DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

NIOSH Recommended 

Exposure Limit

In the United States, occupational regulations and standards were established 

to protect workers against the health 

effects of exposure to hazardous substances and agents when certain values 

(or limits) are reached. NIOSH establishes recommended exposure limits 

(REL) for various hazards on the basis of 

the best available science and practice. 

The NIOSH REL for noise is 85 decibels, using the A-weighting frequency 

response (often written as dB(A) or 

dBA) over an 8-hour average, usually 

referred to as time-weighted average 

(TWA). The A-weighting of sound 

levels is thought to provide a rating that 

indicates the injurious effects of noise 

on human hearing. Exposures at or 

above this level are considered hazardous [NIOSH 1998]. 

The NIOSH REL was developed to 

assess the risk of hearing loss among 

industrial workers exposed to steady 

broadband noise over 8-hour work 

shifts for up to a 40-year working lifetime and thus may not be completely 

applicable to assessing the risk to musicians and other music professionals 

who have irregular and unpredictable 

sound exposures. Musicians’ work 

schedules vary considerably—they typically play less than 4 hours per day, 

and sometimes just 2 or 3 sessions or 

work shifts per week. The REL specifies a maximum allowable daily noise 

dose, expressed in percentages. The 

noise dose is based on both the sound 

exposure level and how long it lasts 

(duration), so for each 3-dB increase in 

noise exposure levels, the duration of 

the exposure should be cut in half (this 

is what’s referred to as exchange rates 

in standards). For example, a person 

exposed to average sound levels of 85 

dBA will reach 100% of their daily noise 

dose over their typical 8-hour work 

shift, but for a musician who is practicing or performing around 60 minutes 

a day, they will reach their maximum 

daily dose of 100% only if the sound 

levels average around 94 dBA. The relationship between exposure duration 

and levels is shown in Table 1.

Description of Risk

Hearing loss is one of the most common 

work-related illnesses in the United 

States. NIOSH estimates that 22 million 

U.S. workers encounter noise exposures loud enough to be hazardous. The 

American Tinnitus Association estimates that 50 million Americans suffer 

from prolonged tinnitus. As of 2012, 

the Bureau of Labor Statistics estimates 

that 167,400 people work as musicians 

and singers, and 77,600 as music directors and composers [BLS 2012]. For 

professional musicians, hearing loss 

or tinnitus can significantly impair not 

Reducing the Risk of Hearing 

Disorders among Musicians

Summary

Musicians and others involved in 

the music industry are at risk of developing permanent hearing loss, 

tinnitus (ringing in the ears), and 

other hearing disorders from exposure to loud sounds. The National 

Institute for Occupational Safety 

and Health (NIOSH) examines the 

risks associated with music exposure and provides recommendations to protect their hearing. 

Time to reach 

100% noise dose

Exposure level 

per NIOSH REL

8 hours 85 dBA

4 hours 88 dBA

2 hours 91 dBA

60 minutes 94 dBA

30 minutes 97 dBA

15 minutes 100 dBA

Table 1. The relationship between 

exposure duration and levels
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only their communication and quality of life, but also their 

career and ability to obtain or maintain a job. 

Although this document is aimed at professional musicians 

(members of an orchestra or a band, or music teachers) many 

of the recommendations also apply to the wide range of occupations in the music profession such as audio engineers, 

producers, crew members, music students, and nightclub disc 

jockeys (DJs). Professional musicians work and practice in a 

variety of venues ranging from large music halls, theatres, 

and arenas; to smaller clubs and school and university music 

rooms. Musicians are often overlooked in terms of occupational safety and health practices. Music-induced hearing 

loss occurs slowly and over a long period of time, and most 

musicians do not seek help until they start to experience secondary symptoms such as tinnitus (buzzing or ringing in the 

ears), distortion of sounds, diplacusis (hearing same notes at 

different pitches), and hyperacusis (extreme sensitivity to everyday sounds) [Santucci 2010]. 

In addition, negative health consequences are associated 

with producing high musical sound levels. Musicians are 

at increased risk for both musculoskeletal and vocal health 

problems when producing high sound levels on musical instruments like the piano, trumpet, guitar, or drums. Increased 

biomechanical demands, whether at the hands, embouchure, 

or vocal cords, elevates the risks for occupational health problems like tendonitis, carpal tunnel, rupture of facial muscles, 

and vocal cord malfunction [Hoppmann 2010]. 

