EXPERT ROUNDTABLE | February 2017 Hearing Review

Custom hearing protection for musicians

Loud sound has been with us as long as humans have existed. However, preventing hearing damage from loud noise is usually possible. Earplugs have been around longer than one might think: earplugs were patented in 1884, and disposable earplugs were patented in 1914.1 Before that, humans plugged their ears by closing off the tragus or placing fingers in the ears—which is surprisingly effective,2 but not practical for long periods of time. While we still have a long way to go to ensure every person is able to hear well for a lifetime, we’ve made significant progress in earplug technology over the past 100 years.

The military led the charge in developing hearing protection, notably with the Mallock-Armstrong earplugs used in WWI and the V-51R earplugs used in WWII. Improvements in comfort were introduced with the development of glass-down plugs in the late 1950s and foam earplugs in the 1970s.1 Today you’ll find a vast array of comfortable earplugs in all shapes, sizes, and colors.

What you may not be aware of is the wealth of information that exists to address earplug use and fitting issues. In my view, the invaluable EAR-Log series,2 written by Elliott Berger, should be standard reading for every hearing professional and assigned in every course on hearing conservation. The EAR-Log series is available free. There are also many excellent textbooks, scientific papers, and online resources devoted to the topic.

Deeply-fitted, slow-recovery polymeric foam earplugs provide maximum protection from loud sound. What could be better? But not everyone needs maximum attenuation; in fact, many individuals need less attenuation and more clarity than standard earplugs provide.

With his “Parvum, Bonum” article,3 Mead Killion challenged the “more is better” assumption regarding hearing protection. Using a design created by his mentor, engineer Elmer Carlson,4 Killion introduced moderate attenuation, high-fidelity earplugs. These earplugs are based on an understanding of the normal ear: placing an earplug in an ear removes the natural canal resonance, resulting in muffled sound quality. However, the Carlson/Killion design replaced the average canal resonance, producing an earplug that reduces sound equally across frequency. These custom Musicians Earplugs™ have not only protected the hearing of hundreds of thousands of musicians since their introduction in 1988, but they allow musicians to hear clearly, making it possible to use them in practice and performance.

A non-custom, low-cost version, the ER-20 ETY-Plugs®, was introduced in 1990. In 2014, the ER-20®XS, a stemless version with replaceable eartips was introduced.

Despite improvements in earplug comfort and performance, hearing loss and tinnitus remain the most prevalent service-connected disability among today’s US veterans.5 Passive hearing protection reduces all sound levels, creating a loss of situational awareness that is critical to war-fighter safety and survival. Active (electronic) earplugs that preserve the average canal resonance and provide cues critical to localization are sold under the names GunSportPRO® and EBLE® earplugs. These high-fidelity electronic earplugs have a 16 kHz bandwidth, which provides critical high frequency cues necessary for localization. In addition, these earplugs provide 35-40 dB instantaneous blast protection. Future versions will offer water resistance and rechargeable batteries.

Musicians also benefit from electronic technology: MusicPRO® earplugs were designed for musicians who want to hear naturally when sound levels are safe (as though nothing is in the ears) and be protected from sudden or continuous loud sound, without the inconvenience of removing the earplugs to hear.

As earplug technology has progressed significantly over the past 100 years, so has awareness of the dangers of loud noise and the need to protect hearing. One excellent resource is the National Hearing Conservation Association ( Established in 1976, NHCA members are committed to the prevention of hearing loss due to noise and other environmental factors in all sectors of society. These dedicated professionals host an incomparable conference every year, which is a must-attend event for anyone interested in hearing conservation. NHCA members are an approachable group and always welcome new members.

The Dangerous Decibels program promotes awareness to youth on the dangers of loud noise through fun, educational exhibits and in-school educational programs. Training to present Dangerous Decibels workshops is open to all professionals. Etymotic Research’s Adopt-A-Band program provides educational materials and earplug discounts to bands of all types and sizes, with a goal of creating a generation of young musicians whose enjoyment of music won’t be affected by hearing loss or tinnitus.

Life has always been noisy. Innovations over the past 100 years have given us high-fidelity hearing protectors that allow us to enjoy loud sound while preserving and protecting our hearing for a lifetime. Innovation in education and outreach have given us the tools to influence a generation for whom noise-induced hearing loss does not have to become a reality. ?


  1. Acton WI. History and development of hearing protection devices. J Acoust Soc Am. 1987; 81[Supp]:S4. PattyJohnsonBioBox
  2. Berger EH. Responses to questions and complaints regarding hearing and hearing protection (Part III). E-A-RLog 10;1983. Available at:
  3. Killion MC. The parvum bonum, plus melius fallacy in earplug selection. In: Recent Developments in Hearing Instrument Technology: 15th Danavox Symposium;1993:415-433.
  4. Killion MC. Elmer Victor Carlson: A lifetime of achievement. Bulletin Am Auditory Soc. 1992;17(1):10-13,20-21.
  5. US Department of Veterans Affairs. VA research on hearing loss. Office of Research and Development. Available at

Citation for this article: Johnson PA. A historical perspective on hearing protection. Hearing Review. 2017;24(2):16-17.



Expert Roundtable: Music & Hearing (February 2017 Hearing Review)

Expert Roundtable: Music & Hearing on the 100th Anniversary of Recorded Jazz, By Marshall Chasin, AuD, Bethany Ewald Bultman, and Dan Beck, Guest-editors

Jazz: An Acoustical Revolution, By Bethany Ewald Bultman

The Evolution of Hearing Conservation Guidelines and Standards in the United States, By Mark Stephenson, PhD

A Historical Perspective on Hearing Protection, By Patricia A. Johnson, AuD

Ear Infections Over the Ages, By Kenneth Einhorn, MD

Promoting Safe Sounds in the Birth City of American Music, By John J. Hutchings, MD, and Bethany Ewald Bultman

Temporary Threshold Shift (TTS) Is NOT So Temporary, By Marshall Chasin, AuD

Have We Really Come That Far? By Dan Beck