Hearing is one of the most important senses we have and is “interwoven with almost every aspect of how [we] interact with the world” (Klickstein, 2009, p. 278). Whether we are listening to our favourite songs or talking with another person, we use our hearing everyday and most of the time we are unaware of it! However, this lack of awareness puts our hearing at risk of being overused, mainly through the exposure to high-intensity sounds. Overstimulating our hearing can cause symptoms such as headaches, disorientation, or permanent hearing loss. Thankfully, with just a few proactive steps, permanent damage to our hearing can be easily prevented.
Musicians are at a high risk for experiencing symptoms of hearing loss. From the rigorous rehearsal and practice schedules to the sheer focus that is required to tune and blend with other instrumentalists, musicians are constantly using their hearing in high-intensity environments. But are musicians taking the proactive steps to prevent damage to their hearing? Furthermore, who is responsible for protecting the hearing of musicians, and what can be done to prevent future musicians from potentially damaging their hearing forever?
How we Hear
Before I answer those questions, it is important to provide some information on what sound is and how the human auditory system works.
What is Sound?
Essentially, sounds are pressure vibrations (Watson, 2009). We perceive sound in two ways:
- By an object producing pressure waves in a particular medium (i.e., air, water, etc.) that travels to the ear.
- Ex. A violin string vibrating the air inside the violin which then travels to the ear.
- By an object vibrating a part of the skull.
- Ex. A tuning fork vibrating the skull when placed on the jaw.
Sound waves have many different characteristics, but the two most important ones for hearing are frequency and amplitude. Frequency refers to the number of times a wave oscillates per second and is measured in hertz (Hz). Amplitude refers to how much a particular wave displaces the medium it is traveling through and is measured in decibels (dB). When we hear, sound waves travel through the air (or any other medium) into the ear, which then allows the ear and brain to interpret the qualities of that sound such as its pitch, timbre, and location.
The Human Auditory System
The human auditory system consists of two parts (as described by Watson, 2009):
- The conversion of sound waves into electrical signals by the ear.
- The interpretation of these electrical signals by the brain.
This blog will focus on the first part of the auditory system as it is relevant to the topic. The ear consists of three main parts:
The Outer Ear
The outer ear is where sound waves first enter the body. Made entirely of cartilage, the outer ear includes the auricle and ear canal. When sound travels towards the ear, it first interacts with the auricle. The auricle acts as a funnel and directs the incoming sound waves into the ear canal.
The Middle Ear (air-filled Tympanic Cavity)
When sound travels through the ear canal, it first interacts with the tympanic membrane (ear drum), which separates the tympanic cavity from the outer ear. The sound waves contact the tympanic membrane and cause it to vibrate. The sound waves (now converted to vibrations) are then sent to three different ossicles: the malleus (hammer), incus (anvil), and stapes (stirrup). The stapes ends with a footplate which rests inside of the oval window. As the vibrations from the tympanic membrane travel through the ossicles, they are further refined and sent into the inner ear through the oval window.
As a note, the inner ear is full of fluid, which does not allow the footplate to vibrate in the oval window easily. As such, the middle ear also has a round window. As the footplate vibrates in the oval window, the membrane of the round window expands, which allows for the vibrations to travel into the inner ear.
The Inner Ear
The fluid-filled inner ear is where the vibrations from the middle ear are processed. The main structure involved with processing these vibrations is the cochlea. The cochlea is made of bone and contains three channels:
- Scala Vestibuli: The upper channel of the cochlea where the oval window is found. Connects with scala tympani.
- Scala Media (Cochlear Duct): The middle channel of the cochlea.
- Scala Tympani: The lower channel of the cochlea where the round window is found. Connects with scala tympani.
