In a small room in the back of a bar in Brooklyn, Jack Grace leads his band through a group of songs about love and hangovers. Lyrics include the line, “What I drink and who I meet at the track is my business.”
The room is mostly red, complete with a velvet curtain and ruby red drum kit. Like other small music venues, sound floods every inch. The audience is brought to the brink of an experience that’s technically too loud, but it’s overpowered by a potent dopamine cocktail that’s served when we listen to music we like.
For the musicians who play that music, sound is an occupational hazard. Overexposure to noise can cause noise-induced hearing loss, which may be up to four times more common in professional musicians than the general public. NIHL is also associated with auditory conditions, including hyperacusis (an extreme sensitivity to loud sounds) and tinnitus (chronic ringing or other noise in the ear), which has plagued many famous musicians and disrupted their ability to play live music in severe cases.
Grace (born John Pancaldo), says he’s lucky not to have developed persistent tinnitus. He’s experienced bad bouts of ringing in the ears, but they eventually fade away.
“The people that I know that’ve gotten it, it’s maddening,” Grace said of tinnitus. “When it comes, it’s like an earthquake, you don’t know when it’s gonna end.”
Hearing loss isn’t limited to musicians. About half of all younger people ages 12 to 35 — about 1 billion — are at risk of hearing loss due to “prolonged and excessive” exposure to sound, according to the World Health Organization, including from music that’s streamed directly into our ear canals by earphone or headphone.
Our craving for loud music, and the positive emotions it brings, is in stark contrast to noise pollution from a jackhammer, or other loud sounds in our environment that make for unpleasant or even stressful experiences, according to Tricia Ashby-Scabis, director of audiology practices at the American Speech-Language-Hearing Association. But while we run toward one and away from the other, it’s the same outcome for our ears.
“It’s not causing frustration or anxiety, but they’re still getting that sound pressure impact on their body — they’re still having that sound pressure impact that’s damaging their ears,” Ashby-Scabis said.
We can take a page from the musician book by looking to advancements in ear protection, potential tinnitus therapy and the counterintuitive calculations we make when exposing our ears to damaging levels of noise that bring us joy.
Tinnitus: The ringing that never stops
While there can be other causes of tinnitus, like an ear infection, high blood pressure or a medical condition, the most common cause is exposure to loud sounds, which over time damage the nerve cells in the inner ear responsible for perceiving sound. The result is a constant sound, typically a high-pitched ringing.
Because there’s no external source of the sound, the severity of tinnitus depends on how bothersome or painful it is to the person experiencing it. Many people with a milder case barely notice it, or only notice it in very quiet places. For others, however, tinnitus interferes with their quality of life or even causes physical pain.
Mark Partain, an audiologist at an online tinnitus therapy company called Treble Health, knows firsthand it’s not just classic rock music that harms hearing. In addition to helping other people manage their tinnitus for a living, Partain is an orchestral percussionist and has had the condition for 18 years.
A turning point in Partain’s tinnitus journey came when he decided to cut caffeine and started practicing mindfulness, in part to manage a tremor he had. When he noticed his tinnitus starting to improve as well, he mentioned it to an audiologist and learned that wasn’t exactly a coincidence.
“They were like, ‘yeah, that makes sense,'” Partain remembered. “‘This is a little bit of tinnitus retraining therapy.'”
Besides ruling out a medical condition that may be causing tinnitus, or using hearing aids to improve the condition, tinnitus retraining therapy is one method that’s improved cases of tinnitus for many people. While there’s no “cure,” TRT helps people manage the stress of tinnitus and reduce how noticeable the sound is through a combination of relaxation exercises and an ear device that plays sound, with the patient typically assisted by an audiologist or other health professional.
Partain walks his patients through this process at Treble Health, which he says can be a six- to 18-month process, with some people getting relief much sooner. As for himself, Partain is still a musician, playing with his group Boys Like Jason. His tinnitus is manageable now, and he brings his personal experience to his patients who may be hard-wired to pay attention to every noticeable sensation that crosses their ear.
“I’ve trained for years to dump emotion into what I’m doing on an instrument,” Partain said. “There’s no way I’m going to do that without associating positive or negative emotions with what’s going on.”
No longer a ‘sonic condom:’ The advancement of ear protection
Grace, whose band had its “heyday” in the ’90s, says he’s experimented with ear plugs over the years. But as a singer, the ones he tried interfered with the sound of the vocals, he said.
