The need to educate college-age musicians on music- and noise-induced hearing loss
Hearing loss can be detrimental to communication in all populations; however, musicians display a unique set of circumstances. In professional musicians, the ability to maintain livelihood can be dramatically altered by hearing loss, tinnitus, hyperacusis (loudness intolerance), diplacusis (difficulty in pitch perception), and other changes in auditory function. Thorough documentation supports that musicians are at risk for damage to the auditory system from noise/music exposure.1-3
Although musicians are at risk for hearing loss, tinnitus, hyperacusis, and diplacusis, previous studies suggest that concern among musicians regarding these problems is low.4 When asked in a survey how worried professional orchestra musicians were about their hearing, approximately 12% said “not at all” and 45% said “only a little.”4 When asked about measures taken to monitor their hearing status, only 13% reported having audiometric testing during the last year. Similar results were found in a study of amateur and professional percussionists, with 85% of respondents reporting not having hearing status monitored within the last year.5
Despite the lack of concern regarding hearing status, 24% of professional orchestra musicians did report experiencing tinnitus for at least 5 minutes in duration.4 Of those reporting tinnitus, almost half reported experiencing constant tinnitus and a quarter reported experiencing tinnitus affecting sleep patterns. A total of 7% of respondents sought hyperacusis treatment, and 8% had tried a treatment for sound distortion.
In general, college students exhibit a lack of concern regarding potential risks to the auditory system. In a survey of college students, the majority (75%) of respondents reported awareness of noise exposure and associated hearing loss; however, half of the surveyed students reported potentially harmful exposure to loud music.6 When college music students were studied, although many (74%) reported receiving information about noise and hearing health, none of the surveyed students reported wearing hearing protection devices (HPDs) all of the time and only 22% reported any use of hearing protection when exposed to potentially harmful sound levels.7 Similar results were found in freshman college music majors, with 95% reporting never using HPDs when performing in concerts, 85% never using HPDs during rehearsals, and 64% never using HPDs in other environments, such as when attending rock concerts and using lawn mowers.8
When assessed through the Youth Attitudes to Noise Scale (YANS), music majors exhibit a healthier attitude toward sound compared to non-music majors.9 Music majors were more likely to perceive noise that may damage hearing as negative; therefore, the authors concluded that music majors were more likely to take measures to decrease personal exposure. In general, music majors were more aware of and attentive to noise.9
Although many music majors may display a healthy attitude toward music, this population exhibits greater declines in hearing than the general population of college students.10 During a 3-year period of study in a university setting, over half of undergraduate music students displayed declines in high frequency hearing.10 Individual susceptibility or resistance to music overexposure was determined to be the most critical factor for acquired hearing loss in the student musicians. When compared to college students with other sources of noise exposure, such as personal listening devices, recreational shooting, and the use of chain saws, snowmobiles, or motorcycles, less than 30% of students displayed reductions in high frequency thresholds.11
Although student musicians are not defined as an “at risk” population according to the Occupational Safety and Health Administration (OSHA), the damage risk criterion established by OSHA is often applied as a reference for music exposure. OSHA implements a permissible noise exposure level of 90 dBA for 8 hours with a 5 dB exchange rate.12 The National Institute for Occupational Safety and Health (NIOSH) enforces similar yet more stringent criteria of 85 dBA for 8 hours with a 3 dB exchange rate.13
Although collegiate music programs are not regulated by OSHA or NIOSH, previous studies documented that all tested student-musicians, regardless of instrument type, were exposed to daily noise doses that exceeded both OSHA and NIOSH standards.7 Similar results were documented in a group of collegiate jazz ensemble members where sound levels exceeding OSHA standards were obtained in 10 of 15 measures.14 If student-musicians were regulated under a governing agency, such as OSHA, a hearing conservation program would be required given these dosimeter measurements.
The primary aim of this study was to explore the amount and types of noise exposure from musical instruments and recreational activities in collegiate musicians. In addition, the frequency of hearing protection use and the reasoning behind hearing protection non-use were assessed. Self-perceptions of hearing loss and tinnitus were also examined.
Reported noise exposure and attitudes toward hearing protection were examined through a survey of 130 college student musicians. During the initial meeting of a Music Convocation series at West Virginia University (WVU), students majoring in music were asked to complete a researcher-generated questionnaire composed of questions concerned with habits and self-perceptions regarding hearing and noise exposure. In addition to demographic information, students were asked about the types of instruments they currently play along with the average amount of time spent playing/practicing all instruments. Students were also surveyed about the other types of potentially hazardous noise (eg, iPod/MP3 player use, concert attendance, target shooting) to which they are exposed. The frequency of HPD use was assessed in these specific conditions as well as preferred type of HPD device. All procedures are on file with and approved by the West Virginia University Institutional Review Board (IRB) for the Protection of Human Subjects.
