Hearing healthcare in the music industry: results from the MusiCares and Tuned partnership survey

Music is one of the few routinely-experienced sounds present well-attended environments at hazardous listening levels. As such, music listening has potential to affect hearing sensitivity for individuals both occupationally and recreationally. MusiCares, in collaboration with the Tuned organization, supports access to hearing health services, financial assistance, and basic human services for members of the music community. This study evaluated responses from self-identified at-risk or injured individuals seeking assistance from MusiCares and Tuned on an in-house health-related survey. Starting in August, 2022 the MusiCares/Tuned survey was available for individuals from the music industry; responses included in the current analysis considered those surveys received by July, 2025. The survey includes a wide range of health-related questions, however only those items related to hearing, such as for example the use of hearing protection, self-assessments of hearing status, and presence of auditory disorders such as tinnitus were considered herein. Surveys were de-identified and descriptive statistics were employed for analysis of participant responses. The survey appears in Supplemental Materials. 1,138 participants accessed the survey. Most hearing-related questions garnered responses from the entire group, although a few participants indicated that some questions were not relevant for their specific case. Findings of note included nearly a 70% prevalence rate among the participants for tinnitus, while 24 % reported loudness tolerance issues. Forty-one percent indicated difficulties understanding speech in noise and/or quiet either as a standalone problem or in combination with other hearing issues. Although 59% of participants indicated careers in music of greater than 20 years, 53% of participants indicated using hearing protection for fewer than 10 years, even as 57% of respondents indicated having experienced acoustic trauma. Individuals in the music industry have the potential, routinely, to experience exposures at hazardous occupational and recreational sound levels. Issues regarding hearing healthcare for music listeners is complicated by job requirements as well as by the thrill experienced and reported upon by music enthusiasts who consume music at levels that most people would consider loud. Audiologists and hearing healthcare specialists must improve consumers' understanding of music's unique capability to damage the organ necessary for its enjoyment.

Hearing loss is the most prevalent sensory disorder in the world, affecting people across age, sex, ethnicity, and occupation. According to the World Health Organization (World Health Organization, 2025), more than 20% of the world's population live with hearing loss, and at least 5% of the world's population—nearly 400 million people—require rehabilitative services in order to address and manage the effects of reduced hearing. Further, a variety of hearing-related disorders, such as tinnitus and disorders of sound tolerance, often co-occur with loss of hearing sensitivity. While the WHO expresses the consequences of hearing loss in terms of economic impact and barriers to access, it is also reasonable to couch the WHO's discussion of “unacceptable rates of hearing loss” in personal terms by investigating the influence of hearing difficulties on specific patient populations. Here, we consider the effects of hearing disorders on musicians and other music-exposed individuals who completed an online survey developed by the second author, Dr. Heather Malyuk, Head of Audiology for Tuned, for their partnership with MusiCares, a non-profit established by the National Academy of Recording Arts and Sciences.

Questioning musicians and others in the music industry regarding their hearing is rarely a straightforward endeavor. A recent scoping review (Firle and Richter, 2025) acknowledged as much, indicating that a “definitive assessment” of music-related hearing loss could not be drawn from the 79 accessed studies that comprised the review. Most of the study participants included in the review were “young, male musicians with little exposure time” while women and retired musicians were underreported. Many workers (not to mention audience members) who listen to music routinely have decades-long careers of being consciously and oftentimes deliberately overexposed to amplified sound (e.g., Santucci et al., 2020).

The listening demands of musicians and related professionals are arguably among the most demanding of any occupation. Motivation to exert effortful listening, and conforming to the related demands on hearing, are likely the highest among this population within the entertainment industry. As a result, the surveyed individuals' responses may be colored not only by their instrument or their exposure times, but also by the confidence they have in their presentation and performance to others throughout activities in their professional sphere. Does a survey respondent worry that others lack confidence in their hearing, and by extension, their value to the music's creation and presentation? Or does a respondent know and accept that changes over time to their hearing precludes performing at past levels of competence/excellence (as suggested by Wartinger et al., 2024)? In either case, the respondent is being asked to provide information about not only a vocational experience, but a vocational experience centered on the creation of sounds that are arguably among the most important and personal events in that person's life emotionally and financially. The creation and presentation of music may be thought of by the creators as simultaneously deeply personal yet with an impetus to being shared, often as widely as possible.

