EXTERNAL AUDITORY-CANAL IN-SITU MEASUREME NT OF SOUND PRESSURE IN A PROFESSIONAL VIOLINIST SUFFERING FROM BILATERAL TINNITUS

Background: A case of a professional violinist suffering from a bilate ral tinnitus is presented. The musician reported the tinnitus to be lo uder and more straining when playing his Vuillaume violin (France 1840 ) as compared with his Carcassi violin (Italy 1763). Case report: In t he 42-year-old musician, audiometry revealed a normal hearing threshol d in the right ear and a slight hearing loss in the left ear of up to 20 dB between 2 kHz and 8 kHz. Transitory evoked otoacoustic emissions could only be measured in the right ear. The tinnitus could be masked (distance type); residual inhibition was only seen in the right ear. By sound intensity measurements in both external auditory canals, the different sound spectra of both Violins could be demonstrated, When pl aying with ''forte'' intensity, sound pressure reached peaks of over 9 0 dB. The tinnitus was ameliorated by lidocaine infusions. Discussion and conclusions: The different sound spectra of both violins may be th e reason for the enhancement of the musician's tinnitus. Interference of air and bone-conducted sound could lead to a cochlear overlap and t hus influence the tinnitus although such a phenomenon can not be verif ied. It was previously reported that high-pitched instruments may caus e tinnitus sensations in performing musicians. A review of the literat ure surprisingly reveals that although professional musicians are expo sed to sound pressure levels that may cause hearing impairment, only v ery few do develop one. This fact has to be taken into account wheneve r an occupational disease is suspected.