When Sound Becomes Painful

November 1, 2025

IM  -  

The working life of musicians is loud! Cutting-edge audio produces high-quality sound, but even if the result is great music, it’s still occupational noise exposure. Whether it’s an orchestra, jazz ensemble, or marching band, everything is cranked up. The added decibel (dB) quotient takes a deafening neurological toll—and the risk goes up with volume and length of exposure.

The ear is a complex system where anything can misfire. Problems can be broadly divided into short-term and long-term issues. More acute deficits can result from ear canal obstruction (infections, like swimmer’s ear, retained water from swimming or bathing, or wax buildup). The middle ear can be affected by infection or allergies, which can cause a buildup of fluid and/or pressure that alters the frequencies reaching the inner ear encompassing the cochlea and semicircular canals.

When sound enters, the fluid inside your cochlea causes tiny hairs to vibrate, sending electrical impulses to your brain. The average person is born with about 16,000 hair cells; by the time you notice hearing loss, many hair cells have been destroyed and cannot be repaired.

The prevalence of tinnitus and hearing loss in the music industry is alarmingly high. Acoustic shock, a condition triggered by exposure to extremely loud noise, can result in persistent tinnitus, hyperacusis (acute sensitivity to sound), and irreversible hearing damage. Several factors contribute to long-term damage, including volume (measured as sound pressure level in decibels, abbreviated dB SPL), frequency distribution, duration of exposure, individual susceptibility (genetics), and age.

Hearing Safe Sound

According to the National Institute for Occupational Safety and Health (NIOSH), exposure levels above 80 dBA can cause long-term injury. Even small increases in dB can make a big difference in how loud something feels and how much damage it can do. For every additional 3 dB, the safe exposure time is cut in half. This means that loudness is not directly proportional to sound intensity. Instead, the intensity of a sound grows very fast. A sound at 20 dB is 10 times more intense than a sound at 10 dB, and would be perceived as twice as loud. At 100 dBA, safe exposure time is only 15 minutes. Playing music adds up to workday exposure. (Download a free app from NIOSH to measure your exposure.)

Musicians are almost four times more likely to suffer noise-induced hearing loss. An annual exam is critical to establish a baseline hearing. When hearing loss is detected early, interventions can be implemented to prevent further injury. Hearing protection technologies have improved considerably over the years. Sophisticated earplugs and in-ear monitors are designed to protect hearing without diminishing sound quality.

Using In-Ear Monitors

Many professional musicians wear personal in-ear monitors (IEMs), which allow them to hear both their own music and other musicians on stage at a safe level. Using these monitors and eliminating on-stage wedge monitors lowers the overall sound level on stage.

Ask an audiologist about in-ear protection. Properly fitted IEMs offer significant isolation from unwanted ambient sound, reducing the noise floor (background noise and noise that equipment naturally creates) and allowing the monitor mix to be heard with full clarity. Using IEMs also puts monitoring level control in the hands of the performer. When things get too loud, it’s easy to turn IEMs down to a comfortable level.

Unexpected sounds—someone unplugging a phantom-powered microphone or a blast of radio frequency (RF) noise—can cause a near-instantaneous peak in excess of 130 dB sound pressure level (SPL), the equivalent of a gunshot to your eardrum. Your personal monitor signal chain should always include a limiter at the receiver with extreme settings (referred to as brick-wall limiting) to quickly reduce the level of signals that exceed a safe threshold. A well-designed limiter will not adversely affect the audio quality, as it only works on unexpected peaks. The limiter’s threshold control should be set well below the level where hearing damage can occur. The ratio should be set as high as possible, with 10:1 being the lowest setting.

Hearing Loss Prevention

The accessibility of reliable hearing protection is no longer the issue. Now it’s about fostering a cultural shift within the music and entertainment industries to make hearing protection a standard practice. Awareness is growing among musicians of all genres. The Colorado Symphony has equipped all 80 of its full-time musicians with state-of-the-art active hearing protection, thanks to a donor gift. The orchestra joins the Chicago Symphony Orchestra, the Metropolitan Opera, the Minnesota Orchestra, the Los Angeles Philharmonic, and others committed to hearing protection strategies.

As awareness grows and protective strategies become standard, the prevalence of tinnitus and hearing loss in the music industry should decrease. Never think of hearing loss as inevitable, or a risk that’s just part of the job.

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