The degree to which music is enjoyed may for some people be proportional, within the dynamic range, to the music's perceived loudness. Fucci et al. (1993) compared loudness of preferred or disliked passages of music among listeners using magnitude estimation. Listeners rated as equally loud the preferred music passages at levels up to 10 dB higher than the disliked passages; personal preference exerted a considerable influence on loudness perception. Such findings raise the likelihood that exposure to favored music could be simultaneously enjoyable and hazardous.

The 2020 American Academy of Audiology Clinical Consensus Document Audiological Services for Musicians and Music Industry Personnel (Santucci et al., 2020) identified sound levels that damage the auditory mechanism associated with music as producing music-induced hearing disorders (MIHD). The authors indicated such disorders included, in addition to puretone threshold loss, tinnitus, distortion, hyperacusis, diplacusis, and dysacusis (considered here a form of distortion); all of these MIHD forms were considered on the MusiCares/Tuned survey. Echoing Fucci et al.'s (1993) findings, Santucci et al. (2020) refute, “the misconception that desired and enjoyable music sounds are less dangerous than unwanted or obtrusive noise sounds.” Musicians and other music-exposed individuals therefore comprise a population exposed to risk factors that may be as diverse as individuals' musical tastes.

A meta-analysis of musician reports was offered by Di Stadio et al. (2018) and indicated rates of hearing problems reported by musicians across different music types (i e., classical, pop) and instruments. The investigators reviewed 42 studies with a total subject pool of 4,618. More than 75% of the musicians sampled in the studies reportedly performed classical music, while 973/4,618 (21%) reported performing pop/rock music. Studies revealed that less than 5% of all participants had hearing loss below 2,000 Hz, while most puretone threshold loss occurred at 3,000 Hz and higher for both musician groups. Rates of hearing loss were substantially higher among the pop/rock musicians (63.5% vs. 32.8%). Asymmetric hearing loss was not explicitly defined across studies, however rates reported were 32% for pop/rock musicians and 46% for classical musicians, and asymmetric loss was associated with instrument type and the likelihood of single sided exposures, such as experienced by a violin player whose left ear would be more exposed than the right ear. Rates of tinnitus for the two groups were nearly identical (26% for pop/rock, 27% for classical) while the pop/rock group had higher rates of loudness tolerance issues (27 vs. 19%).

In a more recent scoping review, Firle and Richter (2025) indicated that the effects of music on listeners could not clearly be identified from 79 reviewed studies. Puretone sensitivity was not consistently reported across studies, nor could firm statements be provided regarding the auditory effects associated with type of music nor instrument played. The authors reported upon studies of different music types (i.e., classical, pop/rock, jazz) as well as military and marching band participants; years playing musical styles varied considerably across studies, as did the possibility that individuals played different styles over time. When hearing loss was present, the findings suggested notched losses were present in 5–70% of study participants across 35 classical music studies, while 20–60% of jazz and rock musicians demonstrated notched or high-frequency thresholds outside the normal range. Most of the studies reviewed centered on classical musicians, and the data extracted related to hearing thresholds with little mention of tinnitus, sound tolerance disorders, or other audiologic findings. The disparate findings across studies from both Di Stadio et al. (2018) and Firle and Richter (2025) affirm that exposures to music are idiosyncratic, highly individual, and as a result preclude firm statements regarding something even as straightforward as music's effect on puretone sensitivity.

McCray et al. (2026) provided an analysis of findings from 67 studies (n = 28,311 participants) that reported upon hearing status among recreational and professional musicians. Studies that compared music-exposed individuals to non-exposed individuals revealed higher rates of hearing loss, tinnitus, and hyperacusis among those exposed in music-related environments. The authors indicated no substantial differences in rates of hearing loss, tinnitus, and hyperacusis among pop/rock musicians vs. classical music categories; genre of music had no effect on the reports of hearing. Across the 67 studies, rates of tinnitus and hyperacusis were 46.2% and 37.3%, respectively, while hearing loss was documented in 25.7% of exposed individuals compared to rates of 13.2% for tinnitus, 11.6% for hearing loss, and 15.3% for hyperacusis among the unexposed groups. Rates of hearing protection use appeared in some studies to be higher relative to previously-reported rates (66.5% in 2018 to 77.5% in 2021 as reported by Couth et al., 2022). The authors asserted that the population's hearing health care needs would benefit from routine assessments and preventive counseling that in theory could be reasonably implemented.

