From an engineering standpoint, the human ear has more design flaws and potential for breakdown than any other mechanism on Earth.

That’s according to audiologists, whose expertise involves evaluating the nature and degree of hearing loss. Since obtaining such expertise requires a masters or doctorate degree, a one year internship, and an intensive exam in order to be certified for practice by the American Speech-Language-Hearing Association (ASHA), I’m inclined to take their word for it.

An audiologist’s job involves performing audiometric tests on patients with possible hearing loss or damage, diagnosing and recommending medical follow-ups, damage prevention methods and rehabilitation options, as well as providing appropriate hearing aids if licensed to do so by the state.

Certified audiologists operate private practices as well as working and doing research in hospitals, nursing homes, clinics, schools, universities and elsewhere. Prospective patients can expect to have their outer ears examined and tested for functional performance in their eardrums and middle ear cavities.

Other non-invasive testing could involve having you listen to different frequency tones in order to establish your hearing thresholds (the levels of a sound which you can hear 50% of the time) but you’ll inevitably be poked and prodded with various instruments to determine things like the presence of infection or wax buildup.

All that concentration is focussed on the ear’s three main components: the visible outer ear, the middle ear and the inner ear. Sound vibrations are funneled by the outer ear into the auditory canal, where sound hits the eardrum (basically a membrane dividing the middle and outer ear). This causes the eardrum to vibrate while tiny hairs in the cochlea (a snail-shaped organ) in the inner ear go to work transforming the vibrations into nerve impulses which are then shot up to the brain through the auditory (cochlear) nerve. At the end of the line, the brain percieves each impulse as a specific sound and any glitch in the process can screw up the whole system.

American Medical Association statistics indicate that one of every eleven Americans suffers hearing loss, with a ratio of one in three among those over 65. The most common symptom is “sensorineural loss”, or more plainly nerve weakness, which affects the inner ear’s ability to properly transmit signals to the brain. Hearing problems can be caused by heredity and disease, side effects from drugs, physical breakdowns related to aging, and by exposure to percussion or loud noises.

High volume music is cited as a leading cause of Tinnitus, typified by constant ringing, hissing or roaring in the ears. People with Tinnitus may or may not suffer other hearing ailments as well and the affliction is rarely curable, though some treatments can help manage its effects.

“Some hearing specialists suggest Tinnitus may be a ‘survival reflex’ inherited from our hunting days, with the brain latching on to some small and inconsequential sound and insisting that it matters,” according to researcher John Billingsley, editor of the quarterly magazine Northern Earth. “Others describe [Tinnitus] as a dysfunctional response of the auditory system - even in silence, there is a constant flow of impulses arriving at the nerves of the ear and if ‘normal silence’ is not present then the brain can misinterpret the pattern it receives as sound...indeed, electromagnetic pollution may actually create a hypersensitivity to sound or certain wavelengths that may subsequently manifest as Tinnitus.”

Federal government guidelines say that Tinnitus can develop when a listener is exposed to sound levels measuring 85 dB and above. A vacuum generates 70 dB on average, a jackhammer clocks in at 100 dB and sandblasting can result in sound levels of 110 dB or more. Any loud noise can damage the hairs in the cochlea, causing Temporary Threshold Shift (TTS), a reversible loss. Permanent damage can occur due to events such as a blow to the head, nearness to an explosion or from prolonged exposure to high volume music generated by stereo and concert speakers.

Sonus treats hearing impaired clients at clinics nationwide, as well as at its San Diego facility. After testing and diagnosis procedures, their audiologists are licensed to provide hearing aids designed to improve sound pickup and perception. Conventional analog hearing aids, worn near or in the ear, have tiny microphones which capture sound. Circuits and resistors filter and compress loud noises while amplifying soft sounds in the wearer’s vicinity, electronically modifying and transforming everything into sound waves which are delivered to the ear canal.

Sonus recommends that anyone diagnosed with auditory problems should purchase a hearing aid for each ear. According to their website, “Research has shown that when there is a hearing loss in both ears and only one ear is fitted with a hearing instrument, the auditory nerve in the unaided ear can atrophy, resulting in audio deprivation effect....a significant decrease in the unaided ear’s ability to recognize speech. Studies have shown that this can happen in as little as seven months after one ear is fitted with a hearing instrument. That’s because the ear with the hearing instrument tends to do all the work, leaving the unaided ear with nothing to do. Its a ‘use it or lose it’ proposition.”