When sound passes through the oval window, the fluid within the scala vestibuli and the scala tympani starts to vibrate. These vibrations are sent inwards to the scala media through the vestibular membrane (where the scala vestibuli and scala media meet) and the basilar membrane (where the scala tympani and scala media meet). The vibrations are sent down to the Organ of Corti, which is nested at the base of the scala media. Within the organ of Corti are outer and inner hair cells. On top of these hair cells are smaller hair cells called stereocilia, which interact with the vibrations and cause the hair cells below them to contract and produces electrical signals. When vibrations enter the organ of Corti, they first interact with the outer hair cells. These cells further amplify and direct the vibrations inwards towards the inner hair cells, which converts the vibrations into electrical impulses that are sent to the brain for further processing.
Damage to the Ear
Human hearing naturally depletes as a person ages, but this process can be sped up in many different ways. The main way this can happen is through prolonged exposures to high-intensity sounds. The hair cells found within the inner ear are incredibly sensitive to both pitch and volume, but they are not well equipped to protect themselves from high volume sounds (Klickstein, 2009). It takes around a 10dB increase for the ear to detect a doubling of intensity (Klickstein, 2009), which may not seem significant, but at higher volumes a 10db increase is the difference between experiencing mild symptoms of hearing loss to experiencing irreversible damage. Because of this, many workplace environments have guidelines to protect workers from the dangers of high volume sounds. As defined by the National Institute for Occupational Safety and Health (NIOSH), the recommended guidelines for sound exposure can be found in the chart below.
| Volume (dB) | Exposure Limit |
| 85 | 8 hours |
| 88 | 4 hours |
| 91 | 2 hours |
| 94 | 1 hour |
| 97 | 30 minutes |
| 100 | 15 minutes |
| 103 | 7.5 minutes |
| etc. | etc. |
When a person has a prolonged exposure to high-intensity sounds, they can experience a variety of symptoms such as:
- Hearing loss.
- Disorientation/dizziness.
- Headaches.
- Hyperacusis: When a person experiences discomfort at lower sound levels.
- Tinnitus: When a person perceives a sound, such as ringing that is not being produced by an external source.
Aside from physical damage, hearing loss can affect other areas of a person’s well-being. Burns-O’Connell et al. (2021) found that musicians with tinnitus can experience difficulties with their emotional and mental health as well as their social lives outside of music. Along with this, Carraturo et al. (2024) cited that hearing damage can cause higher levels of stress and irritation, increase the chances of developing heart problems, and negatively affect both sleep and cognition.
Hearing Health amongst Musicians
For musicians, their hearing plays a significant role in their everyday music-making activities. For instance, hearing for musicians allows them to:
- Create a unified sound with the members of their section.
- Blend their sound with musicians within or outside their section.
- Tune intervals and chords.
- Be deeply immersed in the music they are experiencing.
But how is the overall hearing health of musicians? In the next part of the blog, we will look at the current scholarship surrounding musician’s hearing health to explore the following areas:
- Use of Hearing Protection.
- Factors that Impact the Use of Hearing Protection.
- Hearing Protection and Performance.
Use of Hearing Protection
Hake et al. (2024)* asked professionals (n=282) and amateurs (n=313) to complete an online questionnaire that assessed their general knowledge of hearing health and how hearing affects a person’s overall wellbeing. It was found that professionals are significantly more exposed to high intensity sounds in comparison to amateurs, but no difference was found between the groups when it comes to acquiring symptoms of hearing loss (Hake et al., 2024).
The environment in which professional (49.4%) and amateur (57%) musicians experience the highest amount of sound exposure is in the practice room, followed by the rehearsal hall and concert venues. Surprisingly, the study observed that musicians’ preventative measures to protect their hearing seems quite low as shown in the table on the right.
The Use of Hearing Protection by Musicians
| Fully Protected | Partially Protected | Not Protected | |
| Professionals | 9% | 57% | 34% |
| Amateurs | 1% | 19.5% | 79.5% |
This is quite alarming, as Hake et al. (2024) also found that 50% of professionals are exposed to at least 90dB for 8 hours per day. Relating this to the NIOSH guidelines, this suggests that professional musicians are experiencing four times the recommended exposure time for sounds at 90dB!