The MusiCares/Tuned survey sampled a variety of occupational and recreational elements related to music performing and listening. Participants self-selected, and it is likely that the majority of participants were aware to some degree that they have hearing difficulties, hence their exploration of MusiCares enrollment and services; their subsequent survey responses are reported herein. MusiCares offers enrollees access and healthcare options with consideration of challenges related to the occupational barriers associated with the entertainment industry. Such barriers may include lack of insurance or health-related savings, difficult, and often non-negotiable schedules, as well as challenges related to sleep, diet, physical and emotional stress. As such, the survey may be considered an element of an affected individual's help-seeking behavior as it provides a snapshot of their work, their exposures, and their understanding of the relation between their occupation and the effects of the occupation on hearing.

Expectations for workers in the music industry include demands on listening effort and motivation to listen effortfully, with few parallels in other professions. In addition to singers and players, sound engineers, including those whose work is focused upon the mixing of sound used by performers to monitor their own performance, must comply with artist-specific needs and requests (AAA, 2020). Doing so often requires that they manage sound production and converse in some of the most adverse occupational listening environments. With regard to listening effort, one can imagine a participant's motivation to excel as an arbiter of the sound experience to be shared by performer and audience (Pichora-Fuller et al., 2016). The ubiquity of hazardous exposures likely challenges affected individuals recreationally as well as occupationally.

A substantial portion of individuals in the music industry are not legally required to wear any form of hearing protection devices (HPDs); use of HPDs is therefore voluntary for most music workers (AAA, 2020). HPDs, even when designed for music appreciation, modify the acoustics of the open ear canal, thereby altering outer ear resonance and frequency response to which the music industry professional is calibrated (i.e., Chesky et al., 2009; Killion and DeVilbiss, 1988). Therefore, interest in and uses of HPDs remain limited in the music industry. For a music industry professional, being confident while creating an intended “product” (i.e., music) is often prioritized above hearing safety (Wartinger et al., 2024). Although earplugs are often the first thing a music industry professional tries in the world of hearing conservation, lack of education regarding HPDs, such as which models are most suitable for music appreciation, how to obtain custom, filtered HPDs from specialized audiologists, and myriad other considerations often lead to disappointing outcomes for the professionals who with the best intentions try to protect their hearing.

In-ear monitors (IEMs) are earphones used by those who prefer not to use stage (also known as “wedge”) monitors. Other crew members and engineers use IEMs to support communication and other work-related tasks. Health-related marketing is not regulated in the music industry, and it appears many artists and crews turn to in-ear monitors (IEMs) as a means of protection, at least in part because manufacturers market them as such. However, IEMs in and of themselves are not protective devices but rather potentially dangerous to hearing. Federman and Ricketts (2008) studied the use of IEMs by music industry professionals and found that participants turned the IEM volume to nearly the same intensity as stage monitors, thereby reaching hazardously high sound levels on stage. Without highly specialized fitting and counseling regarding the use of IEMs, wearers are at unknown risk of developing hearing loss and MIHD even as they may believe they are protecting their hearing (i.e., Meibos and Malyuk, 2022).

The MusiCares survey allowed music-exposed individuals to report upon their roles in the industry, instruments played, reports of overexposures, use of HPDs, and perceptions regarding hearing status and exposure levels. Participant responses were compared to results from other studies that posed similar, although not identical questions. Unlike reviews of a large set of studies in which different assessment instruments were employed, the current study sampled responses to specific questions among a large group of participants. Differences and similarities between the MusiCares sample and the dozens of other groups reported upon are summarized below.

