Guidelines IconEvidence-Based Musician Consensus Guidelines 

Evidence-based and consensus guidelines were used in recommending the following audiological procedures targeting musicians and music-industry personnel:

  • Case history
  • Audiometric evaluation
  • Consultation and education
  • Ear-impression techniques
  • Fitting/verification/orientation of devices
  • Counseling regarding gear for the music industry including:
    • Custom and non-custom musicians’ earplugs
    • Custom and non-custom in-ear monitors (IEMs)
    • Active attenuation
    • IEM options
    • IEM best practices
    • IEM safety considerations
    • Sound-level measurements
    • Follow-up hearing tests and support

Musicians of all genres are at risk for auditory injury from loud musical sound exposures. In addition to communication difficulties and health-related quality-of-life degradation, disorders such as tinnitus, hyperacusis, diplacusis, and dysacusis are common and can greatly interfere with the ability to play at a high standard. Furthermore, hearing injury in music-industry professionals can be a severe threat to careers, not only affecting the quality of performances but, in many cases, threatening livelihoods.

Other pioneers and I in music audiology started hearing-loss-prevention activities and products for musicians in the early 1990s. Over time, we have experienced the slow but steady growth of music-industry patients in our clinics. Today, with the higher demand for musicians’ ear plugs and in-ear monitors (IEMs), many general audiologists are seeing an increase in this patient population, as well.

Unfortunately, most doctoral programs in audiology offer little formal training in hearing-loss-prevention strategies for musicians. Because of that, many new and experienced audiologists also lack training in sound reinforcement for live performance.

Of course, musicians assume audiologists are educated to be the experts and gate keepers for the safe use of ear-level devices, but without proper education and ethics, audiologists may find themselves providing devices that may be potentially dangerous, especially in the case of IEMs.

The Academy Task Force on Audiological Services for Musicians agreed that one of the primary motivations for a musician’s first audiological visit is to acquire ear-level equipment such as custom earplugs or IEMs. However, during a thorough musicians’ case history review, many musicians will report tinnitus, distortion, hyperacusis, dysacusis, and diplacusis.

Because these music-induced hearing disorders weren’t the primary reason for the appointment, an audiologist could have easily overlooked the opportunity to act as a doctor of hearing by helping the patient maintain his or her hearing-health status and prevent further injury. Those disorders would most likely go unreported in an appointment for “just ear impressions.”

View this new consensus document, Audiological Services for Musicians and Music-Industry Personnel, on the Academy’s website:

Evidence-Based Research

Evidence-based recommendations in the document are drawn from a review of the literature in peer-reviewed and non-peer- reviewed journals when possible. In the absence of scientific data, consensus practice was considered in making these recommendations. Additional research that would facilitate further development of evidence-based guidelines is recommended in the document when appropriate.

Although this document reflects expert consensus, it is a living document that will require updates perhaps more often than others because of the rapid development of technology and treatment options in this area. Therefore, the task force members and related experts may be called upon by the Academy Board to address new technologies for this population.


The consensus document focuses on hearing-loss-prevention strategies and hearing-protection devices for musicians and music-industry personnel. Unlike industrial hearing conservation, there is no annual audiometric testing or re-testing requirement for many musicians and there is no mandatory hearing-protection requirement.

Musicians practice hearing conservation voluntarily and it’s important for audiologists to realize that wearing an earplug, no matter how good, is a compromise. If musicians are willing to compromise their sound quality during a performance in front of a room full of people to save their hearing, then audiologists can take it upon themselves to learn about music audiology or refer to colleagues who are specialists, as you would other disciplines of audiology where you consider yourself less of an expert.

The task force members agree that a comprehensive hearing-loss-prevention strategy is required for best outcomes for evaluating, treating, and protecting a musicians’ hearing, throughout their careers and afterward.

However, audiologists need to make their services known (hearing tests, etc.) and that hearing care is what we are about, not just impression-taking.

It is the role of the informed audiologist to guide the music-industry professionals to the best quality of care and the best quality of sound. Like any other specialty in audiology, when in doubt, refer.

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