Hearing health literacy among professional and amateur musicians

Table of Contents

Quantitative

Amateur and professional musicians both reported that hearing health was extremely important to them (98% of amateurs and 99% of professionals indicated at least a ‘rather true’ sentiment, as depicted in Fig. 1). Yet, professionals stated getting their hearing checked more regularly than amateurs (25% amateurs and 67% professionals, M_diff = − .88, W = 19358, p < .001, with a moderate effect size (r_rb = − .425)). Moreover, a significantly larger proportion of professionals acknowledge the necessity of wearing hearing protection as a safeguard against the loud sound levels prevalent in orchestras (90.2% compared to 41.2% amateurs replied with either ‘rather true’ or ‘true’, M_diff = -1.73, W = 17108, p < .001, r_rb = − 0.515). However, the adoption of hearing protection among musicians, particularly amateurs, remains low. Only 9.7% (33 out of 306) of amateurs and 58% (170 out of 292) of professionals reported utilizing hearing protection at all. Furthermore, among those who reported using hearing protection, the majority (76% of amateurs, 75% of professionals) admitted to not using it regularly during individual practice sessions. Hearing protection sees wider adoption during collaborative practices or concert performances, with 62% of professionals and 58% of amateurs acknowledging to utilize hearing protection ‘at least sometimes’.

Despite the widespread recognition of the importance of hearing health among musicians, a substantial majority of respondents, both among amateurs (84%) and professionals (69%), acknowledge that the topic is infrequently discussed within their community. Notably, while slightly more amateurs than professionals endorse this belief (M_diff = 0.38, W = 46506, p < .01, with a small effect size r_rb = 0.11), significantly more professionals express a desire for regular counseling on the subject of hearing health and hearing impairment (M_diff = − 0.56, W = 30820, p < .001, with a small effect size r_rb = − 0.2). This desire for guidance is prevalent in both groups, though, with 73% of amateurs and 89% of professionals indicating a preference for such support.

Professionals concede more frequently than amateurs that as musicians, there is not much one can do for mitigating hearing loss (29% of amateurs compared to 55% of professionals affirming a ‘rather true’ sentiment; M_diff = 0.57, W = 27096, p < .001, r_rb = − 0.23). Consequently, in total, 42% of respondents expressed some degree of resignation regarding their ability to influence their hearing health positively. Additionally, roughly a quarter of musicians exhibit reluctance to openly discuss any experienced hearing impairment among their colleagues (24% amateurs, 28% professional; M_diff = 0.05, W = 41616, p = .91, r_rb = 0).

General hearing status

Questions regarding their general hearing status were answered by 319 amateur and 282 professional musicians. A substantial portion of these respondents reported having had a formal hearing assessments: 96% of professionals (N_total = 282) and 69% of amateurs (N_total = 319) stated having had their hearing checked before and reported the results of their hearing assessment (see Table 1). On average, the last hearing assessment for amateurs was 5 years and 3 months ago (SD = 6.5 years; N_total = 204) whereas, for professional musicians, it was 3 years (SD = 4 years; N_total = 255). Most of the respondents reported normal hearing, while some report mild and moderate hearing impairments (see Table 1 for more details). The remaining musicians, i.e., those without prior hearing assessment, estimated their hearing abilities by rating them according to descriptions of typical daily situations involving their hearing, for instance, “Yes, I have the feeling of being severely hearing impaired (hearing loss of 61–80 dB): I can barely understand speech without hearing aids and use lip-reading/sign language to assist communication.” Whereas one professional musician reported a severe hearing impairment, most amateur and professional musicians reported normal hearing or mild hearing impairment. There was no significant difference between amateur and professionals regarding hearing loss (p = .41). Furthermore, 69 amateurs (N_total = 318) and 72 professionals (N_total = 276) reported problems with tinnitus.