The survey was administered on the Tuned platform to those who registered through MusiCares for teleaudiology services. MusiCares (i.e., Musicares.org) is an independent 501(c)(3) charity whose mission focuses on helping, “the humans behind music” in all of music's forms, and as practiced by musicians, engineers, road crews, and any other exposed individuals. Starting in September, 2022, MusiCares partnered with Tuned to provide teleaudiology services, including the survey considered herein intended as a triage/intake opportunity to support provision of services for individuals whose livelihoods centered on the creation and delivery of music. The survey focused on exposure time in terms of career (i.e., in years) as well as in routine exposures (i.e., weekly) both occupationally and recreationally with respect to instrument types and work assignments (i.e., performer, engineer, road crew, etc.). The survey was not validated, nor were individuals recruited to complete it. Participants self-selected, and many of the questions were originally formulated in the AAA, 2020 guideline document (Santucci et al., 2020). As such, the survey provided an opportunity for members of the music industry to report on their work, their work environments, perceptions of sound levels to which they were exposed, as well as their use of hearing protection devices. Participants who completed the survey also reported on their experiences with tinnitus, speech recognition, and sound tolerance issues related to loudness discomfort and pitch disparities (i.e., diplacusis).

Between 2022 and 2025, 1138 individuals completed the survey, although not all participants answered all questions. An additional complication must be mentioned; after the first 915 respondents completed the survey, question #6 (days/week of exposure) was modified so that it was no longer a text response (i.e., participants needed to identify a specific time frame such as 1–2 or 5–7 days). No exclusionary criteria were employed, participants provided electronic affirmation of their willingness to complete the survey. Approval for the analysis of de-identified data was provided by East Tennessee State University's Institutional Review Board.

The de-identified data received for analysis contained neither sex nor age information for the participants. Responses to survey questions were coded and descriptive statistics obtained on most survey items. These data should be considered a record of responses from 1,138 individuals whose health concerns, and for whom the opportunity to enroll for health-related services, compelled them to seek out Tuned MusiCares, and to complete the associated survey. As such, the results reported herein should be interpreted within the context of a general health survey provided to a self-selected population at-risk for hearing disorders. At the same time, many members of this at-risk population may believe that their interests are best served by keeping their hearing-related problems to themselves (i.e., Wartinger et al., 2024). Therefore, the responses of those individuals who elected to complete the survey may represent most reasonably the subset of the general population of musicians, engineers, and other music-exposed individuals who seek help for health issues.

Study population and reported exposures

Table 1 summarizes information regarding participant roles in the music industry. Roles were specified by survey options including, “performer, crew, engineer, teacher, and producer.” Performers accounted for 780/1,138 (68.5%) of the sample, 293 (25.7%) indicated crew, 230 (20.2%) identified as engineers, 160 (14.1%) as producers, while teachers accounted for 51 of the participants (4.5%). Specific information regarding roles was not available, therefore the expected exposure differences between “engineer” and “producer” or “crew” cannot be ascertained, however elements of exposures related to time in the profession and hours/day in the presence of music were included and are discussed below. Fourteen participants did not specify an answer; as is clear from the number of responses, many of the individuals sampled filled multiple occupational positions. More than half the participants identified as performers who played several different instruments, instrument types, and/or were vocalists.

When responding to questions regarding instruments played, the categories from which to choose on the survey included “vocals, percussion, strings, keyboards, wind, electronic.” More than half the respondents indicated playing more than one of the instrument types and/or singing. Stringed instruments comprised the largest proportion with 603/1,138 (53.0%) respondents followed by vocals reported by 534 (47%), keyboards reported by 342 (30.1%) and percussion with 251 (21.9%) of the participants. Thirty four of respondents (3.0%) indicated that their exposures were due to factors other than playing an instrument. Participants were not constrained with regard to the number or type of instruments or musical settings selected. In all, 948/1,138 (83.3%) participants indicated touring (i.e., live music in front of an audience), with a small fraction (9/1,138; < 1%) indicating studio work in addition to touring. Other respondents (98/1,138; 8.6%) indicated engineering or production, both of which are jobs associated with touring and/or studio work. The remaining 83 respondents indicated performing office work, promotion, or other tasks completed either in an office, or from their homes.

