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Music Induced Hearing Loss and Hearing Protection

By: John F. King, Au.D.

Longer than I’ve been an audiologist, I’ve been playing drums and percussion in marching, concert, and drum set venues. I know first hand what a thrill it is to perform in front of thousands of people and the adrenaline rush one gets from playing loud. However, I want to raise the awareness of hearing heath, because often by the time you notice your hearing is deteriorating, there isn’t much anyone can do about it.

The music industry as a whole lacks regulations on the use of hearing protection devices (HPD) and the duration of exposure to high intensity sounds which ultimately leads to permanent hearing loss. The fact is, musicians of all genres, from heavy metal to classical, suffer from various durations of high intensity sound exposure. Percussionists are at particular risk of hearing loss given the potential for their instruments to produce short duration high impact sounds. Given that there are no regulations in the music industry on hearing conservation, it is imperative to educate yourself on music induced hearing loss and protect your most valuable asset as a musician…your ears!

Ear Anatomy

The human ear can be broken down into three parts: the outer ear, the middle ear, and the inner ear. The outer ear is composed of the pinna (the most common appendage people get pierced), ear canal, and the tympanic membrane (ear drum). The middle ear houses the 3 tiniest bones in the body called the ossicles, which transmits and amplifies sound waves from the ear drum to the oval window of the cochlea, which is the beginning of the inner ear. Within the cochlea are thousands of hair cells, tonotopically arranged by frequency like a xylophone, and this is where exposure to loud sounds does most of its damage.

Music Induced Hearing Loss

There are two parameters that are associated with music induced hearing loss: how loud the music is and how long you are exposed to it. For example, current regulations from the occupational safety & health administration (OSHA) state that workers will not be exposed to 90 dB sound levels for longer than 8 hours per day. Rock concerts easily reach 100 dB, which would have an allowable time limit of only 2 hours per day. Of course, that’s not accounting for the remaining 22 hours in which you may be in a noisy kitchen, listening to your iPod or other portable device, etc.

Overtime, the cochlear hair cells, which are responsible for amplification and transmission of neural impulses to the acoustic nerve, will become flattened, frayed, and broken due to exposure to loud noises. In addition to permanent hearing loss, exposure to loud sounds may also cause tinnitus, a high pitch ringing or buzzing sound. You may have experienced this sensation following a rock concert or rehearsal along with a sense of fullness in the ears and muffled sounds. This is an indication that you were exposing yourself to damaging intensity levels and is known as a temporary threshold shift. These symptoms usually resolve after a day or two, but not all musicians will have the same reaction and these symptoms can become permanent if action is not taken. If you experience any of these symptoms or have to shout to be heard less than a foot away, then you are in a loud environment and should be wearing some form of hearing protection device.


So, now that you know about music induced hearing loss, what can you do about it? First and foremost, you should visit a licensed audiologist as soon as possible and get your hearing tested. Having this test completed early on in your music career will provide you and your audiologist with a baseline test to compare future test results to. After your initial hearing test, you should return annually for follow-up hearing tests to watch for any changes in your hearing. The next step is to invest in quality hearing protection devices which will protect your hearing without distorting your music.

Musician’s Earplugs

Many of you have probably experienced using the one-size-fits-most foam style earplugs. This style of earplug attenuates high frequencies much more than low frequencies, making everything sound muffled, and they aren’t too comfortable either. Custom-made musician’s earplugs resolve these issues by incorporating a flat frequency response filter into a silicone or vinyl mold. To get started, your audiologist will first take an impression of your ear canals. These impressions would be sent to an earmold lab where they will create the earplug based on your ear canal shape and length as well as any specifications given by your audiologist. The finished product will then be sent back to your audiologist where he or she can inspect them in your ears, make sure they fit properly, and instruct you on proper insertion and removal of the musician’s earplugs. Filters are made by Etymotic Research and come in 9, 15, and 25 dB attenuation levels. I do not recommend getting anything lower than 15 dB filters for percussionists.

In-The-Ear Monitors

When performing on stage, musicians have customarily used floor monitors, or wedges, to better hear themselves and their band mates. However, there are many drawbacks to this type of system. Acoustically, the floor monitor mix, which is directed at the musicians on stage, can reach such high levels that it begins to interfere with the front of house mix which is directed at the audience. This usually leads into a volume war, in which the front of house engineer, monitoring engineer, and musicians keep turning up the volume of their own particular mix until they are on the verge of feedback. Timing issues may also arise as musicians vary their distance from the floor monitor which is left stationary at their position on stage. Lastly, floor monitors are bulky and take up physical space on stage and in touring vehicles.

In-the-ear monitors, like musician’s plugs, are custom made for your ear in either a silicone, acrylic, or hybrid mold. It is recommended that you either obtain a silicone or an acrylic with a silicone canal portion mold to get the most sound isolation benefit. By utilizing in-the-ear monitors, sound quality to the musicians and audience improves by isolating the monitoring mix from the front of house mix. Timing cues also improve as the musician never varies in distance from the in-the-ear monitor, it goes wherever he or she goes.

Finally, in-the-ear monitors provide a convenient way to have your own mix and potentially protect your hearing. I say potentially because in-the-ear monitors still have the ability to damage your hearing if you do not use them properly. Most musicians that have used floor monitors while performing will turn up the volume to the same levels when they switch to in-the- ear monitors. We are creatures of habit, but this is one that must be broken if you want to save your hearing. When worn properly, in-the-ear monitors will help protect your hearing by attenuating external sounds, allowing you to listen to your mix at a reduced volume. Again, annual hearing tests from a licensed audiologist are paramount to monitor your hearing and your use of in-the-ear monitors.

Taken from the Sound Advice Website which provides practical guidance and interpretation of NAWR:

The Table below gives the noise levels to which teachers were exposed during lessons for individual pupils and group practice at a school with excellent teaching facilities. The Leq is the measured level when pupils were actually playing, rather than the average level over the lesson. Daily exposure increases with both the level and duration of the sound. The exposure time to 80 dB LEP,d is the total time in the day that a teacher is hearing pupils play at the measured sound level before that teacher reaches their 80 dB daily exposure.

Activity Leq dB Exposure time to 80 dB LEP,d FAL
Leading and playing with eight member saxophone group 93 to 95 15 to 24 minutes
Conducting brass, woodwind and percussion orchestra 94 19 minutes
Saxophone lesson 95 15 minutes
Trombone lesson 90 48 minutes
Flute lesson 89 60 minutes
Electric guitar lesson 88 75 minutes
Singing lesson 85 2.5 hours
Piano 82 5 hours
Violin lesson tutor providing
piano accompaniment
Small practice room 82
Large practice room 76
5 hours
Not exceeded
  • From the above it is quite easy to see how brass, woodwind and percussion tutors could easily exceed their daily noise exposure dose within one lesson under the new NAWR requirements.
  • Given that peripatetic music teachers have very busy multiple lesson schedules and will move between schools in a variety of practice/rehearsal rooms, some suitable, some not then there is the potential for daily and therefore weekly exposures to be exceeded.

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