Description of Exposure

Measurements of sound levels on stage of rock-and-roll concerts range from 105–120 dB SPL (90 – 110 dBA) [Speaks et 

al. 1970]. A study of sound exposure levels among orchestral 

members during individual or group rehearsals and during 

live performances showed sound levels reaching as high as 

100 dBA. The highest sound exposure levels among orchestra 

members were found in percussionists, 95 dBA; flute/piccolo 

players, 95 dBA; and brass players, 92‒94 dBA [Laitinen et 

al. 2003]. A study of noise exposure associated with marching bands found average sound levels of 95-122 dBA for 

brass drums, 106-118 dBA for cymbals, and 95-113 dBA for 

snare drums [Keefe et al. 2004]. Studies of sound exposure 

during college wind band performances and rehearsals found 

average levels of concert and symphonic bands were 89‒90 

dBA [Chesky 2010], and 52% of subjects had a daily noise 

dose that exceeded the NIOSH REL [Stewart 2009]. A questionnaire from the Stewart study found the use of hearing 

protection to be almost nonexistent during “instrumentplaying activities.” Even employees of music clubs are at risk 

of developing hearing loss; average sound levels at eight different music clubs during performances ranged from 95 to 

107 dBA [Gunderson et al. 1998]. 

Although great strides are being made in research on musicinduced hearing loss, overall hearing conservation efforts 

have been minimal and left to the individual. A few countries (Australia, UK, Switzerland, Italy, Austria, Finland, and 

Sweden) have specific recommendations for occupational exposure limits for music or noise in the entertainment 

industry. Two excellent resources are the Control of Noise 

in the Music Entertainment Industry from the Worksafe 

Western Australia Commission and the Control of noise at 

work in music and entertainment from the United Kingdom 

Health and Safety Executive.

NIOSH Investigation 

NIOSH conducted a Health Hazard Evaluation during 

middle and high school music classes and marching band 

rehearsals [NIOSH 2012]. Music instruction and rehearsals took place in a band room and in a cafeteria. NIOSH 

researchers measured the instructor’s personal noise exposure using a noise dosimeter. Researchers measured sound 

levels throughout the room and cafeteria areas. Sound levels 

during most band rehearsals ranged from 91–97 dBA, and 

exceeded 100 dBA numerous times. The band director’s personal exposure over 6 different classes and rehearsals (228 

minutes) was 92 dBA (TWA), with a dose of 461% (both 

well above the NIOSH REL). Sound levels in the band room 

were much greater than in the cafeteria, mostly because the 

cafeteria was larger and had higher ceilings. NIOSH recommendations included treating the rooms with acoustical 

absorbent materials; providing appropriate space for practice based on the number of the students; improving faculty 

and students’ awareness of the risk of developing noise-induced hearing loss; increasing distances between students 

and band directors; lowering sound levels during rehearsals, 

if feasible; taking breaks in quiet areas; and providing teachers and students with custom-fitted musician earplugs.

Figure 1. An image of the volume and other knobs on a 

speaker amp.

Photo by ©ThinkStock
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Recommendations

NIOSH recommends hearing conservation programs for all 

workplaces with noise levels that exceed the REL of 85 dBA. 

However, because music is part of musicians’ work and is 

the direct result of deliberate and desired actions, effective 

interventions must be behavioral and should rely primarily 

on awareness, knowledge, competency, and accountability of 

those producing musical sounds. 

Employers, music venue operators, schools and colleges, and 

anyone responsible for music-related activities should consider the following recommendations:

1. Educate musicians and those involved in the industry about the importance of using increased distances 

between individuals and arrangements of instruments to 

reduce overall noise exposure during practice and performances. [For more specific recommendations, see 

Chasin 2010]. 

2. Develop a hearing conservation program that includes 

annual audiometric testing and training about protecting 

musicians’ hearing.

3. Encourage participation in education and awareness 

campaigns of music-induced hearing loss, see a list of resources in the “more information” section below.

4. Since music levels fluctuate greatly from one practice or 

performance to another, conduct regular sound level assessments at a reference location and establish an average 

and a range of music levels during rehearsals and performances. Conduct personal exposure monitoring of 

performers and exposed staff. Assessments should be 

conducted, where practicable, by a certified industrial hygienist or an occupational safety and health specialist. 