Nearly 80% of survey respondents indicated music-related occupational exposures for more than 10 years with 231/1,138 (20.3%) reporting 10–20 years of work, and 672/1,138 (59.1%) exceeding 20 years, while 124 (10.9%) reported exposures of 10 years or less. 121 (10.6%) indicated working in locations or in jobs with minimal exposures (i.e., artist management). Music-related exposures reported by participants occurred 5–7 days/week for 385/1,138 (33.8%) of the respondents, 2–4 days/week for 580 (51.0%), and 0–1 day/week for 144 (12.7%). No responses were recorded from 29 individuals. With regard to hours exposed, on those days indicated as exposure days, 182/1,138 (16.0%) reported 1–2 h/day, 571 (50.2%) indicated 2–4 h/day, 228 (20.0%) indicated 5–7 h/day, 78 (6.9%) participants reported 8+ h/day, while 79 individuals (6.9%) did not provide a response.

Exposure outcome

Table 2 provides a comparison between the group of participants reporting tinnitus (68.4% of the total) to those without tinnitus across several survey items that are summarized below. Few participants routinely accessed audiologic services. Of 1,138 respondents, 787 (69.2%) indicated they “never” have their hearing assessed by an audiologist while 307 (27.0%) reported occasionally seeking audiologic services. Only 43 (3.8%) indicated annual audiologic care. When asked about their own hearing, 95 (8.5%) indicated above average, while 761 (68.4%) reported average, and 215 (19.3%) below average. An additional 42 respondents (3.8%) indicated that they were unsure regarding their hearing status at the time they completed the survey. Bonferroni adjustment was applied to the items in Table 2, confirming significant differences associated with tinnitus reports regarding acoustic trauma, self-perceived hearing loss, hyperacusis, and difficulty understanding speech in noise.

In addition to the questions regarding their perceptions of their own hearing, participants were given the opportunity to report hearing-related difficulties including tinnitus, hyperacusis, speech-in-noise difficulties, speech-in-quiet difficulties, and dysacusis/diplacusis. Answers could include one or more of the conditions. Of the 1,138 participants, 167 (14.7%) did not report any of the hearing difficulties listed above; on Table 2, these individuals are included in the non-tinnitus columns. For those individuals specifying only one condition (N=361), 253 (70.1%) reported tinnitus; 62 (17.2%) indicated speech-in-noise problems, 34 (9.4%) indicated hyperacusis, 9 (2.5%) reported dysacusis/diplacusis, and 3 (0.9%) reported speech-in-quiet difficulties. By a similar wide margin, tinnitus was reported most often in combination with other conditions. Of the 610 participants reporting multiple audiologic problems, 526 (86.2%) included tinnitus; therefore, tinnitus was reported by 779/1,138 (68.5%) of the study participants. Speech-in-noise difficulties were reported in combination with other conditions in 376 (61.6%) of respondents; hyperacusis was reported in combination with other conditions by 348 (57.0%) of respondents. The total number of co-occurring tinnitus and hyperacusis reports was 297 (48.7%) of respondents with more than one stated problem. Table 2 contains comparisons across patients with or without tinnitus, of the different hearing problems.

Tinnitus prevalence exceeded that of all other audiologic reports from the current study group, as well as the prevalence reported by Di Stadio et al. (2018). Tinnitus also co-occurred with other problems (i.e., loudness intolerance, speech recognition in quiet and in noise, dysacusis) more commonly than any other auditory condition. Tinnitus was the most-commonly reported auditory problem echoed the findings offered by Santucci et al., (2020) in the consensus document. The notion that participants in prior studies and reviews may have experienced tinnitus in the presence of puretone thresholds in the normal range should serve as a reminder that the emergence and intrusiveness of tinnitus is not contingent upon documented puretone sensitivity loss.