Audiologists at UCSD’s Medical Center in Hillcrest also conduct hearing evaluations, offer diagnostic advice and dispense hearing aids, at least to patients willing to wear them. “Unfortunately,” says Pat Baird, M.A., director of the UCSD Audiology Center, “some people feel that there is a stigma to hearing loss and they refuse to get help. As a result, co-workers and friends begin to talk around the hearing-impaired person because it is too difficult to get the point across. Or the person with hearing loss often becomes reclusive because he or she is embarrassed by the problem."

"The good news is there are literally hundreds of hearing assistance devices on the market and we see improvements in these devices everyday...newer models are better at cutting out extraneous background noise, picking up soft voices, and capturing sound from greater distances."

UCSD audiologists were first in San Diego to test a new high tech unit designed for severely deaf patients called the Nucleus 22 Channel Cochlear Implant, in a program directed by Jeffrey Harris, M.D., chief of head and neck surgery. Twenty-two microscopic electrodes are implanted into the inner ear, each programmed to pick up a specific frequency band. Recipients are then taught how to translate the resulting sound into understandable words and sentences.

"The cochlear implant is like a miracle for our patients who have lived in almost complete silence,” says Baird. “People are able to return to productive lives at work, school and at home.".

At more than twice the price of conventional hearing aids, digital units are now available and most specialists agree that the sophisticated technology provides exceptional results. Digital devices are categorized and described according to the number of "frequency processing channels” each features. Current models can include from two to fourteen channels but quality shouldn’t be gauged by the numbering since fewer definable channels may be more effective for wearers who don't want or need the advanced functions and potentially confusing options found in high number units from manufacturers like Siemens, Widex and DigiFocus.

Less expenesive than digital, there are some analog units offering “digital programming” of features like “multi-channel automatic processing” which tunes and divides sound into separate frequency ranges much like fully digital aids. Some models also sport an “automatic loudness adjustment” to reduce feedback common in analog units and allowing wearers to use the telephone without having to change the volume settings of their hearing aids.

Hearing loss among those aged thirty or less is attributed more often to loud music than any other cause. Researchers at the University of Florida tested a volunteer group of teenagers and found that seventeen percent already had problems hearing high pitched sounds, often an early symptom of damage.

Significant hearing loss was confirmed among students who frequently listened to high volume music at concerts, rave parties and clubs.

Studies confirming the link between amplified music and resulting hearing damage are plentiful in the Archives of Otolaryngology, a collection of published papers, medical thesis’, experiment logs and other records related to audiology. One experiment reported in its pages concerns scientist researching ear protection who force-fed loud rock music to a guinea pig for eighty-eight hours over a two month span. The animal’s left ear was intentionally blocked with a wax plug and experienced no apparant harm. The unprotected right ear, however, suffered severe damage which, in humans, would be painful, permanent and untreatable.

So music fans have reason to be concerned about hearing loss from excessive noise and loud music common in nightclubs and concert venues. Bars may even provide further risk since studies indicate the ear’s natural defense reflex against loud noise can shut down when veins and arteries become constricted due to alcohol consumption.

Could getting buzzed leave your ears buzzing for life? "Anything that alters the blood flow might also alter the person's susceptibility to getting hearing loss or Tinnitus," says Director Robert Sweetow of the UCSF-Stanford Audiology Department.

Not that Sweetow targets nightclubs as the only hot spots for hearing harm. You don’t even have to leave home or step out of your car to be deafened by decibels, he points out, thanks to advances in sound technology. "The music we listen to now is nosier. Twenty years ago when I would drive my car, I could limit the loudness of music because when I turned my music up too loud it would start to distort but now I could just keep cranking my radio up louder and louder and the speakers are so good and the amplifiers are so good, it almost never distorts."

Marek Roland-Mieszkowski of Digital Recordings, a sound engineering company, spends much of his “free” time spreading the word about how dangerous dance club music can be if played too loud. A resulting chain effect can turn non-musical sources into potential ear-busters as well, he says. "The danger is when music gets so loud that you have to shout in somebody's ears. Shouting can produce up to 140 decibels close to the mouth."

Concert patrons who feel their hearing has been damaged because of a specific show or venue have the option of filing a civil lawsuit to seek compensation. Court records show that clubs like ‘Canes, Soma and others have been sued for “personal injury” and “negligence” by customers claiming hearing loss.

Few judgments are leveled, due to the difficulty identifying one specific source responsible for an ailment with symptoms which may or may not be immediately evident.

The law provides more civil and criminal ammunition to employees working in environments typified by loud music. Federal and state regulations already recognize and address their high risk of hearing loss due to the constant bombardment of piercing frequencies and percussive vibrations.

According to The National Institute for Occupational Safety and Health (NIOSH), exposure to sound levels higher than 105 dB for as little as 4 minutes, 43 seconds a day can inflict severe auditory damage. NIOSH guidelines recommend that workers regularly exposed to 100 dB of sound or more should wear earplugs in addition to backup protection such as earmuffs.

