Music-Induced Hearing Disorders (MIHD)

There are few things more desirable in a career or avocation than to do something you love. Making music holds great personal (and, for the fortunate few, financial) rewards for the artistically inclined. But there are risks – specifically, Music-Induced Hearing Disorders (MIHD).

What is MIHD?
MIHD stands for Music-Induced Hearing Disorders, which includes a range of physical conditions caused by prolonged and repeated exposure to music at high volumes. Also known as NIHL (Noise-Induced Hearing Loss), MIHD can be career-threatening for musicians, sound engineers, and others in music-related professions. According to a 2003 study by Kim Kaharit, et al., 74% of rock and jazz musicians tested exhibit symptoms of Music-Induced Hearing Disorders.

What specific disorders are classified as MIHDs?
MIHD includes a variety of hearing disorders, including tinnitus (ringing of the ears), hyperacusis, diplacusis, loss of high-frequency hearing ability, temporary threshold shift, and a general loss of hearing ability. See definitions below.

Is MIHD preventable?
Absolutely. By understanding the risks of prolonged exposure to loud music and taking preventive measures, the risk of MIHD can be significantly reduced, allowing a lifelong career in music. Tools like musicians’ earplugs and in-ear monitor systems can help, but the most important aspect of preventing hearing damage is your own behavior.

How loud is too loud?
Anything with a sustained average volume of 85 decibels (dBA) is potentially damaging, whether it’s music or industrial noise. The louder the sound, the shorter the “safe” daily exposure time. Even brief exposure to sound over 115 dB can pose a serious health risk.

Define “Noise”
“Noise” means anything you can hear. Music, jet planes, power tools, driving with the window down, whatever. If it’s over 85 dB, it’s potentially damaging.

But I like loud music!
So do we! But like so many “guilty pleasures,” there are limits to what your body can handle. A two-hour rehearsal that averages 100 dB is a full day’s safe allotment of loud sound, according to OSHA. At 105 dB, safe exposure time is only one hour! And that assumes you have no other exposure over 85 dB that day. The more conservative (and Sensaphonics-recommended) NIOSH standards are even more restrictive.

Are there warning signs?
MIHDs can be insidious, often starting as a temporary loss or threshold shift, or a ringing or buzzing after a performance or rehearsal. In most cases, these effects are temporary when first noticed, often clearing up after a few hours, or overnight. But over time, the effects become more pronounced and longer lasting. Without warning, they can become permanent. The key is to see your audiologist at the first sign of trouble. Tracking the results of annual hearing tests will show any changes in your hearing. Remember: Many people don’t experience any symptoms! That’s why regular hearing check-ups are so important.

I already have some tinnitus and hearing loss. Why change now?
To keep it from getting worse! Most MIHDs develop slowly over time with repeated exposure. By learning to limit your daily “intake” of loud sound, you can slow or even stop the progression of most MIHD symptoms.

Won’t the government protect me?
In a word, no! While OSHA and NIOSH both provide guidelines for safe listening, the music industry is essentially unregulated by the federal government. So for musicians and sound engineers, typical concert levels of over 100 dB – and the resulting danger of MIHD – is considered an occupational hazard.

Don’t local noise ordinances protect me?
Not really. Local noise ordinances attempt to limit volume levels for the audience (and neighborhood), but enforcement is often lax and rarely addresses the critical issue of stage volume. So when it comes to your your hearing health, you’re basically on your own.

Isn’t MIHD just a problem for loud concert musicians?
Every musician is at risk – amplified or acoustic, on stage or in the studio, across every genre of music. Even today’s church musicians are often exposed to rock concert sound levels. Between practice, band rehearsals, performances, and the normal daily exposure to environmental noises like iPods, city traffic, construction sites, airplanes, etc., your ears are constantly bombarded by sound. In short, if you’re serious about music, you should be serious about your hearing.

I’m still young. Can’t I just rock hard until I’m, say 30 or 35?
You can, but it’s gambling with your career. Just as your body needs a good night’s sleep after a night of partying, your ears need time to recover from overexposure to loud sound. Today’s custom-fit in-ear monitors allow you to experience high-impact audio at lower volumes. But that advantage is lost unless you turn it down. Every individual is different, but one fact remains constant: too loud is too loud.

OK, I’m concerned, but I can’t spend my life worrying about every decibel.
The key is awareness and behavior. Learn how loud you are listening, and find ways to limit your daily exposure to excessive volume. There are smartphone apps that can measure the decibel levels in the room. Once you know, talk to your audiologist about how to control your exposure without stopping the show.

So how can I protect my hearing?
First and foremost, do what you do for your vision and teeth – with an annual visit to an audiologist for a hearing test. As a music professional, your hearing is essential to a long and productive career. To find an audiologist, see our Audiologist Referral List.

Second, invest in hearing protection. One of the best options is the use of high fidelity earplugs like our Musicians Earplugs.

Finally and most obviously, turn it down! On stage, consider replacing floor monitors with custom-fit, isolating earphones. Well-fitted IEMs allow you to hear the mix more clearly at lower volumes, but it’s up to you to take advantage of the benefits.

See our Hearing Tips for Musicians page for more ideas.


Following are descriptions of the most common forms of MIHD. Symptoms may begin as temporary but become permanent and more intrusive with continued exposure to loud music and insufficient recovery time for the ears. It is not uncommon for music professionals to develop multiple MIHD disorders.

Tinnitus – The most commonly reported type of of MIHD, tinnitus is a persistent ringing or buzzing sound heard in the ear. Tinnitus typically begins as a temporary symptom, but can become chronic and debilitating. Tinnitus can be caused by prolonged and repeated exposure to loud sounds, or even by short exposure to very loud sound.

Hyperacusis – Increased sensitivity of hearing, sometimes across a specific frequency range. In this condition, soft or moderate sounds will be perceived as unpleasantly loud, while loud sounds will literally cause pain.

Diplacusis – Literally, double hearing. In diplacusis, a single tone is perceived as two different pitches by the two ears. The cause is a loss of sensitivity in one ear across a certain frequency range, causing it to perceive pitches differently.

Threshold Shift (TS) – An increase in the volume level required in order to hear, meaning that only sounds louder than a certain level will be heard. Threshold Shift is a form of ear fatigue from overexposure to loud sound. The most common form is Temporary Threshold Shift, with recovery to normal hearing after the ear has had sufficient rest. Repeated exposure without sufficient recovery time can result in chronic or permanent Threshold Shift.


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