Participants were asked about exposures to potentially hazardous levels of occupational and recreational music levels. With regard to occupational overexposures, 642/1,138 (56.4%) indicated they had at least once “experienced acoustic trauma (e.g., very loud feedback).” The number of instances of overexposure produced by sound than other than feedback was not questioned, hence the true number and extent of such exposures cannot be determined from the data provided. When traumatic overexposure was compared to hearing protection use, it was clear that individuals with exposure histories were more likely to report using hearing protection than those without such exposures, although the group differences were not substantial (Figure 1). Between 56–59% of respondents who indicated a traumatic exposures reported wearing hearing protection at least 25% of the time while less than half the participants without exposures used hearing protection at least 25% of the time. General occupational exposures (i.e., not necessarily hazardous sound levels) were reported on 1,132 surveys, and indicated as bilateral in 884/1,132 (78.1%) of participants, with 138 (12.2%) indicating the left ear was exposed most often, and 110 (9.7%) indicating the right ear. No information was provided regarding the number or frequency of such exposures.

Respondents offered their perceptions regarding the loudness of their music playing/producing vs. perceived loudness of the work environment. All but 19 participants answered the question regarding environment, and 61 did not respond to the question regarding their own playing. From 1,119 responses, 586 (52.4%) indicated that the work environment was “just right” while 507 (45.3%) reported it was “too loud.” The balance of 26 respondents stated the work environment was “not loud enough.” When compared to the respondents reporting on the loudness of their own playing, 826/1,077 (76.7%) indicated just right, while 169 (16.0%) stated their own playing was “too loud” and 63 (5.8%) Note that it was more likely that a respondent indicated that their own playing was “just right” or “not loud enough” when compared to the loudness of the work environment. The difference may relate to personal preferences, as it was demonstrated (i.e., Fucci et al., 1993) that listeners perceived music they liked as equally loud to music they did not like when the former exceeded the latter by up to 10 dB presentation levels. The high rate of participants indicating their own playing is “just right,” while the playing of others as “too loud” might be consistent with the Fucci et al. findings. Again, a comparison with regard to tinnitus presence and perception of work-related loudness reports appears in Table 2.

Hearing protection

Figure 2 depicts the rates of hearing protection use across the hearing difficulties reported by participants. Hearing protection use was questioned with regard to style of protectors as well as the regularity of their use. With regard to type of hearing protection, devices employed by participants included foam, and other non-custom earplugs, filtered custom earplugs, solid custom fit earplugs, or an unspecified “other” option. Participants were able to specify one or more types of earplugs and nearly half the participants indicated using more than one form of hearing protection. Amount of time using hearing protection was questioned with regard to one's career in years as well as the % of time the hearing protectors were typically used. For their careers, 102/1,138 (9.0%) indicated “never” wearing protective devices and 126 (11.1%) did not respond to the question. Note above that the majority of respondents (59.1%) reported working in the music industry for more than 20 years; hearing protection use appears to be a long-term issue for this population. Proportion of time working that hearing protection was used during “loud music listening” was also considered. Of 1,132 respondents to the question regarding usage time, 156/1,132 (13.8%) indicated 100% of the time; 337 (29.8%) indicated 75% of the time; 212 (18.7%) indicated 50% of the time, while 248 (21.9%) indicated 25% of the time and 179 (15.7%) reported never wearing hearing protection, even when listening to loud music.

An additional survey item questioned respondents regarding the type of monitoring equipment they used occupationally. Options included in-ear monitors (IEMs), standard headphones, wedge monitors, or none. Respondents could indicate one or more of the options. Of the 1,137 responses obtained, 322 (28.3%) indicated using no monitor type at all (i.e., none); 77 (6.8%) indicated using IEMs only; 176 (15.5%) indicated standard headphones, and 89 (7.8%) reported using wedge monitors. For respondents with more than one option chosen, 266/1,137 (23.4%) used IEMs plus at least one other option, and 206 (17.9%) used standard headphones and wedge monitors. Participants were also asked whether they considered IEMs to provide hearing protection. Only 153 participants answered the question, with 85 (55.6%) indicating that they considered IEMs hearing protection devices.

The MusiCares/Tuned survey was accessed by 1,138 individuals who work, in various roles, in the music industry. As such, the participants co-exist with a variety of factors putting them at risk for hearing loss, tinnitus, sound tolerance issues, speech recognition difficulties, or other disorders more specific to music listening such as diplacusis or dysacusis. The participants reported on their personal history in music, related exposures, use of HPDs, and their awareness of hearing problems. Generalizability of the results must be considered cautiously, given the heterogeneity of the music-exposed population, as well as the observation that more than half the respondents reported involvement in the music industry for more than 20 years.