5. If sound level assessments show elevated levels (consistently exceeding the NIOSH limit of 85 dBA), 

consider reducing the amount of time musicians and staff 

are exposed through rotation or offering frequent breaks 

in quiet areas.

6. Work with musicians and affected workers to identify 

hearing protection solutions that work best for the individual. A variety of hearing protection options are available 

from inexpensive foam earplugs to potentially more costly 

products designed specifically for professional musicians 

and other entertainers. 

7. Although more studies are needed to verify the effectiveness of general noise control solutions for musicians’ 

workspaces, the following features may be effective in reducing the overall sound exposure levels among musicians 

and staff:

— Consult with architects, acousticians, and sound engineers to create the best desired and most effective 

musical workspace

— If the workspace for musicians or staff is very reverberant, treat certain sections of walls and ceilings 

with sound absorbent material to reduce reverberation time. Higher ceilings also help reduce 

reverberation for high energy instruments such as 

brass instruments and percussion 

— For rehearsal and practice, consider using appropriate size rooms for the number of musicians 

— Placement, spacing, and use of enclosures can help 

reduce overall sound levels from certain instruments

— If rooms or venues have hard reflective surfaces, 

position instruments and speakers to direct sound 

away from musicians

Musicians and workers in the music industry should consider the following recommendations:

1. When possible, play music at lower levels during individual and group rehearsals. If using amplified speakers 

in live performance, work with sound engineer to adjust 

the volume down to desired but acceptable levels. 

2. If you use In-Ear monitors (IEM) to listen to vocals and 

stage instruments, work with your sound engineer and 

fitting audiologist to reduce sound output to workable 

levels, especially during practice and rehearsals. 

3. Wear hearing protection when appropriate and ask your 

employer or audiologist about getting custom-fitted earplugs that work best for your environment. 

4. Have your hearing evaluated annually by an experienced 

audiologist who understands noise exposures in the 

music industry. 

5. Always be aware of your sound exposure level, an 

easy and practical way is to use your smartphone and 

a sound meter app (see NIOSH evaluation of smartphone sound measurement apps http://blogs.cdc.gov/

niosh-science-blog/2014/04/09/sound-apps/).

6. Give your ears some rest; ears typically need about eighteen hours of quiet after exposures to loud sounds in 

order to return to normal hearing. Take advantage of 

breaks (in quiet areas) whenever possible.

Acknowledgments

The principal contributors to this publication were Chucri 

Kardous, Christa Themann, and Thais Morata from the 

NIOSH Division of Applied Research and Technology 

(DART); Jennifer Reynolds of the University of Florida 

College of Medicine; and Susan Afanuh from the NIOSH 

Education and Information Division (EID).
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References

BLS [2012]. Occupational outlook handbook. Washington, 

DC: U.S. Department of Labor, Bureau of Labor Statistics. 

http://www.bls.gov/ooh/entertainment-and-sports/

home.htm

Chasin M [2010]. Hear the music: hearing loss prevention for musicians. Toronto, Canada: Musicians Clinics 

of Canada. http://www.marshallchasinassociates.ca/pdf/

Hear_the_Music_2010.pdf

Chesky K [2010]. Measurement and prediction of sound 

exposure levels by university wind bands. Med Problems 

Performing Artists 25(1):29–34. http://www.ncbi.nlm.nih.

gov/pubmed/20795377

Gunderson E, Moline J, Catalano P [1997]. Risks of developing noise‐induced hearing loss in employees of urban 

music clubs. Am J Ind Med 31(1):75–79. http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1097-0274(199701)31:

1%3C75::AID-AJIM11%3E3.0.CO;2-4/abstract;

jsessionid=5D6A3192FFE85F6FF1E8E2A1E14C

B120.f04t03

Hoppmann RA [2010]. Musculoskeletal Problems of 

Instrumental Musicians. Performing Arts Medicine, 3rd 

ed. Chapter 11. http://www.sciandmed.com/tpam/journal

viewer.aspx?issue=1188&article=1859

Keefe J. [2005]. Noise exposure associated with marching and pep bands. http://acoustics.org/pressroom/

httpdocs/150th/Keefe.html

Laitinen HM, Toppila EM, Olkinuora PS, Kuisma K [2003]. 

