Aural Diversity

People hear differently.

Even people with ‘normal’ hearing (defined as the hearing of a typical 18-25 year old) start to hear differently as age brings a decline in the hearing mechanism. This natural process varies from person to person and goes under the medical name of presbyacusis. Other forms of hearing loss, such as hyperacusis (extreme sensitivity to normal sounds), diplacusis (hearing two pitches in place of one), noise-induced, genetic, perinatal, viral, etc. also negatively affect people’s hearing in different ways. Tinnitus introduces a layer of unwanted sound that masks what you are trying to hear. And this is to say nothing of deafness!

Yet the music industry assumes that people hear normally. Stereo presupposes two equally balanced ears that hear a full frequency range. 5.1 surround sound is best when the listener is seated in a ‘sweet spot’ that, once again, assumes two normally working ears. Live music is no different, with the sound almost always mixed into the physical space on the assumption of a normally hearing listener. For musicians, it is even worse, because the musician’s ear is widely assumed to be in some way better than that of a non-musician. It should be able to discriminate, to hear subtle variations in tuning, rhythm, timbre, etc. in ways which an untrained ear cannot emulate.

Many musicians suffer some kind of hearing loss, other than the normal presbyacusis, that affects their ability to function professionally. All too often, this is kept secret to avoid adverse consequences for their career. Yet aural diversity need not be a disability.

We need a change in attitude that places the listener in control of the musical experience and a new kind of music that can adjust to accommodate the aural diversity of its audience.

Rather than being held to the arbitrary standard set by BS ISO 226:2003 (otologically normal hearing), would it not be better to tailor music to the actual hearing limitations of its audience? It is true that EQ and balance controls allow people to adjust their experience, but the music itself is not conceived for these controls. If I boost the right channel and increase the lower frequencies to help my hearing, I am in fact distorting the music itself, which was not intended to be heard this way.

Andrew Hugill

Balance Disorders

The human body, rather inconveniently, situates the mechanisms of hearing and balance within the same chamber of the inner ear. It is not surprising, therefore, to discover that many people with hearing loss also have balance disorders. Indeed, inner ear problems are the principal cause of balance disorders. These have a wide reach: 1 in 3 of the population under 65 will have a balance disorder at some time in their lives. Everybody knows someone who has had some kind of balance disorder.

Balance disorders are often both unclear and difficult to diagnose. The field has suffered from a fragmented nomenclature and conflicting medical opinions, resulting from a general uncertainty and even confusion about both symptoms and causes. Terms such as: dizzy, light-headed, floating, woozy, giddy, off-balance, feeling faint, helpless, or fuzzy, are used loosely and interchangeably, consolidating the impression that this is a vague collection of ailments. The more accurate medical terms – vertigo, dysequilibrium and presyncope – are poorly understood by the general public. While no balance disorder is in itself life-threatening, the consequences on health and well-being can be profound. Whether symptoms of some other underlying problem, or recognised conditions in their own right, balance disorders are having a major effect on the health and wellbeing of people, and consequently a negative socio-economic impact. For that reason alone, they deserve to be better understood and more comprehensively researched.

For that reason, I have developed with Professor Peter Rea, a consultant otolaryngologist and surgeon, a Balance Disorder Spectrum. The idea is to show people the full range of balance disorders and give additional information in an interactive website that is visually appealing. This will be launched to general public during Balance Awareness Week (September 16th – 22nd). A further development will be to create an AI tool for the diagnosis of balance disorders.



With the support of GNResound, a hearing aid manufacturers, I will be conducting a series of interviews with musicians with hearing loss and musicians with Ménière’s Disease with the aim of deepening understanding of musicians’ needs and improving both audiology and hearing aid design. I will also be organising a series of musical events to celebrate and investigate aural diversity. Readers with an interest in being involved in either of these are invited to contact me via email at

My own composition has been profoundly affected by the changes to my hearing and balance. I have been building a diplacusis piano which reproduces the irregular variations in pitch that I hear between my left and right ears. I have also been modelling my tinnitus in Max/MSP. The idea of composing music that enables people to hear what I hear is, I believe, quite new. The challenge facing me as an artist is to make something beautiful out of what are generally distressing and challenging phenomena.

By Andrew Hugill 

Andrew Hugill is a Professor of Music, a composer and musicologist. In 2009, he was diagnosed with Ménière’s Disease, which he has previously written about.

Ménière’s Disease combines four symptoms: vertigo, hearing loss, tinnitus, aural fullness. Andrew has severe hearing loss in his right ear and mild in his left, constantly fluctuating tinnitus, and still suffers from some dizziness, although this has been considerably reduced by a course of gentamicin injections delivered in 2011. Gentamicin works by destroying the balance function.

He has recently created the Balance Disorder Spectrum that provides, for the first time, a summary of the existing knowledge of balance disorders in one interactive website. This will be launched to the public during Balance Awareness Week, 2018.

In this article, Andrew discusses the consequences of all this for his music and how his research is aiming to change things for people with balance disorders and hearing loss.