Schurig et al. (2024)* asked professionals (n=370) and amateurs (n=401) to complete an online questionnaire. There was an overwhelming number of responses (99% of professionals and 98% of amateurs) that felt that hearing health plays a vital role in their careers. Along with this, many of the participants (69% of professionals and 84% of amateurs) believe that hearing health needs to be discussed more amongst musicians (Schurig et al., 2024). Comparing these results with Hake et al. (2024), it is interesting to see that while musicians are aware of the importance of hearing health, they rarely use hearing protection. Many of the participants from Schurig et al. (2024) mentioned that there are underlying issues regarding hearing protection, such as their stigmatization and the lack of support from the administration.
*Hake et al. (2024) and Schurig et al. (2024) are part of a larger study that observed the hearing health of German and Austrian professional and amateur musicians in 2024.
Factors that Impact the Use of Hearing Protection
A study by Beach et al. (2012) interviewed young adults (n=20) who regularly attend night clubs and use earplugs to understand what factors influence their choice to use hearing protection. Most of the participants said that they use hearing protection for many different reasons:
- They have experienced symptoms of hearing damage.
- They know of someone who has lost some of their hearing.
- They want to protect their hearing so they can continue to enjoy listening to music.
The group also noted that there is a stigmatization towards hearing protection which can affect a person’s self-image (for example, the use of earplugs can be seen as a sign of weakness and that a person cannot handle high-intense sounds) and their enjoyment of music (Beach et al., 2012). Ultimately, the participants stated that it is up to the individual to protect their own hearing health, regardless of any external pressures (Beach et al., 2012).
Huttunen et al. (2011) created a study to see if hearing protection is a factor that influence a person’s choice to use hearing protection. The study asked a group of professional musicians (n=15) and amateur musicians/music students/music enthusiasts (n=10) to complete a questionnaire, an auditory exam, and a Real-Ear Attenuation at Threshold (REAT) test with and without earplugs. Both groups noted that earplugs themselves were a factor that influenced their choice to use hearing protection. These factors included:
- Occlusion effect: When sounds produced by the body (such as speaking or vibration of the lips) are distorted because of an object blocking the ear canal.
- Not being able to hear: 80% of participants said that earplugs affect their ability to hear themselves and 100% said hearing protection affects their ability to hear others.
- Hypersensitivity: When wearing earplugs, the sensitivity of our hearing increases because of the dampened sound. When earplugs are taken out too quickly, our sensitive ears get overloaded with sound and can cause headaches and disorientation.
After analyzing the data from the REAT tests, it was concluded that earplugs are only effective when they are used properly and when there is an abundance of high intensity sounds in the environment (Huttunen et al., 2011).
Hearing Protection and Performance
Thomas et al. (2020) conducted a two-part study to see whether earplugs can affect the musical experience of both a performer and an audience member. Part A asked professors (n=10) to perform a series of notes and melodic excerpts with and without earplugs to see if earplugs affected their performance. Part B asked participants (n=96) to listen to recordings of Part A with and without earplugs to observe whether their ability to identify pitch, dynamics, and intonation was affected. It was found that the perception of both groups was mildly affected but was not consistent with whether they were wearing earplugs or not (Thomas et al., 2020). As such, the study concluded that the use of earplugs is an effective way to protect musicians from damaging hearing levels and that it does not impede their performance.
In a similar study, MacLeod et al. (2022) wanted to explore how different types of hearing protection can affect a musician’s sense of pitch in comparison to not wearing any protection. The study asked a group of music students (n=72) to listen to a reference and altered pitch with and without earplugs, after which they would tune the altered pitch to the reference pitch in perfect intervals. The group was found to have the highest intonation accuracy without wearing earplugs, then with musicians’ earplugs, and then with foam earplugs (MacLeod et al., 2022). Much like Thomas et al. (2020), MacLeod et al. (2022) also found that the use of earplugs only slightly altered the participant’s sense of pitch, and that the consistent use of earplugs can limit the effect musicians’ earplugs have on pitch perception.
Interlude
So far, the current scholarship shows the following:
- Musicians are constantly exposed to high levels of sound, particularly in individual practice.