The results obtained from 1,138 participants depict diverse experiences related to job description, use of hearing protection, career exposures, and reported hearing challenges. While more than half the participants reported working for more than 20 years in music, nearly 80% indicated they never seek services from an audiologist, and nearly half reported wearing hearing protection 50% of the time or less when exposed occupationally. Nearly 90% of the participants rated their hearing as “average” or “below average” hence the lack of audiologic care received by the participants was counter-intuitive. Why would individuals whose careers and well-being depend upon the health of their ears not devote more time and resources to following published hearing protection guidelines or to seeking audiologic management?

A brief report (Jones, 2023) summarized several reasons why workers and employers may ignore safety guidelines in occupations requiring compliance. Although the context of this brief piece centered on industrial exposures, the author identified elements that may be of importance to the music-exposed population. Jones reported five reasons for lack of compliance: employee burnout, time constraints, overconfidence, lack of regular training, and miscommunication. One could argue that music-exposed individuals rationalize the infrequency with which they employ hearing protection and audiologic services as containing elements of the Jones summary. For example, Jones specifies “overconfidence” as a worker's “tendency to underestimate the importance of safety protocols or overestimate personal skill levels” as he asserts such an attitude usually accrues in an individual who is “highly comfortable with their roles or have been in their positions for an extended period…” The long careers of most survey participants would seem consistent with the notion that complacency in the face of known overexposure may influence choices regarding protective devices.

Reported use of HPDs suggested that music-exposed individuals did not in any meaningful sense acknowledge the value of exerting personal control through limiting hazardous exposures. About 40% of the respondents indicated wearing HPDs more than half the time they were exposed. The music-exposed workers sampled herein may lack training with regard to effective use of hearing protection, or they may have experienced challenges when trying to use HPDs. Many HPDs substantially influence music's spectrum for the listener (i.e., Beach and O'Brien, 2017); as a result, the worker's ability to play or engineer music for themselves or for an audience suffers. Note also that 76% of survey respondents believed their own playing to be “just right,” although 45% indicated the work environment was “too loud.” The possibility that an individual's perception of loudness is contingent at least in part on personal preference for the music (i.e., Fucci et al., 1993) cannot be dismissed as a contributor to MIHD.

Comparisons to the Di Stadio et al. (2018) analysis were highlighted by a large difference in tinnitus prevalence. The MusiCares/Tuned survey results revealed nearly 70% of participants with tinnitus reports against 27% across 4,628 subjects from 41 studies reviewed by Di Stadio et al., and 42.6% among the studies analyzed by McCray et al. (2026). Rates of hyperacusis were similar to the pop/rock group (26% on the current survey vs. 27% from Di Stadio et al. and McCray et al. Music-exposed individuals in the MusiCares/Tuned survey likely evinced a broader spectrum of occupational activities than were provided in DiStadio's review. In the current survey, musicians from a broader range of genres than those sampled in the DiStadio review participated. Additionally, almost 90% respondents to the current survey reported working in the industry for more than 10 years, hence their health- and hearing-related issues may also be influenced by age to a greater degree than those offered by the Di Stadio review.

Santucci et al. (2020) reported tinnitus as “perhaps the most reported form of MIHD among musicians,” an observation borne out on the current survey. High prevalence of tinnitus in this sample was not unexpected, given participants' age and the years of exposure to music, reported by nearly 80% of respondents as 10 years or more. The lack of participants accessing audiologic services might be consistent with lack of tinnitus-related care or participants accessing on their own inaccurate or incomplete information regarding tinnitus mechanisms and management. In spite of the high rate of tinnitus, 77% of respondents rated their hearing as “average” or “better than average.” Either this study sample does not consider tinnitus overburdensome with regard to evaluation of their own hearing, or they were not willing to endorse the notion on the survey. Either way, the relation between tinnitus and perceived hearing loss in this population requires considerable attention; music is well-regarded for its ability to lessen tinnitus intrusiveness in a variety of environments. Perhaps some study participants' occupational exposures inoculate them to some degree from bothersome tinnitus, or at the very least, their proximity to music may reduce at times the magnitude of tinnitus annoyance.