State laws regulating workplace noise levels are enforced by The California Occupational Safety and Health Administration (CAL-OSHA). Those laws state that employees exposed to sound levels over 85 dB must wear ear protection and receive annual hearing exams paid by their employer. CAL-OSHA does not, however, enforce compliance by randomly testing sound levels at clubs and arenas.

“We don’t have the funding or resources necessary to keep agents in the field doing spot checks,” says Administration spokesman Dean Fryer. “Once we get a specific complaint from an employee of a business, however, then we can show up at the site, launch a comprehensive investigation, interview anyone with relevant information, measure sound levels or do any other testing needed in order to reach a judgment.”

Workers afraid of losing their job over filing a CAL-OSHA grievance can send an anonymous complaint and Fryer says the same investigation will take place. “Any employer who fires or inflicts punitive punishment on a worker just for contacting us is breaking the law and subject to severe penalties, including jail time.”

“Club owners don't give a [expletive]," according to club DJ Pete Avila. "All they want is your money. They don't care about you." Avila spent four years as music director for the Sound Factory in San Francisco. The job “took a toll on my ears," he says, and caused hearing loss which is getting progressively worse. "When there's a busy restaurant with a lot of noise, it's hard for me to hear someone who's sitting right across from me.”

Avila now wears earplugs on the dance floor but he takes them off when it’s time to start spinning discs. "It's difficult, because when you are in the club situation and in the moment, you sort of want the music loud to feel what people are feeling on the dance floor.”

Billy “Jimbo” James spent years running sound at concerts. During the late sixties and early seventies, he worked for the Grateful Dead alongside sonic pioneers like Augustus Owsley Stanley III, designer of the band’s wraparound sound system.

In those days, he says, little thought was given to how concert volume might affect the hearing of those present. “The upper limit of human hearing is around 20kHz. Anything higher than that is considered ultrasound. But just because you can’t technically hear ultrasound, doesn’t mean that it can’t affect you somehow. It’s in the background all the time, affecting our moods and the way we hear audible sounds.”

He feels lucky to have suffered only minor hearing damage despite being present at nearly a thousand high-volume events. “I’ve had a low hum that rumbles in my ears for over twenty years now, but it’s not the kind of vibrating noise like with Tinnitus. I’m sure it’s from being planted in front of so many speaker cabinets but it’s so deep and low that it’s actually comforting to me. I mean, like humming a mantra, I can hum along in key when I’m going to sleep or just meditating or whatever.”

“Now if I worked for Blue Cheer of Vanilla Fudge, I’d probably need a megaphone stuck in my ear to hear anything now!”

Jeff Kelly played drums with Price Of Dope and co-founded Audio Design, a music equipment rental center. He’s run sound equipment at concerts for over adozen years and says the speaker configuration for rock ‘n’ roll is “designed for a loud hurt-your-ears kind of sound. It’s geared toward volume.”

Some bands want it louder still, insisting that levels be pushed past Spinal Tap’s “11” until the music drowns out Lindbergh Field.

“The Black Crowes was an extremely loud show...we’ve done some other pretty funny acts like Ronnie James Dio and some other acts that [were so loud] it was just ridiculous. Why would they want it so loud? Because they think they’re fifteen still? I don’t know, because they think they’re cool? I have no idea.”

He suspects that ridiculous volume of causing the hearing damage he first noticed several years ago. “I’ve got to turn up the TV a lot more. I try to wear earplugs as much as I can but the volumes we’re around...you’re talking 140 dB 130 dB every night, you put an earplug in and it’s a 20 dB decrease, it’s still not enough.” Does he worry about this? “Somewhat. But everybody gets old.”

Band manager and booking agent Tom Cantor thinks modern earplug technology should be taken more seriously by players like Kelly. “You’d expect musicians to be gung ho about hearing protection, for them and the audience. But nobody cares.”

Cantor often does extra duty running concert concession stands for bands he represents and says “I pitch T-shirts, programs, tapes, CDs and stuff like that but the first time I asked the guys in a band if they wanted to sell earplugs at a show, they looked at me like I was asking them to sell heroin! They said ‘Why the hell would we want [the audience] to cover up their ears and block out our music?’ And there’s no point even mentioning that maybe they should wear their own [ear protection] on stage.”

The people in front of the concert speakers will usually get the best aural protection from conventional foam earplugs or earmuffs. Musicians’ needs require more specialized protection since their playing and timing depends on full integration with other bandmembers’ parts.