“It’s like a sonic condom,” Grace joked.
For Ira Dechter, a musician, sound engineer and hearing instrument specialist at the Hearing Clinic in Denver, advancements in hearing protection and musician-grade ear plugs mean you don’t have to sacrifice sound quality at the expense of your auditory health. Modern devices are designed to uphold the quality of sound while offering protection against damaging levels of noise. And fortunately, Dechter says he notices more younger musicians and bands taking advantage of them.
“You just have to protect what you’ve got,” Dechter explained. “That’s your livelihood, or your hobby or your passion.”
For his musicians, he’d recommend brands like Starkey, which sells custom-made sound attenuators for musicians, or Westone, which also makes custom hearing protection. But these devices can benefit anyone who wants to conserve the quality of sound but make it a little less loud.
Ashby-Scabis says that some of the musician-grade ear plugs work to protect the “integrity” of the sound because they “take all of the sound and turn it down by a set amount,” as opposed to classic foam ear plugs which muffle and quiet sound, but often at the expense of the fullness of the acoustics or sound of the music.
Products like these eartips or plugs from Westone are meant to be sold with filters that reduce different levels of noise, like 25 decibels or 10 decibels of attenuation, which you can slip in and out depending on how loud your environment is.
You can also get reusable plugs like these ones from EARasers. However, if you’re an avid concert-goer or musician, you may benefit from investing in a custom fitting by a hearing professional, for sound quality preservation but also to make sure they fit your ear perfectly.
Reading the room (and adjusting the volume accordingly)
Grace says a big part of staving off hearing loss is reading the room — specifically, the size of the venue. Failing to do so can separate the novices from the professionals, as there’s a difference between an enjoyable loud and so loudyou feel compelled to stuff napkins in your ears (a true story, he says).
Grace says he saw this a lot in the ’70s, when “loud guitars were commonplace,” but the idea that louder is better may actually be a cultural phenomenon that transcends live music. The loudness wars, which can be traced back to the advent of the CD and even records, has created an environment where musicians are fighting to quite literally fill the room. This may be to the benefit of venue owners, as one study found that people are more likely to buy drinks in louder music venues. But according to an Australian study on people who frequent night clubs and music venues, most concert attendees may actually prefer it to be a little less loud.
All of this ties into the larger idea of sound, how we consume it and the types of emotions we associate with it. Musicians often strongly crave loud music, sometimes at the expense of their health. While far from being the only type of worker exposed to unsafe levels of noise, musicians may represent the complicated tug-of-war between an emotional craving for certain sounds, and the health complications it may bring. Some research shows loud music can even be addicting.
“Musicians have a hard time differentiating sound from emotion,” Partain said. “They’re taught to conflate the two really closely.”
It is possible to enjoy music and protect your hearing health, if only that means saving yourself from the worst of the worst, noise-wise. One of the most important things anyone can do, according to Dechter, is taking breaks from sound. You can use a common vocalist tip, which is to keep silence between shows on tour in order to preserve the voice, but apply it to your ear health.
“Give your ears a break — that’s really important with noise exposure,” Dechter said.
By taking sound breaks, you can reduce the risk of permanent hearing loss or tinnitus. After a loud concert or other significant noise exposure, it’s common to experience some ringing in the ears or a slightly muffled feeling, which Ashby-Scabis says are “threshold shifts” in hearing. The problem is when the auditory symptoms don’t go away after repeating episodes.
“When you have enough of those temporary threshold shifts — that onset of ringing, your hearing seems kind of diminished or full — it then causes a permanent threshold shift, which is going to impact how well you hear,” she said.
The National Institute for Occupational Safety and Health has specific guidelines for musicians, citing research that says music-induced hearing loss typically happens slowly, over time. Most musicians don’t seek help until there’s a disruption in sound associated with it, like tinnitus. And as we trick our ears into thinking we’re professional musicians ourselves, equipped with state-of-the-art earphones and music on demand, we can follow best practices written for them. This might look like taking a break from headphones and taking an advantage of the quiet, getting your hearing evaluated and wearing hearing protection whenever possible — still respecting the part of you that needs a full sound.
“It’s gotta be loud, and that’s the whole thing,” Dechter said. “Enjoy it, but definitely protect the hearing.”