The Royal Opera House orchestra was rehearsing Die Walküre. For more than three hours violist Chris Goldscheider sat in front of twenty brass players belting out Wagner at 90dB. His hearing was permanently damaged. The Opera House argued that artistic standards took precedence over the risk of acoustic shock, but the courts thought otherwise and awarded Goldscheider substantial damages.
A musician’s job is to create sound. Rock musicians ramp up the amplifiers and often lose their hearing temporarily after a particularly loud concert. Many don’t acknowledge the warning. Over time, even violinists can lose 6dB of hearing in their left ear.
Many publicans and restaurateurs foster sound. They rip out partitions, strip out soft furnishings and turn up the music. Chatter turns to shouting and then to screaming, and by the time the sound level is 90dB – that’s the same as a pneumatic drill – they have created the vibe they think their clientele enjoy. At least that’s what many of them told Action on Hearing Loss. I wonder. You can’t pour your heart out, or even chat to your mates, against a wall of sound. When a bartender brings a legal case for acoustic damage, publicans may think again.
"Noise affects patient care. If staff are distracted or unable to clearly hear information or instructions, lives are at risk."
Silence is elusive. Over four days, walking along the Thames path from its source to Oxford, we were out of the sound of traffic for just half an hour. Military jets scream over the remote Highlands and police helicopters clatter over secluded corners of Regents Park. Libraries now entertain kids singing nursery rhymes, art galleries display video installations, and the espresso machine thumps and grinds in cafes where people go to read and work.
Hospital calm? Gone are the days! Machines, phones, bleeps, call bells (left unanswered because they’re short-staffed), crashing trolleys, long visiting hours with noisy families . . . the noise level in ITU can be over 100dB.
Noise affects patients. A Swedish study found that loud environments triggered more re-admissions. More hypnotics are prescribed. Patients self-discharge to get a good night’s sleep.
Noise affects patient care. If staff are distracted or unable to clearly hear information or instructions, lives are at risk.
Noise affects us all. Raised blood pressure, increased risk of cardiovascular problems, poor sleep and its attendant consequences, low birth-weight, obesity, diabetes and cognitive impairment . . . these are some of the consequences. My worst experience of noise was in Santiago de Cuba. The ancient, grinding engines of trucks and buses which had long lost their exhaust silencers woke us at dawn and deafened us until nightfall. We found relief at a cliff-top café. There was a pervasive smell of drains but, like most people, we could put up with pollution better than noise.
Nearly 2000 years ago Juvenal listed noise as one of the seven plagues of Rome (along with high rents and fashionistas). Victorians were assailed by the hawkers’ cries, wooden clogs on the cobbles, clattering carts – rubber tyres were a late 19th century innovation.
Now, noise has been weaponised. In Guantanamo it’s been used as an instrument of torture. Holed up in the Vatican nunciature, Panamanian leader General Noriega didn’t surrender until the CIA blared rock music into the building. (You can hear it on YouTube). In contrast, shopping malls broadcast Beethoven to see off hooligan loiterers.
Our valuation of noise is very subjective and poorly related to the damage it does, which is determined by its acoustic intensity and how long we are exposed to it. The decibel scale is logarithmic, so a 70dB sound is ten times more intense than 60dB. The safe exposure time for a 90dB lawnmower is two hours; for 100dB it is 15 minutes. And we live in an environment full of 100dB noises.
With earbuds you can escape from the cacophony of the street into your own soundworld. It isn’t safe, though. That constant exposure is building up damage, and the hair cells can’t tell prog rock from Puccini.
It isn’t just us humans whose lives are disrupted by noise. A blackbird that can’t sing over the ambient noise won’t attract a mate. Whales use sonar communication which is disrupted by the noise from shipping.
Unlike some animals, humans don’t have ‘earlids’. When we lived in caves, we could close our eyes, but we couldn’t risk not hearing danger approaching. So we are programmed to respond to noises. In the modern world we are particularly distressed by sound which is unpredictable, or which we feel could be controlled.
Under the 1990 Environmental Protection Act, noise is a ‘statutory nuisance’. You can measure ambient noise levels using phone apps such as Decibel Meter and SoundPrint. So if your neighbour is using a leaf-blower (110dB) on Sunday, phone your council Noise Team.
In ‘Sound Advice’, the Health and Safety Executive provides comprehensive practical advice to the music industry – to concert halls, marching bands, schools – on the law, venue design, rehearsal and concert programming, orchestral arrangement, baffles . . . and ear plugs which reduce the intensity but not the appreciation of music.
If ambient noise ruins your evening, say so. If you find complaining difficult, Action on Hearing Loss’s Speak Easy tells you what to say: to the management, on social media and to the press. With enough adverse comments, restaurants will take noise off the menu.
Twenty years ago little attention was paid to food and noise in hospitals, and both were abysmal. Eventually people realised that decent, well-presented meals aided patients’ recovery. Kings College London’s Hospital Project on Noise, Sound and Sleep aims to do the same for noise. It starts with listening to the soundscapes and deciding how it can be modified. Rubber corners on trolleys, acoustic finishes on surfaces and sound masking are just a start.
Humans use their ears to tell them where to look, so it is not surprising that we are much more aware of landscapes than soundscapes. It would do us good to actively listen to our sonic environment. We will notice ear-sores and acoustic litter. Aircraft noise, for example. Remember the peace in the spring of 2010 when Eyjafjallajökull filled the air with volcanic ash and planes were grounded? With pressure from governments, doctors and audiologists and the public, even planemakers will respond with quieter aircraft.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum and an LMC chair. She started a charity which for nine years enabled medical students to go to Cuba for their electives.
Judith is a long-time supporter of NASGP and has been providing regular articles for The Sessional GP for over 12 years, her reflections ranging widely on practical, ethical and cultural aspects of health and medicine.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…