to loud sounds. However, there is a strong tendency for those exposed to louder sounds to suffer more hearing loss and tinnitus. It is likely that hearing loss by pianists and piano tuners (as well as rock band members, etc., and people who routinely listen to very loud music) is much more widespread than is generally reported.

Tinnitus is present in 100% of people 100% of the time, but is so soft in normal people that it cannot be heard unless the person is in a soundproofed room. The human hearing mechanism "turns up the amplification" when there is no sound. There are many causes of tinnitus, and some may originate in the brain. Tinnitus is almost always an indication of the onset of hearing loss so that if you notice tinnitus, but are not aware of hearing loss, it is a good idea to see an ENT doctor to get hearing tests to serve as future references, as the hearing loss worsens with time.

For those who do not have audible tinnitus, there is probably no need to avoid loud music, within reasonable limits. Thus practicing the piano at any loudness should be harmless up to about age 30. Those who already have tinnitus should avoid exposure to loud piano. However, tinnitus usually "sneaks up" on you, so that the onset of tinnitus often goes unnoticed until it is too late.

Therefore, everybody should receive tinnitus education and wear ear protection after age 40 - 50 during piano practice, especially if there is any noticeable tinnitus, which is the easiest measure of hearing loss -- louder tinnitus indicates greater hearing loss, so avoid activities that increase tinnitus. Ear protection is initially an abhorrent idea to most pianists but when you consider the consequences, it is definitely

worthwhile. Moreover, once you start to use it regularly, you may start to feel sorry for those not wearing protection, because you know how soon they will start to suffer ear damage. Before wearing protection, do everything possible to reduce sound intensity, such as soundproofing the room (adding carpets to hard floors, curtains to hard walls, etc.), voicing the hammers, and generally practicing softly [(25) Staccato Practice, Soft Practice, even loud passages -- which is a good idea even without possibility of ear damage]. Ear damage is cumulative and partly self-healing, so occasional loud sounds can be harmless. Soundproofing a room is easy because you only need to prevent multiple reflections, which can be accomplished by soundproofing only two or three surfaces. An alternative to ear protection is to practice on digitals with the volume turned down.

Ear protectors (noise canceling is not necessary) are readily available from hardware stores because many workers using construction or yard equipment need such protection. For pianists, an inexpensive unit or light headphones will suffice because you need to hear some music. Commercial noise canceling protectors completely surround the ear and provide a better sound barrier; turn off the noise cancellation, and you will still get sufficient protection. Although the sound through the headphones will be different from the original, the human ear adapts quickly and you will get used to the new sound. It is worthwhile to try ear protection just to experience these different sounds. For example, you will realize that the piano makes many strange (mechanical) sounds you never noticed before! For lower quality pianos, ear protection will result in sound simulating a higher quality instrument because the undesirable high harmonics and extraneous sounds are filtered out; that is, sound filters tend to preferentially filter out the more harmful sounds.

The brain automatically processes any incoming data, whether you want it to or not. This is what music is -- the brain's automatic interpretation of sounds. Thus when you wear ear protection, this stimulus is reduced, and a part of the brain's processing power is freed to do other jobs. You may find that progress is faster when wearing ear protection! In the future, piano students will wear ear protection (or turn the volume down for digital pianos), just as many athletes and construction workers use helmets today. It doesn't make any sense for us to spend the last 30 or more years of our lives without hearing – an important lesson Beethoven taught us.

It may not be an accident that Beethoven became prematurely deaf. We must practice Beethoven's

music with possible ear damage in mind. His music has some unique characteristics not found in other

composers' music, and one of them may be ear damage. Beethoven invented minimalist music [(50)

Beethoven's Pathetique, Op. 13, First Movement] which he incorporated into most of his compositions. This type of music hits the same note repeatedly, thus over-stressing that part of the auditory system.