- Musicians understand the importance of hearing health, yet they rarely use hearing protection.
- There are internal and external factors that influence a musician’s choice to use hearing protection.
- Musicians’ earplugs slightly affect a musician’s sense of pitch, intonation, and dynamics, but can be limited through consistent use.
It is worth mentioning that these findings apply to musicians’ hearing within the context of music-making activities. Outside of these activities, musicians are exposed to various types of intense sounds every day. These exposures can include the sounds of a busy city (ex. Construction, street traffic, sirens, etc.), listening to music with headphones, or going out to a bar or nightclub. Factoring these environments with music-making activities, it is no wonder that musicians are experiencing high levels of hearing loss as their sound exposure is tremendously exceeding the healthy guidelines of healthy exposure to intense sounds by NIOSH.
Reflecting on everything that has been discussed in the blog, it is shocking to see how little musicians take care of their hearing especially when hearing plays a vital role in their lives. What is more shocking is that musicians are aware of the risks and dangers of being exposed to high levels of sound and yet they still willingly choose to not wear hearing protection.
So, How do we Save our Ears?
Wear Earplugs
Regardless of the type of earplug, wearing earplugs is the most effective way a musician can protect their hearing (Klickstein, 2009). A common type of earplug used by musicians is attenuating earplugs. These earplugs decrease the volume of sound entering the ear canal through by using an attenuation filter. These filters can come in a variety of attenuation levels between 9dB and 20dB (Klickstein, 2009). Attenuating earplugs can either be pre-made or custom-made (musicians’ earplugs).
With the table on the right, it is easy to see the pros and cons of the different types of attenuating earplugs and figure out which kind of earplug suits an individual’s needs. However, one major downside of attenuating earplugs is that they are only effective in environments that are loud consistently. In quieter environments (and environments that have varying sound levels), they are not as effective and can limit what a person can hear. Another major downside to attenuating earplugs is that they are not covered by most insurance plans. While insurance plans will cover hearing aids for a person who has already experienced hearing damage, most will not cover protective devices that will prevent hearing damage from occurring in the first place.
| Pre-Made Earplugs | Musicians’ Earplugs |
| Relatively inexpensive [$25-$100 CAD as of 2025] and can be purchased online or in local music shops. | Fairly expensive [over $200 CAD as of 2025] and are ordered through an audiologist. |
| Are mass-produced and can cause discomfort. | Are custom molded to an individual’s ear canal. |
| Filters are not interchangeable. | Filters are interchangeable. |
| Can distort incoming sound quality. | Minimizes distortion of sound quality. |
Within the last decade, there have been developments in a new type of attenuating earplug called active (electronic) earplugs. These earplugs use microphones to automatically adjust attenuation rates, which allows them to adapt to rapidly changing sound environments. O’Brien et al. (2014) explored how active earplugs can affect musicians (n=26) and found that their reaction to the earplugs were fairly positive. While the earplugs are still early in their development, the musicians commented that the earplugs were more comfortable than regular attenuating earplugs, they were more adaptive to changing sound levels within the orchestra and that they could be worn for longer periods of time without discomfort (O’Brien et al., 2014). However, these earplugs are quite expensive and still require further development before they can be a viable option for musicians.
But what about foam earplugs? While foam earplugs are inexpensive and readily available, they may not be the best solution. Foam earplugs tend to only be effective in high volume environments and have been noted by Thomas et al. (2020) and MacLeod et al. (2022) to impact a musician’s sense of pitch, intonation, and dynamics. However, they still are better than not wearing any hearing protection.
Manage/Monitor Exposure to Sound
Another effective way to protect your hearing is to be mindful of your sound exposure throughout the day (Klickstein, 2009). As seen with current research, musicians experience a vast amount of high-volume exposure in individual practice. These practice sessions are usually done in smaller rooms that are not acoustically treated, which “may be flattering to the tone [of an instrument,] but will also maximize the intensity of [its] sound.” (Watson, 2009, p. 298) It is important for musicians to understand just how much sound is being produced by their instrument (refer to Table 4). With this table, it is obvious that instruments (especially wind, brass, and percussion instruments) can produce volumes that are equivalent to volumes found in nightclubs. For curiosity’s sake, let’s apply the NIOSH guidelines for sound exposure to the clarinet. For the clarinet, it is recommended that exposure should be limited to 2 hours at the lowest volume and 7.5 minutes at the highest volume. These guidelines further support the idea that musicians need to be more aware of how their instrument is affecting their individual hearing.
