The ear can be exposed to short periods of sound in excess of 120 dB without permanent harm — albeit with discomfort and possibly pain; but long term exposure to sound levels over 85 dB(A) can cause permanent hearing loss. There are two basic types of<unk> : *NIHL caused by acoustic trauma and *gradually developing<unk> . Acute acoustic trauma<unk>  caused by acute acoustic trauma refers to permanent cochlear damage from a one-time exposure to excessive sound pressure. This form of<unk>  commonly results from exposure to high-intensity sounds such as explosions, gunfire, a large drum hit loudly, and firecrackers. According to one US study, excessive<unk>  levels in cinemas are sufficiently brief that movie-goers do not experience hearing loss. Perceived harmfulness vs. actual harmfulness The discomfort threshold is the loudness level from which a sound starts to be felt as too loud and thus painful by an individual. Industry workers tend to have a higher discomfort threshold (i.e. the sounds must be louder to feel painful than for non-industry workers), but the sound is just as harmful to their ears. Industry workers often suffer from<unk>  because the discomfort threshold is not a relevant indicator of the harmfulness of a sound. Gradually developing Gradually developing<unk>  refers to permanent cochlear damage from repeated exposure to loud sounds over a period of time. Unlike acoustic trauma, this form of<unk>  does not occur from a single exposure to a high-intensity sound pressure level. Gradually developing<unk>  can be caused by multiple exposures to excessive<unk>  in the workplace or any source of repetitive, frequent exposures to sounds of excessive volume, such as home and vehicle stereos, concerts, nightclubs, and personal media players. Earplugs have been recommended for those people who regularly attend live music concerts. A range of earplugs are now available ranging from inexpensive disposable sets to custom fit, attenuated earplugs which provide true fidelity at reduced audio levels. Personal listening devices Although research is limited, it suggests that increased exposure to loud<unk>  through personal listening devices is a risk factor for<unk> . More than half of people are exposed to sound through music exposure on personal devices greater than recommended levels. Research suggests stronger correlations between extended duration or elevated usage of personal listening devices and hearing loss. Workplace About 22 million workers are exposed to hazardous<unk> , with additional millions exposed to solvents and metals that could put them at increased risk for hearing loss. Occupational hearing loss is one of the most common occupational diseases. 49% of male miners have hearing loss by the age of 50. By the age of 60, this number goes up to 70%. Construction workers also suffer an elevated risk. A screening program focused on construction workers employed at US Department of Energy facilities found 58% with significant abnormal hearing loss due to<unk>  exposures at work. Occupational hearing loss is present in up to 33% of workers overall. Occupational exposure to<unk>  causes 16% of adult disabling hearing loss worldwide. The following is a list of occupations that are most susceptible to hearing loss: *Agriculture *Mining *Police *Construction *Manufacturing *Utilities *Transportation *Military *Musicians *Orchestra conductors Among musicians Musicians, from classical orchestras to rock groups, are exposed to high decibel ranges. Some rock musicians experience<unk>  from their music, and some studies have found that "symphonic musicians suffer from hearing impairment and that the impairment might be ascribed to symphonic music." In terms of the population of musicians, usually the rates of hearing disorders is lower than other occupational groups. However, many exposure scenarios can be considered a risk of hearing disorders, and many individuals are negatively impacted by tinnitus and other hearing problems. While some population studies have shown that the risk for hearing loss increases as music exposure increases, other studies found little to no correlation between the two. Experts at the 2006<unk>  in Children at Work and Play" Conference agreed that further research into this field was still required before making a broad generalization about music-induced hearing loss. Given the extensive research suggesting that industrial<unk>  exposure can cause sensorineural hearing loss, a link between hearing loss and music exposures of similar level and duration (to industrial<unk>  seems highly plausible. Determining which individuals or groups are at risk for such exposures may be a difficult task. Despite concerns about the proliferation of personal music players, there is only scarce evidence supporting their impact on hearing loss, and some small-sample studies suggest that only a fraction of users are affected. People