The specific type of piano is also important. Most uprights that do not produce sufficient sound are probably least damaging. Concert grands that transfer energy efficiently into the strings with long sustain probably do not cause as much damage as medium quality pianos in which a large amount of energy is imparted into the initial, percussive bang associated with the hammer striking the strings. Thus the medium size grands (about 6 ft) may be most damaging. In this regard, the condition of the hammer is important, since a worn hammer can produce a much louder initial bang than a properly voiced hammer. This is why worn hammers cause more string breakage than new or well voiced hammers. With old, hardened hammers, probably most pianos can cause ear damage. Thus proper voicing of the hammer may be more important than many people realize, for practicing pianissimo, playing musically, technical development, and protecting the ear. If you have to close the lid of a grand in order to play softly, or to reduce the sound to a pleasant level, the hammers probably need voicing.

Some of the loudest sounds are produced by even tiny ear phones used to listen to music. Parents should warn their youngsters not to keep turning up the volume, especially if they subscribe to the culture that plays loud music. Some youngsters will fall asleep with their ear phones blasting; this can be very damaging because ear damage is cumulative. It is a bad idea to give gadgets with ear phones to youngsters -- postpone it as long as possible. Make sure to educate them about ear damage when they start using such devices.

Important: On the other hand, this the time to introduce them to the "right type" of music; you

must learn how to give them recordings of music you want them to listen to, and how to play them on their devices. In that case, you may want to give them these listening devices at a younger age. Then they can listen to a lot of good music while walking to school or riding in a car.

Except for some special cases of tinnitus (such as those in which you can alter the sound by moving your jaws, etc.), there is no cure. Large doses of aspirin can cause tinnitus; in that case, stopping its use can sometimes reverse the damage. Small amounts of aspirin taken for cardiac purposes (81mg) apparently do

not cause tinnitus, and there are some claims in the literature that these small amounts may delay the onset of tinnitus. Loud tinnitus can be debilitating because it is present all the time, it only increases with age and some have been driven to thoughts of suicide. Although there is no cure, there are remedies. There are hearing aids that supply sufficient sound so that the brain turns down the amplification; many people believe that the sound masks the tinnitus, but that is not the case. Because the brain automatically turns up the amplification when there is no sound, absolute quietness can cause the tinnitus to become annoyingly loud. Thus a person with loud tinnitus has three hearing problems: (1) hearing loss, (2) the tinnitus masks soft sounds, and (3) the tinnitus prevents the brain from increasing the amplification to hear soft sounds.

Another approach to treating tinnitus is to train the brain to ignore the tinnitus. The brain is amazingly trainable, and part of the reason why tinnitus causes suffering is the inappropriate brain response of the person. The brain has the ability to either concentrate on the sound, thereby driving you crazy, or to ignore it, in which case you won't hear it unless you are reminded of it. Thus the treatment starts with teaching the patient that others have succeeded in living with it with minimal discomfort. Then the patient receives ear training in such a way as to be able to ignore the tinnitus. Fortunately, the brain is quite adept at learning to ignore a constant sound, sometimes by creating its own anti-sound, as in the case with excessive use of the (13) Metronome.

If you read enough stories about tinnitus suffers and hearing loss, you will probably follow the advice to wear ear protection after age 40 - 50 when practicing the piano, at least when practicing loud passages for long periods of time. At the first hint of tinnitus, it is imperative that you start ear protection procedures because once the tinnitus starts, ear deterioration can proceed rapidly with exposure to loud sounds, with significant deterioration every year. Look for an ENT specialist immediately, especially one experienced in tinnitus treatments. Ear protection applies to other members of the household exposed to loud piano practice; therefore, if at all possible, isolate the piano room acoustically from the rest of the house. Most quality (glass) doors will be sufficient. There are a few herbs and "natural" medications that claim effectiveness against tinnitus. These do not work, and the ones that seem to benefit some people have significant side effects.