With this table, it is obvious that instruments (especially wind, brass, and percussion instruments) can produce volumes that are equivalent to volumes found in nightclubs. With this in mind, Klickstein (2009) provides many ways that a musician can both manage and monitor how much sound they are being exposed to with their music-making activities:
- Practice in rooms (preferably larger rooms) that are acoustically treated.
- Strategize practice sessions so that loud practice is spaced out with quiet practice.
- Practice for shorter amounts of time.
- Space out music-making activities throughout the day: do not put music-making activities back-to-back especially if they will be high in volume.
- Regularly get your hearing checked by an audiologist.
If you are interested, audiologist Frank Wartinger created a wonderful resource that outlines how musicians can both monitor and manage their exposure to high-intensity sounds within music-making activities. The resource can be found here:
Wartinger, Frank. (2017). Hearing wellness for musicians. The Hearing Journal, 70(4), 42. DOI: 10.1097/01.HJ.0000515659.73105.1d
| Sound Source | Approx. Level (dB) |
| Violin | 84-103 |
| Cello | 82-92 |
| Oboe | 90-94 |
| Flute | 85-110 |
| Piccolo | 95-112 |
| Clarinet | 92-103 |
| Moderately loud piano playing | 92-95 |
| French Horn | 90-106 |
| Trombone | 85-113 |
| Timpani/Bass Drum rolls | 106 |
| Personal stereo at 50% volume | 94 |
| Symphonic music peak | 120-137 |
| Rock concert | 110-150 |
| Dance club | 110 |
| Power mower/saw | 107-110 |
| Jet engine at 100 ft. | 140 |
In Closing
Through this blog, I have introduced how the ear interprets sound waves and how our hearing can be damaged; I have explored the current scholarship surrounding the hearing health of musicians and provided various ways that musicians can protect their hearing. However, I have yet to answer the most important question of this blog: Who is responsible for protecting the hearing of musicians? Is it up to the individual to take matters into their own hands to ensure their hearing is protected (Beach et al., 2012), or is it up to the administrative of institutions that represent musicians?
Firstly, it is important to remember that “sound-induced hearing loss is 100% preventable” (Klickstein, 2009, p. 278). Hearing is engrained into every part of a musician’s life, and as such it is nearly impossible to eliminate all potential exposure to high intensity sounds. In addition, there are so many different external and internal variables that play into a person’s overall hearing health and how high-intensity sounds affect them. As such, a person is the only one who can fully understand what they are capable of enduring in high volume environments and for how long. Because of this, I believe that it is the responsibility of the individual to take their hearing health into their own hands (or ears if you will). However, I also do believe that institutions also play an important role in the protection of musician’s hearing. As noted by the studies in the blog, a lack of support by administrators and the ongoing stigmatization of hearing protection within the symphony orchestra are major barriers for musicians. Which is why I believe that there needs to be the following changes made:
- De-Stigmatize Hearing Health: There needs to be more support systems provided to musicians to de-stigmatize the discussion of hearing health and a person’s choice to use hearing protection.
- Include Hearing Protection in Insurance Policies: The most effective way to prevent hearing loss for musicians is to use hearing protection, specifically attenuating earplugs. However, these can be expensive and can be a financial hurdle for most musicians. Hearing protection is a necessity for musicians in work environments, and as such, should be covered by insurance policies.
- Promote Awareness Early: Hearing health awareness and the risks of hearing loss needs to be included in the education of future musicians. The earlier young musicians are taught about hearing health and what they can do to prevent hearing damage, the more likely they will regularly engage in healthy hearing habits.
