By Ian O’Brien PhD MAudSA(CCP)
While hearing loss among classical musicians is certainly not a recent topic (think Beethoven), the problems faced by musicians hoping to avoid damaging their hearing from overexposure to excessive sound while playing has really only been the subject of serious research for the last forty years or so. While this has in some way been related to increased activity surrounding workplace health and safety, the health care of performing artists has also become a much more prevalent issue in this time.
There are essentially two types of ‘excessive’ or potentially hazardous sound in the orchestra. The most obvious are peak sound levels such as cymbal crashes and brass ‘stabs’ which come and go very quickly. While these can cause great discomfort and stress at the time, they only very rarely exceed agreed ‘hazard’ levels. (They are however best mitigated or avoided if possible!)
A much greater danger to the ears of orchestral musicians is exposure to loud or moderately loud sustained sound levels over long periods of time.
Sound levels in orchestras and the practice room
Sound levels in professional orchestras have been comprehensively studied in many orchestras across the world, with over 40 peer reviewed scientific articles published on this topic alone. Most of these publications have reached similar conclusions regarding the risk of music induced hearing loss in the orchestra and it has been shown that this risk is dependent upon instrument played, repertoire, orchestral set-up and venue. On the whole, brass players are at the highest risk, closely followed by percussion, wind players, upper strings, cellos, basses and harp.
However, it turns out things are not quite that simple. Investigating ongoing claims that a musicians’ own instrument is generally responsible for the majority of their sound exposure in the orchestra, Schmidt et al.  recorded sound levels at each ear using specially designed equipment during orchestral rehearsals and found that while upper string players had relatively low average accumulated sound exposure on their right ears (including a viola section with their right ears directly facing the brass section), left ear exposure was as high as some of the brass instruments, even when the rest of the orchestra were not playing. The researchers concluded that violin and viola players are highly exposed to continuous sound from their own instrument and that this was a possible explanation to the high rates of hearing loss in the left ear seen among these musicians.
Still further research showed that many orchestral musicians were at high risk of hearing damage while practicing their instruments alone. 
Evidence of hearing loss among musicians
Over the years many studies have examined the hearing of orchestral musicians. While some Scandinavian studies have found few differences between the hearing of orchestral musicians and the broader population, many more have found that musicians do exhibit significantly greater incidence of noise related hearing loss, tinnitus and other sound exposure related pathologies when compared to the norm, with some studies finding these musicians are nearly four times more likely to be affected. 
Hearing conservation and risk management
If you are an orchestral musician, protecting your hearing over the course of your career is all about managing risk. You can do this by
- reducing your exposure time,
- keeping track of your daily exposure by investing in a personal sound level meter/app
- using wrap-around absorptive screens (perspex sheets are not recommended: they create problems ‘upstream’ and have been shown to only have minimal effect even if positioned very close to the ear),
- increasing distance from high level sound sources (both vertically and horizontally),
- using a mute while practicing and warming up, and
- using appropriate hearing protection.
If you are being exposed to ongoing moderately high levels of sound regularly, then use of earplugs is essential. If you are experiencing tinnitus or ‘dulled’ hearing after practice, rehearsals or concerts, then it is likely you will need to increase the frequency of your earplug use or take other steps to reduce your sound exposure.
While earplugs should always be seen as a last resort, they are tools of the trade and it is essential that, just like all the other skills you have developed as a musician, you develop the skill of being able to play at your very best while wearing hearing protection.
To maximise the chances of being able to do this you need high quality earplugs designed for use in a musical setting. These are generally custom moulded for you by an audiologist and have filters of varying strengths. For any musicians whose instruments come in to contact with their head (such as brass, woodwinds and upper strings) this custom moulding needs to be quite deep in the ear canal in order to overcome a predominance of your own sound while playing (known as the occlusion effect). It is also very important that any earplugs you use do not cut out too much sound, or ‘over-attenuate’ (often 9-10 dB is more than enough, depending upon what you are being exposed to – you should discuss this with your audiologist). Earplugs that are too strong tend to stay in the instrument case rather than be in the ears when needed in the orchestra. Before using earplugs in ensemble, try practicing with them in for five to ten minutes a day to get used to the differences that earplugs introduce to the playing experience.
There are also some non-occluding filters now in the market and electronic earplugs that only cut in when sound levels become high. While no earplugs sound ‘perfect’, it has been shown that the electronic variety are significantly more usable than passive earplugs for orchestral musicians. If you are a studio musician or do a lot of work requiring fold-back, an in-ear monitor or hybrid in-ear monitor/earplug may be the right device for you.
Orchestras and instruments have been getting louder over the last century or so, and legislation surrounding workplace safety is getting tighter. Further to this, permanently damaging your body or your senses in some way in the pursuit of art is ultimately self-defeating. If you are a musician, your hearing is perhaps your most important faculty. If you are looking for long and successful career, then developing the tools and processes to look after your ears seems fairly fundamental and should not only be practiced by all, but also taught to students from the outset.
If you are a teacher, remember that up and coming musicians look to the practices of established professionals and teachers. Start a discussion with your students today about how they can maintain their hearing while making fabulous music.
For further information on any issue raised here please contact Ian O’Brien via the website.
 Jesper H Schmidt et al., “Hearing Loss in Relation to Sound Exposure of Professional Symphony Orchestra Musicians.,” Ear and Hearing 35, no. 4 (July 2014): 448–60, doi:10.1097/AUD.0000000000000029.
 Ian O’Brien, Bronwen Ackermann, and Tim Driscoll, “Sound Exposure of Professional Orchestral Musicians During Solitary Practice,” J Acoust Soc Am 134, no. 4 (October 1, 2013): 1–7.
 Tania Schink et al., “Incidence and Relative Risk of Hearing Disorders in Professional Musicians.,” Occupational and Environmental Medicine 71, no. 7 (July 2014): 472–76, doi:10.1136/oemed-2014-102172.
 RCH Libera, M Burns, and S Mace, “Shielding a Musician: a Case Study on the Effectiveness of Acoustic Shields in Live Ensemble Rehearsals,” 2009.
 Ian O’Brien et al., “A Clinical Trial of Active Hearing Protection for Orchestral Musicians,” Journal of Occupational and Environmental Hygiene 11 (July 1, 2014): 450–59, doi:10.1080/15459624.2013.875187.