Music-related hearing problems

In addition to general hearing issues, musicians frequently encountered various music-related hearing difficulties. A notable proportion experienced challenges in hearing other orchestra members (55.4% of professionals versus 65.5% of amateurs reported experiencing this ‘rarely’ or more often) or themselves (ranging from 44.9 to 51.7%) while performing (refer to Fig. 2). Moreover, perceiving differences in intonation or pitch presented issues for a significant portion of respondents (37.3% of professionals versus 55.6% of amateurs). Some participants also struggled with recognizing different instruments (27.1% of professionals versus 44% of amateurs). Interestingly, the least frequently reported problem was a perception of washed-out or blurred sound (31.1% for both professionals and amateurs). Notably, amateurs consistently reported a higher prevalence of music-related hearing issues compared to professionals. However, statistical significance was observed only for difficulties in perceiving intonation or pitch differences (M_diff = 0.25, W = 50952, p < .001, with a small effect size r_rb = 0.14), challenges in recognizing other instruments (M_diff = 0.22, W = 50828, p < .001, with a small effect size r_rb = 0.15), and hearing what other members are playing (M_diff = 0.11, W = 47052, p < .05, with a very small effect size r_rb = 0.07).

When examining the musician cohort categorized by instrument groups (considered irrespective of professional or amateur status), distinct variations emerged in the perceived importance of wearing hearing protection. Notably, when respondents were asked about the potential risk posed by orchestra sound levels to their hearing health, the majority of percussionists (72%), brass players (65%), but only half of the string players (50.5%) affirmed this concern. This pattern persisted when musicians were asked to evaluate the statement “The sound levels in the orchestra are so high at times, that I should wear hearing protection”. While only 57% of string players concurred with this statement (i.e., respond with “rather true” or higher), a higher proportion of brass players (70%) and percussionists (82%) acknowledged the necessity of protective measures (see Fig. 3). Upon applying Bonferroni correction for multiple comparisons, a significant difference was observed solely between string players and brass players (M_diff = 0.46, W = 18480, p = .04, r_rb = 0.11), while the difference between string players and percussionists was not statistically significant (M_diff = 0.89, W = 3474, p = .08, r_rb = 0.11). This outcome may be attributed to the conservative nature of the statistical test, which accounts for the relatively small sample size and the inherent variability among percussionists. Regarding actual hearing protection usage, string players (26.3%, 85 out of 323) and brass players (29.8%, 31 out of 104) reported rather similar rates of occasional use. Percussionists demonstrated the highest usage at 64.7% (11 out of 17). Interestingly, among those employing hearing protection, 57% of brass players and 62.4% of string players never used them during solo practice, in contrast to consistent use reported by all percussionists.

Qualitative

In the qualitative analysis, all responses to open questions were considered no matter whether the participant was included in the quantitative analyses or not. The open responses of professional as well as amateur musicians showed that positive experiences with hearing protection were relatively rare (44 of 621 participants; 7%). Specifically, respondents stated that adjustments to the hearing protection could take some time, but once they were used to it, they embrace it. Avoidance of hearing issues and experiencing greater relaxation were mentioned as important reasons. Some of them also reported wearing the protection in certain situations only.

“Works well. Put it on for loud passages and take it off again for quiet ones.” (professional, male, 50–59 years old, trumpet, no. 1174).

“Whenever I wear hearing protection, I am much more relaxed and less stressed after rehearsals compared to no hearing protection.” (professional, female, 30–39 years old, 2nd violin, no. 1229).

However, the majority of respondents commented on hearing protection more negatively (692 of 2454 responses, 28%). Respondents claimed that wearing hearing protection could impair their performance, that they hear themselves differently, and cannot adjust their volume, intonation and sound to others.

“as if you were driving at a high speed through thick fog“ (professional, male, 50–59 years old, viola, no. 1513).

An additional issue concerns the intelligibility of speech either among musicians or the conductor.

“Additionally, I’m afraid that I won’t be able to hear the verbal instructions of the conductor and the conversations with colleagues.” (amateur, female, < 30 years old, 1st violin, no. 4382).