Sound exposure among the Finnish National Opera 

personnel. Appl Occup Environ Hyg 18(3):177–182. http://

lib.tkk.fi/Diss/2010/isbn9789526030746/article1.pdf

NIOSH [1998]. Criteria for a recommended standard: occupational noise exposure. DHHS (NIOSH) Publication No. 

98‒126. http://www.cdc.gov/niosh/docs/98-126/

NIOSH [2012]. Health Hazard Evaluation report: noise evaluation of elementary and high school music classes and 

indoor marching band rehearsals—Alabama. By Chen L, 

Brueck S. NIOSH HETA No. 2011‒0129‒3160. http://www.

cdc.gov/niosh/hhe/reports/pdfs/2011-0129-3160.pdf

O’Brien I, Driscoll T, Ackermann B [2013]. Sound exposure of 

professional orchestral musicians during solitary practice. J 

Acoustical Soc America 134(4):2748–2754. http://scitation.

aip.org/content/asa/journal/jasa/134/4/10.1121/1.4820900

Santucci M [2010]. Saving the music industry from itself. 

Hearing J 63(6):10–14. http://journals.lww.com/thehearing

journal/Fulltext/2010/06000/Saving_the_music_

industry_from_itself.3.aspx

Speaks C, Nelson D, Ward WD [1970]. Hearing loss in 

rock-and-roll musicians. J Occup Environ Med 12(6):216–

219. http://journals.lww.com/joem/Citation/1970/06000/

Hearing_Loss_in_Rock_and_Roll_Musicians_.4.aspx

Walter J [2009]. Sound exposure levels experienced by 

university wind band members. Med Problems Performing Artists 24(2):63–70. https://www.questia.com/

library/journal/1P3-2823067431/sound-exposure-levelsof university-jazz-band-members

Suggested Citation

NIOSH [2015]. Reducing the risk of hearing disorders among musicians. By Kardous C, Themann C, Morata T, Reynolds 

J, Afanuh S Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 

National Institute for Occupational Safety and Health. DHHS (NIOSH) Publication No. 2015–184.
More information about noise-induced hearing loss is available 

on the NIOSH Web site at http://www.cdc.gov/niosh/topics/

noise/about.html

To receive documents or other information about occupational 

safety and health topics, contact NIOSH at

Phone: 1-800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348 ■ E-mail: cdcinfo@cdc.gov

or visit the NIOSH website at www.cdc.gov/niosh.

For a monthly update on news at NIOSH, subscribe to NIOSH 

eNews by visiting www.cdc.gov/niosh/eNews.

Mention of any company or product does not constitute 

endorsement by NIOSH. In addition, citations to websites 

external to NIOSH do not constitute NIOSH endorsement of 

the sponsoring organizations or their programs or products. 

Furthermore, NIOSH is not responsible for the content of 

these websites.

Examples of efforts to reach musicians and other professionals 

exposed to music can also be found from some of the Safe-inSound Excellence in Hearing Loss Prevention AwardTMrecipients, 

an award created by NIOSH in partnership with the National 

Hearing Conservation Association (NHCA) See http://blogs.

cdc.gov/niosh-science-blog/2011/01/25/music/ and http://www.

safeinsound.us/archive.html

Reducing the Risk of Hearing Disorders 

among Musicians

Additional resources:

H.E.A.R – Hearing Education and Awareness for Rockers

Hear Tomorrow – Hearing Conservation Workshop

Listen to Your Buds – American Speech-Language-Hearing 

Association 

Musicians’ health and therapy – American Federation 

of Musicians

For musicians and music lovers – American Tinnitus 

Association 

Basic Information on Hearing Health – National Association 

of Schools of Music

Adopt-A-Band – Etymotic Research, Inc. 

Musicians’ Clinics of Canada – Musicians Clinics of Canada

This document is in the public domain and may be freely 

copied or reprinted. NIOSH encourages all readers of 

the Workplace Solutions to make them available to all 

interested employers and workers.

As part of the Centers for Disease Control and Prevention, 

NIOSH is the Federal agency responsible for conducting research and making recommendations to prevent work-related 

illnesses and injuries. All Workplace Solutions are based on research studies that show how worker exposures to hazardous 

agents or activities can be significantly reduced.

DHHS (NIOSH) Publication No. 2015–184

For More Information

safer • healthier • peopletm June 2015