Tinnitus, ear plugs and hearing loss — how can musicians protect their hearing?

Fiona Butterworth is a Clinical Lead at Harley Street Hearing, a leading hearing clinic based in Central London. 

She answered a few of our questions about a range of important issues, from tinnitus and ear plugs to how musicians can protect their hearing with discounted audiological assessments and custom-made hearing protection.

Together Help Musicians and the Musicians’ Hearing Services offer musicians access to hearing assessments and custom made ear plugs for £50. This scheme is carried out by audiological experts like Fiona, and includes an assessment, education and best advice on protecting your hearing. 

You can apply for a hearing assessment here, which also outlines the eligibility criteria.

What is tinnitus and what causes it?

Tinnitus is the sensation of hearing a sound in the absence of any external sound. 

It can be in one or both ears, feel like it comes from the head or ear, or can even be hard to pinpoint the exact location. The duration of it can vary, with some people noticing it only occasionally, whereas others hear it constantly.

It is most common in those who have a hearing loss or other ear problems, but can also occur when there are no other issues.

What are the first signs of tinnitus?

Noticing sounds such as ringing, buzzing or hissing are generally typical of tinnitus, but if you start to notice a sound that you cannot link to an external sound, then this could be a form of tinnitus.

Is there a cure?

There are ways to manage tinnitus to reduce the impact it has on your day-to-day life. These can be explored using hearing therapy, and can include things such as meditation, cognitive behavioural therapy (CBT) and mindfulness, as well as using other techniques to manage factors that can increase tinnitus such as stress and anxiety. In some cases, hearing aids are used to help manage the co-existing hearing loss, or sound generators are used to mask the tinnitus sounds.

Can tinnitus cause hearing loss or deafness?

Tinnitus does not cause hearing loss, but can co-exist and often may be experienced because of hearing loss.

Can you get used to tinnitus after a while or is it always an annoyance?

With management techniques and time, many people can grow accustomed to their tinnitus. This means that it would still be present, but the awareness of the tinnitus and emotional response is significantly reduced to the point that it does not have a negative impact on your day-to-day.

In some cases, tinnitus can also be related to a temporary threshold shift following noise exposure to unsafe levels of sounds. When this has happened, the tinnitus can be temporary and will usually resolve within the following 48 hours, but this is your warning sign that the environment you were in has the potential to permanently damage your hearing if you don’t use hearing protection or manage the noise levels appropriately.

How can I prevent tinnitus?

1. Manage your exposure to noise to ensure you are not reaching unsafe levels.
2. Remove yourself from situations that have unsafe and uncomfortable levels of noise where possible.
3. Reduce the volume of your equipment, or use hearing protection such as those available from Help Musicians and the Musicians’ Hearing Services, and perhaps consider using IEMs instead of on-stage monitoring equipment so that you can reduce the level of ambient sound.
4. Keep track of your hearing with regular hearing tests.

It is important to note that sometimes tinnitus can be present and not be linked to the level of noise exposure that someone has had. 

Use management techniques such as mindfulness and meditation to manage stress and anxiety that can negatively impact your tinnitus.

Why are ear plugs important for preventing hearing damage?

Ear plugs help to reduce the overall level of sound entering the ear canal. They are important as they can reduce the sound level for the user while allowing the environment to stay the same. As noise exposure is cumulative, ear plugs help each individual to personally manage their own noise exposure in all environments.

Where and when should musicians wear ear plugs?

What we recommend is that when musicians are playing, rehearsing or performing, the ear plugs should be in. 

With amplified music the volume level will be borderline unsafe for an extended amount of time. For orchestral musicians it can depend on duration and the situation.

It’s not just the volume levels but the duration, and the duration is cumulative. It’s not like at midnight everything resets for the next day. 

Musicians have to take into account not just their musical exposure but what happens over the week. Day-to-day sounds, like being on a tube for example, can have an effect on a musician’s exposure.

Why are custom-made ear plugs better than off-the-shelf ones?

Everyone has experienced the foam plug ones, the kind they give out in bars and clubs. They aren’t designed for musicians; they’re designed for industrial noise. They cut out as much as they can to make sure the person operating machinery is safe.

Then you have the off-the-shelf ones, which are shaped kind of like a Christmas tree. They were created with musicians in mind. They create a flatter response across frequencies, resulting in a more natural and positive experience for the musicians who use them. With off the shelf plugs, you notice you’re more protected and more comfortable compared to foam ones but sometimes it can feel like the treble has been cut out more than you would like.

The problem however, is that one size doesn’t fit all, they can move around and let more natural sound through. The best for hearing protection is custom-made musicians’ plugs, which create an efficient seal in the ear, so that all sound is diverted via the dedicated filters. The filters have been designed to be as flat across frequencies as possible so musicians experience reduced volume rather than alterations to bass, mid and treble. 

Off-the-shelf hearing protection is a good temporary solution, but more often than not people want to take them out. With custom-made you don’t even need to take them out to have a conversation with the person next to you. They’re so much more effective and comfortable.

What services are available to musicians to help protect their hearing?

The Musicians’ Hearing Services and Help Musicians work together to offer all professional musicians in the UK affordable access to specialist hearing assessments and hearing protection.

If you qualify you will receive an audiological assessment, education and best advice on protecting your hearing as effectively as possible, by people that understand musicians, and a set of custom ear plugs, all for £50.

Musicians can put their application in and someone from our team will see if they are eligible or not.

If you aren’t eligible you will still receive info around the plugs but you will be paying standard price rather than having it discounted through the charity.

What is the process for ordering a pair of custom ear plugs?

Visit our hearing protection page to find out about eligibility and apply.

Aside from tinnitus, what are the other most common hearing issues that you deal with on a daily basis?

Hearing loss, wax, hyperacusis, and diplacusis. 

What are the first signs of hearing damage?

Hearing damage can present in a number of ways; a sense of muffled hearing, the presence of tinnitus, and difficulty hearing clearly. We would recommend seeking help as soon as you notice a change in your hearing.

Do you have any other advice for musicians about preventing hearing damage or what to do if they know they’ve already damaged something? 

The most important thing is to have regular hearing tests. Every one to two years you should have a test. Even if you have no concerns, it is important to keep track and know how your hearing is so you can make comparisons if a problem develops, especially if you are a musician and your job involves exposure to loud sounds on a daily basis. 

In terms of your general wellbeing, remember that your ears need time to rest. In the same way you wouldn’t go the gym and do the same exercises 7 days straight, you also need time away from musical environments.

If there is a problem, don’t wait and don’t assume it will get better on its own. Obviously we hope that it is not anything serious, but if it is you are in a much better position if you take action quickly and speak to an expert, whether that’s a GP or an audiologist.