from ages to 6–19 have an approximately 15% rate of hearing loss. Recommendations for musicians to protect their hearing were released in 2015 by NIOSH. The recommendations emphasized education of musicians and those who work in or around the music industry. Annual hearing assessments were also recommended to monitor thresholds as were sound level assessments to help determine the amount of time musicians and related professionals should spend in that environment. Hearing protection was also recommended, and the authors of the NIOSH recommendations even suggested that musicians consider custom earplugs as a way to combat<unk> . In 2016, the National Association of Schools of Music (NASM), a music school accreditation body in the US, published a hearing health advisory to help with efforts directed at informing faculty and music students about potential risks associated with school activities, during rehearsal and performance. Specific resources are available for administrators, faculty and staff, and students. The use of the documents is voluntary and are not to be used as standards or as part of accreditation procedures. Despite these recommendations, musicians continue to face unique challenges in protecting their hearing when compared to individuals in industrial settings. Typically environmental controls are the first line of defense in a hearing conservation program, and depending on the type of musicians some recommendations have been proposed. These recommendations can include adjusting risers or level of the speakers and adjusting the layout of a band or orchestra. These changes in the environment can be beneficial to musicians, but the ability to accomplish them is not always possible. In the cases where these changes cannot be made, hearing protection is recommended. Hearing protection in musicians offers its own sets of benefits and complications. When used properly, hearing protection can limit the exposure of<unk>  in individuals. Musicians have the ability to pick from several different types of hearing protection from conventional ear plugs to custom or high fidelity hearing protection. Despite this, use of hearing protection among musicians is low for several different reasons. Musicians often feel that hearing protective devices can distort how music sounds or makes it too quiet for them to hear important cues which makes them less likely to wear hearing protection even when aware of the risks. Research suggests that educations programs can be beneficial to musicians as well as working with hearing care professionals to help address the specific issues that musicians face. In 2018, a musician named Chris Goldscheider won a case against Royal Opera House for damaging his hearing in a rehearsal of Wagner's thunderous opera Die Walkure. Workplace standards NIOSH Occupational<unk>  Exposure Criteria Document In the United States, the Occupational Safety and Health Administration (OSHA) describes standards for occupational<unk>  exposure in articles 1910.95 and 1926.52. OSHA states that an employer must implement hearing conservation programs for employees if the<unk>  level of the workplace is equal to or above 85 dB(A) for an averaged eight-hour time period. OSHA also states that "exposure to impulsive or impact<unk>  should not exceed 140 dB peak sound pressure level". The National Institute for Occupational Safety and Health (NIOSH) recommends that all worker exposures to<unk>  should be controlled below a level equivalent to 85 dBA for eight hours to minimize occupational<unk> . NIOSH also recommends a 3 dBA exchange rate so that every increase by 3 dBA doubles the amount of the<unk>  and halves the recommended amount of exposure time. The United States Department of Defense (DoD) instruction 605512 has some differences from OSHA 1910.95 standard, for example, OSHA 1910.95 uses a 5 dB exchange rate and DoD instruction 605512 uses a 3 dB exchange rate. There are programs that seek to increase compliance and therefore effectiveness of hearing protection rules; the programs include the use of hearing tests and educating people that loud sound is dangerous Employees are required to wear hearing protection when it is identified that their eight-hour time weighted average (TWA) is above the exposure action value of 90 dB. If subsequent monitoring shows that 85 dB is not surpassed for an eight-hour TWA, the employee is no longer required to wear hearing protection. In the European Union, directive 2003/10/EC mandates that employers shall provide hearing protection at<unk>  levels exceeding 80 dB(A), and that hearing protection is mandatory for<unk>  levels exceeding 85 dB(A). Both values are based on 8 hours per day, with a 3 dB exchange rate. A
Noise-induced hearing loss
Vibroacoustic disease
Conductive hearing loss
Cochlear hydrops
Nasodigitoacoustic syndrome
Musical ear syndrome
Autoimmune inner ear disease
Sensorineural hearing loss