Musician’s earplugs are not intended for maximum attenuation. Custom made earplugs are fit from an exact mold duplicating the ear canal based on an impression made by a hearing specialist, which is sent to a lab for finishing with the addition of desired mechanisms. Their design is not intended to block high frequencies but to instead attenuate all frequencies evenly in relation to hearing.

Popular models, such as the ER-15 and ER-25, cost $150.00 to $250.00 and include a special filter which lets the wearer hear a full range of music with no muting while lowering incoming dB levels to a safe range.

Of course, hearing damage or loss doesn’t necessarily weaken all musical skills or abilities. The composer Beethoven was, in the early 1800’s, enjoying his greatest success and popularity among the Viennese aristocracy when his hearing began deteriorating.

Beethoven retired from performing but most music lovers and scholars agree that subsequent compositions are among his most powerful masterpieces. During this time period, he created his Symphony No. 3 in E-flat major op. 55 (the Eroica, completed 1804), Fidelio, and the Symphony No. 5 in C minor op. 67 (1808).

Eventually, Beethoven was nearly deaf and withdrew from ALL public appearances even while increasing his work pace to an all time high. In 1818, he began complex, large scale works such as the Sonata in B-flat major op. 106 (Hammerklavier, 1818), the Missa Solemnis in D major op. 123 (1823), the Thirty-Three Variations on a Waltz by Diabelli in C major op. 120 (1823), the Symphony No. 9 in D minor op. 125 (1824), and his last string quartets. He spent virtually all his time composing until his death from pneumonia in March 1827.

Former President Bill Clinton played saxophone in bands for a few brief years during his late teens and blames that sax addiction for his own hearing damage. Clinton’s affliction makes it difficult for him to hear high-frequency sounds, a symptom common among sufferers exposed to loud noises. In 1997, the 51 year old baby-boomer was fitted with his first hearing aid, hidden inside the hearing canal and rarely visible to others. A Presidential press secretary joked at the time “Now the President can finally make out what the hecklers are shouting at him during his speeches.”

Hecklers also commonly tested the hearing of the late Ike Turner. A half century of performing caused Turner enough hearing damage to seek audiological assistance during his north county residency. “He came into our office dressed in kind of a seventies leather Soul Train outfit,” recalls one specialist’s assistant of Turner’s first appointment with her employer. “He looked a lot like that pimp from Starsky and Hutch, ‘Huggy Bear.’ The woman with him was, like, his seventh wife and I was just dumbstruck that women still want to marry the guy!”

She calls Turner “the most difficult customer, ever. I was actually happy when he flew off the handle, started swearing and calling us names and marched out the door promising to take his business somewhere else. That’s one promise we all wanted him to keep.”

Otolarynologist Dr. Sam Levine points out that even senior citizens can recover from long-term damage and regain much of their hearing. “What happens is the hair cells are damaged, but they’re not dead. As they’re damaged, you lose some of your hearing. Most of the time, if you get out of the environment, your hair cells will recover somewhat. Each day, it [your hearing] comes back, but not as good as it did the day before. Eventually, over a long period of time, hair cells are permanently damaged instead of temporarily damaged.”

Levine explains that damaged or destroyed hair cells cause an abnormal sound which isn’t really physically created but occurs literally “in your head,” as the sound of Tinnitus.

Guitarist Pete Townshend of the Who was among the first musicians to publicly discuss Tinnitus (which he traces to an exploding drum prank played by Keith Moon during a Smothers Brothers TV show taping).

Dave Pirner of Soul Asylum alluded to his apparent Tinnitus as the band shifted toward acoustic music and modified stage equipment with protective sound- deflecting barriers placed around drummer Grant Young’s kit.

Bob Mould mentions his accelerating deafness often, once telling Rolling Stone “I know I’m reaching the end of what I can do because of my hearing.”

Lars Ulrich of Metallica goes as far as filming public service TV spots: “Three of the four members of Metallica wear earplugs. Some people think earplugs are for wimps. But if you don’t want to hear any records in five or ten years, that’s your decision.”

Hearnet.com co-founder Kathy Peck, former bass player and singer for the San Francisco punk band The Contractions, also has severe hearing damage. Her efforts to spread awareness about hearing protection include posting advisory PSAs on that site, taped by volunteers such as Townshend, Spinal Tap and DJ Qbert, and giving away downloads of the song "Tinnitus Sucks" featuring Herbie Hancock, the Mermen and Clayton Cameron of Tony Bennett's band.

“There’s no cure for Tinnitus or hearing loss,” warns Dr. Levine. He recommends being tested by an audiologist at the first sign of hearing difficulty or damage. “Your ears are trying to tell you something. That ringing is the scream of your hair cells dying.”