Works Cited
Beach, EF., Williams, W., & Gilliver, M. (2012). A qualitative study of earplug use as a health behaviour: The role of noise injury symptoms, self-efficacy and an affinity for music. Journal of Health Psychology, 17(2) 237-246. https://dx-doi-org.proxy3.library.mcgill.ca/10.1177/1359105311412839
Burns-O’Connell, G., Stockdale, D., Cassidy, O., Knowles, V., & Hoare, D. (2021). Surrounded by sound: The impact of tinnitus on musicians. International Journal of Environmental Research and Public Health 18. https://doi.org/10.3390/ijerph18179036
Carraturo, G., Kliuchko, M., & Brattico, E. (2024). Loud and unwanted: Individual differences in the tolerance for exposure to music. The Journal of the Acoustical Society of America, 155(5), 3274-3282. https://doi-org.proxy3.library.mcgill.ca/10.1121/10.0025924
Hake, R., Kreutz, G., Frischen, U., Schlender, M., Rois-Merz, E., Meis, M., Wagener, KC., & Siedenburg K. (2024). A survey on hearing health of musicians in professional and amateur orchestras. Trends in Hearing, 28. https://doi-org.proxy3.library.mcgill.ca/10.1177/23312165241293762
Huttunen, K., Sivonen, V., & Pöykkö, V. (2011). Symphony orchestra musicians’ use of hearing protection and attenuation of custom-made hearing protectors as measured with two different real-ear attenuation at threshold methods. Noise & Health 13(51), 176-188. https://dx-doi-org.proxy3.library.mcgill.ca/10.4103/1463-1741.77210
Justin Evans. (2011). File:SoundWaveDiagFreqAmp [Online Image]. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:SoundWaveDiagFreqAmp.png
Klickstein, G. (2009). The musician’s way: A guide to practice, performance and wellness. Oxford University Press, UK. https://ebookcentral.proquest.com/lib/mcgill/detail.action?docID=4702280
MacLeod, RB., Geringer, JM., & Miller, DS. (2022). The effect of wearing foam and etymotic earplugs on classical musicians’ pitch perception. Journal of Research in Music Education, 69(4). https://doi-org.proxy3.library.mcgill.ca/10.1177/0022429421989993
Madhero88. (n.d.). File:Organ of corti [Online Image]. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Organ_of_corti.svg
O’Brien, I., Driscoll, T., Williams, W., & Ackermann, B. (2014). A clinical trial of active hearing protection for orchestral musicians. Journal of Occupational and Environmental Hygiene, 11(7), 450-459. https://doi-org.proxy3.library.mcgill.ca/10.1080/15459624.2013.875187
OpenStax. (2016). File:1404 The Structures of the Ear [Online Image]. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:1404_The_Structures_of_the_Ear.jpg
Open Stax. (2016). File:1406 Cochlea [Online Image]. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:1406_Cochlea.jpg
Primal Pictures Ltd. (2006). Anatomy.tv. Primal Pictures Limited. http://anatomy.tv/new_home.aspx
Schurig, E., Hake, R., Birke, M., Derks, D., Siedenberg K., & Kreutz, G. (2024). Hearing health literacy among professional and amateur musicians. Scientific Reports, 14(1). https://doi-org.proxy3.library.mcgill.ca/10.1038/s41598-024-79875-1
Thomas, KS., Smith, R., Teglas, S., & Hodges, DA. (2020). Musicians’ earplugs: Do they affect performance or listeners’ perceptions? Medical Problems of Performing Artists, 35(4), 188-195. https://dx-doi-org.proxy3.library.mcgill.ca/10.21091/mppa.2020.4027
U.S. Centres for Disease Control and Prevention. (2024, January 30). National Institute for Occupational Safety and Health (NIOSH): Noise-Induced Hearing Loss. https://www.cdc.gov/niosh/noise/about/noise.html
Watson, AHD. (2009). The biology of musical performance and performance-related injury. Scarecrow Press, UK. https://ebookcentral.proquest.com/lib/mcgill/detail.action?docID=467511