Why AC/DC's Brian Johnson is a 'medical astonishment'

DW: The news that AC/DC has had to cancel concerts on its US tour due to lead singer Brian Johnson's acute hearing loss doesn't really come as a surprise. Are rock musicians at a greater risk of this than, for example, a trombone player in a classical orchestra?

Wolfgang Angerstein: Probably, yes, but no serious medical research has been done on the issue yet. Rock concerts are usually much louder than classical concerts, but there are exceptions to the rule. An orchestral musician seated just behind the timpani will have his ears subjected to high decibels.

In rock music, and especially with hard rockers like the Australian band AC/DC, who've been on stage since 1973, drastic volumes are part of the show. Has that changed over the years? Are concerts getting louder and louder?

That's not my impression, but it's only subjective. I can't back it up with statistics. I think rock and pop music professionals have grown more aware of hearing issues. If the volume hasn't increased, the stress definitely has.

But as a physician, I treat more classical musicians. Orchestras tune their instruments to the chamber tone A, and that note is moving progressively upward in pitch, which affects singers, too. Composer Guiseppe Verdi (1813-1901) set that pitch at 432 hertz, and as a member of parliament in Rome, he was instrumental in making it the law of the land. Today's standard is a half pitch higher, though. That's a problem, because it subjects vocalists' muscles to high stress. If you sing higher but not necessarily louder, it's a far higher burden for the vocal apparatus.

So in medical terms, I see less of a problem in increasing volume and more in the fact that the chamber tone A continues to move upward, so singers grow hoarse and lose the texture of their voices sooner. That's a far more serious problem than potential hearing loss.

Which health problems do you most frequently encounter in your hospital station for musicians?

Here at the station for musicians at the Dusseldorf University Clinic - which, incidentally, is the largest of its kind in Europe - we see professional and amateur musicians even in their student years. It's clear that the demands on musicians are growing. Orchestras have to cut back, musicians have to perform more, rehearse more, and are put on a high-achievement track.

If you can't keep up, you're quickly fired. That alone creates additional medical problems for orchestral musicians. And they're growing more sensitive to health issues.

Musicians are highly sensitive professionals, but they often don't have the courage to consult a doctor. They're usually on only one- or two-year contracts. If it comes out that they're getting medical treatment, the director may well say, "It's been nice working with you, but now we'll have to get someone else." I think many more require treatment, but aren't getting it. Every physician specializing in musicians' disorders knows that.

Are rock musicians among your patients?

Definitely far fewer than classical. Only the ones with acute ailments consult us - hearing disorders or voice problems. But to be honest, with AC/DC singer Brian Johnson, I'd have trouble distinguishing age-related hearing loss from the kind created by noise. Hearing disorders don't turn up at the beginning of a career, of course, but only over the course of years.

In medical terms, isn't it actually remarkable that Brian Johnson, or Mick Jagger of the Rolling Stones, have kept up so long as singers?

It's medically astonishing, especially if you take these musicians' drug and alcohol consumption and overall lifestyles into account - none of which fosters good health. They must have iron-clad constitutions to even withstand the stress of a rock concert.

Onstage, the spotlights emit a lot of heat, 30 to 35 degrees Celsius, and the humidity is about zero. It's a dusty, dirty, sweaty environment. All that puts a heavy physical burden on a rocker, affecting both the hearing and the voice. So doing that job for decades requires iron-clad stamina. But as far as Brian Johnson is concerned, the only thing that could help him now would be a hearing aid or an implant.

Dr. Wolfgang Angerstein is chief physician for phoniatrics und audiology at the Dusseldorf University Clinic. The station there for musicians' disorders is the largest medical establishment of its kind in Europe, treating instrumentalists and singers of every genre.