Furthermore, some of the respondents report that they use hearing protection even though it appears to be uncomfortable, impractical, and does not adapt to loud and quiet passages. Wind players can feel a heightened perceived inner pressure in the head in addition to sounds that originate from their playing (lips, tongue) which, so they claim, prevents them from using hearing protection.

“The inner pressure when blowing into the oboe is very intense, so that hearing protection is impedimental.” (professional, male, 60–69 years old, oboe, no. 1467).

“It’s uncomfortable to wear for long periods of time.” (professional, female, 30–39 years old, horn, no. 1500, original in English)

“The vibrations of the lips when producing each tone on the trombone cause strong additional sounds when using hearing protection.” (professional, male, 50–59 years old, trombone, no. 1090).

As opposed to many of the professional musicians, who feel that hearing protection is necessary but it impairs their performance or is uncomfortable, a number of amateur musicians stated that hearing protection is not necessary in an amateur orchestra, because high sound pressure levels are seldomly reached in their ensemble. This is also reflected in the category “no knowledge/experiences with hearing protection” as one of the reasons why participants did not use hearing protection. This category contained answers from 57 respondents, most of which (56) were amateur orchestra musicians. They claim that they had not thought about the topic of hearing protection before and/or were not aware that it might be important to use hearing protection in the orchestra. Interestingly, some of them write that nobody else has provided any information on this topic which is why they were unaware of it.

“Never thought about it.” (amateur, female, 30–39 years old, 2nd violin, no. 4788).

“Was never offered hearing protection; professional hearing protection if often very expensive.” (amateur, male, < 30 years old, bassoon, no. 5183).

Thus, these observations suggest that some amateur musicians tend to hold other people responsible for their hearing health, blaming them for not receiving enough information about the issue. In some cases, professional musicians behave similarly in shifting the responsibility towards medical professionals, the orchestra management or acousticians, all of whom do not seem to be able to help or understand the difficulties or specific requirements musicians face or need. They claim that their employer either does not provide any appropriate hearing protection or does not listen to complaints regarding that topic. Some of the professional musicians would have wanted to be informed about this topic, possibly already during their studies, and do not feel supported and heard which leads to frustration especially in combination with already existing hearing difficulties.

“Unfortunately, I was not informed about hearing protection at work on time. I had 3 instances of acute hearing loss and now my right ear is deaf …” (professional, female, 60–69 years old, 2nd violin, no. 4558).

“I feel left alone and misunderstood regarding this issue.” (professional, female, 50–59 years old, bassoon, no. 1460).

While many of the professional musicians struggle to get their employers to acknowledge hearing difficulties as more than an individual issue, the topic is also controversially discussed among colleagues. One musician states that there is “slow progress, but even young trumpet players seldomly understand the exposure [to high sound pressure] of the colleagues in front of them” (professional, male, 50–59 years old, viola, no. 1513). Several of the musicians (34) even explain that the topic of hearing health is still stigmatized in orchestras: people wearing hearing aids are seen as “inferior” (professional, male, 40–49 years old, bass, no. 1866), “weak, should not play in an orchestra, should resign” (professional, female, 50–59 years old, bassoon, no. 2139), they are less respected (professional, female, 40–49 years old, horn, no. 2255) and wearing hearing aids can be understood as “disregard of the musical achievement of colleagues” (professional, male, 30–39 years old, horn, no. 1120). One example of this stigmatization can be found in the following words of a professional musician: “Orchestral music is played and felt. A loud passage is different in character from a quiet one. This is intended by good composers. If someone has an issue with this, they should, during their training, have thought about getting a desk job instead.” (male, 60–69 years old, horn, no. 2331). However, it should be noted that this statement demonstrates one of the most extreme attitudes captured in the present dataset. Other responses reflect the perspective of someone who either wears hearing protection and feels judged by their colleagues or would like to have an open discussion on this topic among colleagues and feel that this is not possible. Only 5 respondents state that stigmatization is not an issue in their ensemble, and that hearing health is important for their peer group of colleagues.

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