Meibos and Malyuk (2022) reported upon a survey that examined U.S.-based audiologists' knowledge, beliefs, and clinical practices related to custom-fit IEMs. Audiologists were recruited through physical mailings, targeting those listed on IEM manufacturer websites, as well as through email and social media outreach. Of 400 surveys mailed, 101 audiologists completed the questionnaire. The median participant age was 40 years, with a median of 12 years in clinical practice, and 86% held a Doctor of Audiology (Au.D.) degree. Among respondents, 96% (of 81) agreed that audiologists should possess knowledge of hearing conservation as it pertains to IEM use. However, 94% (of 99) either reported believing that IEMs were safe for hearing or expressed uncertainty regarding their safety.

Educational practices surrounding hearing conservation in the context of IEMs remain limited. Approximately 74% (of 92) of respondents reported spending 15 min or less educating patients on IEM-specific hearing conservation strategies. Moreover, 63% (of 83) indicated that in at least half of their clinical encounters with music industry professionals seeking IEMs, their services were limited to ear impressions, with no additional counseling or audiometric assessment. Consistent with this trend, 76% (of 92) stated that they “sometimes,” “rarely,” or “never” conducted audiometric testing with this population, and 77% (of 81) did not verify IEM fit or output (Meibos and Malyuk, 2022).

Although IEMs should not be classified as hearing protection devices, more than half of respondents in the current study indicated that they consider IEMs to serve such a function. This misconception may be attributed to marketing practices within the IEM industry, wherein manufacturers frequently promote IEMs as safety devices. Due to limited formal training regarding IEMs in most audiology programs, audiologists may be particularly vulnerable to adopting manufacturer claims without critical evaluation or evidence.

Despite these gaps in care, 77% of the 80 aforementioned surveyed audiologists reported that they “never” or “rarely” refer patients to audiologists specializing in music industry hearing health. With regard to clinical practices, 60% (of 99) of audiologists expressed a desire for additional training to enhance their competence in managing IEM-related care. These data underscore a critical need for improved education and training regarding hearing conservation practices among audiologists serving music professionals. Given the pervasive marketing of IEMs as inherently protective, audiologists must assume a central role as gatekeepers of hearing conservation to ensure that accurate, evidence-based information guides both clinical practice and patient understanding. Furthering best practice and education of music-industry professionals would create a culture shift around the understanding of what IEMs truly are – dangerous for hearing when not fit and used properly.

The results of this survey highlight the urgent need for increased audiologic education and care within this population. Although “music audiologists” have existed since the late 1980s, it is apparent that evidence-based outreach and care geared specifically to the music-exposed population remain scarce. This data set shows trends related to work in the music industry contributing to high rates of preventable MIHDs; unfortunately, the study population does not readily seek audiologic care. While the reasons for this lack of service uptake were not expressed in these survey answers, it can be surmised that mistrust, undereducation, and barriers to access for those who tour may be at play. The MusiCares/Tuned partnership attempts to bridge that gap successfully by providing teleaudiology services and screenings to this population.

The MusiCares/Tuned survey remains open and will continue to provide those philanthropic organizations the opportunity to further meet their constituents' needs. A few trends from this brief analysis bear mention. First, tinnitus was the most common audiologic complaint reported by participants, reinforcing its ubiquity among at-risk populations. Second, the rate of HPD use in this population affirmed the need for education and outreach focused on the needs of music-exposed individuals. Third, the study population could benefit from dissemination of data and recommendations regarding the use of in-ear monitors. Although the devices are not HPDs, education regarding their use and sound limiting potential could reduce risk while contributing to the occupationally-required sound fidelity. Finally, the possibility that some music-exposed individuals are accepting of, or seek out, loud music experiences without fully acknowledging their co-existence with hazardous sound necessitates management and counseling efforts that would target such unhealthy behaviors. Providers' work will remain challenging because few other, if any, occupational health risks are as enjoyable for those exposed as music.