(62) Teaching

Teaching Babies: Babies can hear before birth. Many hospitals screen babies immediately after

birth in order to identify hearing impaired babies who will need special treatments immediately. Because hearing impaired babies do not receive auditory stimuli, their brain development will be retarded because

auditory inputs affect practically every part of the brain. Which means that extra auditory experiences,

such as music, will help the brain to develop.

The memory of external sounds is initially empty. Thus any sounds heard at that stage are special, and all subsequent sounds are referenced to them. Babies (of most species, not only humans) use sound to identify and bond to the parents. Of all the sound characteristics that the baby uses for this identification,

absolute pitch (AP) is probably a major characteristic, which may explain why every youngster can readily

pick up AP and why they lose it later. Some parents expose babies to music before birth to accelerate the babies' development. There is evidence in the literature that babies learn sounds while in the womb (search the internet for the newest reports). For implanting AP, a electronic piano is better than an acoustic because it is always in tune.

Practically every world class musician, athlete, etc., had parents who taught them at an early age; thus "prodigies" are created, not born, and parents exert greater control over "prodigy" production than teachers or brain power. Constantly test the child for hearing, rhythm (clapping hands), pitch (singing), motor control, attention span, what interests them, etc. As soon as they are ready (walking, speech, music, art, math, etc.), they must be taught and encouraged. There are always "tipping points" beyond which they will take off on their own, without outside support; provide extra support until this point is reached (see nucleation growth theory in (56) Origin and Control of Nervousness).

Babies learn differently from adults because their brains are changing. Adults must be taught; in young children, you only have to awaken the concept in their brains, and provide a supportive environment as their brains take off in that direction. They can quickly advance so far that you can't teach them any more. Good examples are Mental Play (MP) [(15) Mental Play (MP)] and AP. Awaken MP by letting them listen to music and asking if they can sing it back to you. Let them get the idea that there is music in their head, not

only the music they hear. Get them musical toys. Make sure that they listen to music in perfect tune, because off-tune sounds will quickly confuse the AP. Then teach them the scale (teach C, D, E . . ., used by most music schools, and do re mi, as both will be needed), then teach them the C4 octave. At this age, learning AP is automatic and almost instantaneous; when you teach them C4, they will recognize that no other note is C4, because they have no other memory to confuse them. This is why it is so critical to teach them as soon as they are ready. Then teach them relative pitch, such as octaves; then 2-note intervals (child has to identify both notes), then 3 note chords or any 3 random notes played simultaneously -- all the way up to 10 notes, if possible. These musical lessons can be taught between the ages of 2 and 8. This process will be greatly accelerated if someone plays the piano from before their birth. For babies in the womb, sound pitch remains the same in the amniotic fluid so that they can learn AP before birth.

Long before their first piano lesson, you can show them pictures of enlarged music notes (tadpoles!) and familiarize them with the music staff, where the notes go, and where to find them on the piano. If the parents are not pianists, one parent can take piano lessons with the child; this is a good way to get youngsters started.

Piano Lessons: MP should be taught from the very first lessons (or before, by parents) in order to

train the youngest students to play music in their minds. Teach MP when memorizing new pieces. If this is done at the correct pitch, youngsters will acquire AP after only a few lessons with little effort; in fact, most children who have AP learned it before starting their lessons. Support their MP by providing good music to listen to, and train them to recognize compositions by name and composer. Singing or a musical toy (in tune) is a good way to teach pitch, rhythm, and motor control. As soon as they start piano lessons, MP is further developed by memorizing and creating a memorized repertoire. Be prepared to support them if they

immediately start composing at any age – provide ways to record their music or teach them dictation. If they start composing at an early age, don't be surprised if they prefer to invent their own music notation — don't ignore this or force them to change to conventional dictation; support them, because they will naturally transition to conventional dictation with time, out of necessity. Formal composition lessons are not needed until the student asks for them, when they feel the need for help to achieve certain musical objectives, such as how to end a piece.

If MP is not taught, the students may not even realize that they are doing it, and not fully develop it. Moreover, because they are not aware of what they are doing, they will tend to neglect MP as they get older