The investigation included data analysis from 130 music majors ranging in age from 18 to 25 (mean 19.4 years). Of those indicating gender, 47% were female and 53% were male. The large majority (95%) were members of an ensemble at the university. Table 1 shows general demographic information for study participants.
Noise exposure. When habits regarding noise exposure and HPD use were examined, students reported playing their primary instrument from 5 hours (double bass) to 17 hours (percussion) per week. Percussion, clarinet, tuba, and trombone were the instruments with the longest reported playing times, while oboe, French horn, voice, and double base had the least reported amounts of playing time.
Specific instruments and playing times for primary as well as second, third, and fourth instruments (if applicable) are displayed in Tables 2 and 3. When instrument groups were examined, percussion had the longest reported playing time of 14.5 hours per week, followed by piano (13.4 hours), brass (12.3 hours), woodwind (12.1 hours), string (10.0 hours), and voice (7.7 hours).
TABLE 2. Average weekly reported practice time of specific individual instruments per week of 130 respondents.
In addition to noise exposure from musical instruments, students were also asked whether they participate in 14 other activities involving potential noise exposure and whether hearing protection is used during these activities. The most frequently reported activities were attending concerts (95%), using iPod/MP3 players (92%), and frequenting restaurants/bars with loud music (87%). Examples of less frequently reported activities included machinery use (15%), target shooting (14%), hunting (11%), and construction work (6%). Additional areas of potential recreational noise exposure are displayed in Figure 1.
FIGURE 1. Student musicians’ areas of potential recreational noise exposure in addition to exposure from musical instruments.
Hearing protection use. The majority of respondents (79%) admitted to never wearing hearing protection when practicing or rehearsing their instruments, and the overwhelming majority (90%) did not wear hearing protection during ensemble performances. In addition, no students reported consistent use of hearing protection during performance, and few students reported “sometimes” (4%) or “rarely” (6%) wearing HPDs when performing with their instrument. For the majority of recreational activities, hearing protection was not reportedly worn. Interestingly, nearly all (94%) students who engaged in target shooting wore hearing protection devices. Reported HPD use in recreational activities is shown in Figure 2.
FIGURE 2. Student musicians’ amounts of HPD use for specific activities in which they participate.
Of those students who did report wearing hearing protection, the types included foam plugs/flange (39%), non-custom music quality headsets (25%), earmuffs (6%), wax/molded (6%), custom musicians’ ear plugs (5%), and other (19%). Over half of students (53%) reported that they did not feel that hearing protection was needed, resulting in the most frequent reason for HPD non-use. Other students noted additional reasons for non-use of hearing protection, including unable to hear environmental sounds (29%), comfort (27%), unable to communicate (26%), hassle (26%), and appearance (21%). Table 4 provides a summary of all reported reasons for non-use of hearing protection.
Self-perceptions. Self-perceptions of hearing loss, tinnitus, and personal listening device use were also determined. Only 15% of students agreed with the statement “I have difficulty hearing.”
When asked about tinnitus, over half (54%) reported occasional ringing or buzzing in their ears. Only 5% of respondents reported frequently occurring tinnitus, and the remaining students (41%) reported never experiencing tinnitus.
Self-perceptions of personal listening device volume were addressed by asking students to respond to the statement: “When you are listening to your iPod or MP3 player headphones, other people can hear the music.” Most students (64%) were either neutral (34%) or disagreed (30%) with this statement.
Although students report up to 17 hours per week of instrument playing time, very few reported any use of HPDs while practicing their instrument and no students reported consistent use during performance. Percussionists reported the most extensive amounts of playing time and should be monitored accordingly.
Additional activities outside of instrument playing time with potential music exposure (concert attendance, personal stereo use, and restaurant/bar noise) were also frequently reported in this population, which may increase their risk for noise-induced hearing loss. In other instances where potentially hazardous noise levels are likely to be reached, students also indicated that they did not wear hearing protection, with the exception of target shooting, in which case the majority of students who participated in this activity did wear HPDs.
The most common reason for HPD non-use was that students reported feeling that HPDs were not needed. Recording sound levels of instruments, as well as monitoring of time spent playing the instruments, will provide the necessary information for making specific recommendations for HPD use. In the workplace, NIOSH recommends that HPDs should be used as a last resort while the most effective way to prevent NIHL is to apply engineering controls to reduce sound levels or to remove the worker from excessive noise exposures.13 Similar recommendations should apply to music students, with exploration of other ways to reduce potential risks to hearing such as decreasing exposure time and implementing environmental modifications rather than solely relying on HPD use due to reported resistence by student musicians.
The inconsistent use of HPDs along with the amount of reported playing time places many of the students in this study at risk for permanent damage to their hearing, as well as other auditory problems such as tinnitus, hyperacousis, and diplacusis. These results support the need for education about noise- and music-induced auditory damage.
The Health Promotion in Schools of Music (HPSM) project15,16 established in 2004 promotes healthy hearing habits along with strategies for preventing other occupational injuries in collegiate musicians. Raised awareness of the HPSM hearing initiatives in schools of music for both students and faculty will increase knowledge of the risks associated with high intensity music exposure and of the steps to preserve hearing.
The majority of students did not report difficulty hearing; however, previous studies have shown that over half of students majoring in music display declines in hearing over a 3-year period, suggesting that some students in this study who perceive no difficulty hearing may actually have reduced audiometric thresholds.10 Previous studies have also shown that compliance with HPD use is higher in musicians with known hearing loss,4 indicating the need for annual audiometric testing to reveal declines in hearing and monitoring hearing status to promote hearing preservation.
Half of the surveyed students in this study also reported occasional tinnitus, which is often a sign of transient damage to the auditory system from excessive noise exposure.17 Students should be educated about warning signs of tinnitus and should be encouraged to protect their hearing if tinnitus is a regular occurrence after music practice or performance.
The denial of others being able to hear personal stereo systems when students are listening to headphones suggests the likelihood that the music students are listening at moderate levels. Previous literature in MP3 player/iPod use in similar age groups suggests that most iPod users are not putting themselves at risk for hearing loss when listening to their devices in quiet situations.18 Nevertheless, students should be informed during hearing conservation programs about the potential risks of excessive intensity/duration of personal stereo use since almost all of the music students reported use of MP3 players or iPods.
In conclusion, this study supports the need for continuing efforts to raise awareness in student-musicians through educational programs that outline the risks of excessive noise/music exposure. Annual hearing evaluations and consistent use of HPDs, as well as environmental modifications to reduce sound levels and reductions in prolonged instrument playing time, are all options to aid in preservation of hearing in young adult musicians.
The authors thank Keith Jackson, John Hendricks, Sandra Schwartz, and Chris Nichter of the Division of Music, College of Creative Arts, at West Virginia University for their assistance in this project.
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- Einhorn K. The medical aspects of otologic damage from noise in musicians. In: Chasin M, ed. Hearing Loss in Musicians. San Diego: Plural Publishing; 2009:31-40.
- Laitinen H, Poulsen T. Questionnaire investigation of musicians’ use of hearing protectors, self reported hearing disorders, and their experience of their working environment. Int J Audiol. 2008;47:160-168.
- Curk AE, Cunningham DR. A profile of percussionists’ behaviors and attitudes toward hearing conservation. Med Probl Perform Art. 2006;21(2):59-64.
- Rawool VW, Colligon-Wayne LA. Auditory lifestyles and beliefs related to hearing loss among college students in the USA. Noise Health. 2008;10(38):1-10.
- Miller VL, Stewart M, Lehman M. Noise exposure levels for student musicians. Med Probl Perform Art. 2007;22(4):160-165.
- Zeigler MC, Taylor JA. The effects of a tinnitus awareness survey on college music majors’ hearing conservation behaviors. Med Probl Perform Art. 2001;16(4):136-143.
- Chesky K, Pair M, Landford S, Yoshimura E. Attitudes of college music students towards noise in youth culture. Noise Health. 2009;11(4):49-53.
- Phillips SL, Shoemaker J, Mace ST, Hodges DA. Environmental factors in susceptibility to noise-induced hearing loss. Med Probl Perform Art. 2008;23(1):20-8.
- Mostafapour SP, Lahargoue K, Gates GA. Noise-induced hearing loss in young adults: The role of personal listening devices and other sources of leisure noise. Laryngoscope. 1998;108(12):1832-9.
- Occupational Safety and Health Administration. Regulations (Standards – 29 CFR) Occupational noise exposure – 1910.95, 1998. Available at: www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=9735. Accessed July 30, 2009.
- National Institute for Occupational Safety and Health (NIOSH). Criteria for a recommended standard occupational noise exposure, revised criteria, 1996. Available at: www.nonoise.org/library/niosh/criteria.htm. Accessed July 30, 2009.
- Henoch M, Chesky K. Sound exposure levels experienced by a college jazz ensemble: Comparison with OSHA risk criteria. Med Probl Perform Art. 2000;15(1):17-22.
- Chesky KS, Dawson WJ, Manchester R. Health promotion in schools of music: Initial recommendations for schools of music. Med Probl Perform Art. 2006;21(3):142-144.
- Chesky KS. Hearing conservation in schools of music: The UNT Model. Hearing Review. 2006;13(3):44-48. Accessed July 19, 2010.
- Davis A, Rafaie EA. The epidemiology of tinnitus. In: Tyler RS, ed. Tinnitus Handbook. San Diego: Singular Publishing; 2000:1-23.
- Danhauer JL, Johnson CE, Byrd A, DeGood L, Menel C, Pecile A, Koch LL. Survey of college students on iPod use and hearing health. J Am Acad Audiol. 2009;20(1):5-27.
Correspondence can be addressed to Ashleigh Callahan, PhD, at .