Marshall Chasin, Editor
"This is the best of blogs; this is the worst of blogs'. To paraphrase Dickens’s A Tale of Two Cities, it is the two-headed nature of music and hearing aids that a hearing aid can be great for speech yet useless for music, and, conversely, great for music yet less than optimal for speech. What are some tricks that can be used to improve a hearing aid for music? How can we prevent hearing loss from loud music? This blog asks these questions, and with your input, even more. Comment Policy

When I first started as a young audiologist in 1981, custom hearing aids were not yet being marketed and all that was available were rather large sized BTE aids, eyeglass aids, and even body aids. I recall that there was an Oticon P11P and a Wilco H37D body aid.  The Wilco H37D came with either a red or a yellow dot receiver where the output and gain were higher with the red dot. It’s amazing that I still carry around such trivia in my memory!

Whether the hearing aids were eyeglass hearing, body, or BTE hearing aids, one can say with some certainty that they were not invisible.

Back then, the federal laws were not yet in place that prevented discrimination based on hearing loss or any other physical disability. Well, even today musicians and other “contract employees” still fall into rather large cracks in the various jurisdictional laws.  A hard of hearing conductor or musician wearing any hearing aid would simply, for “unknown reasons”, not have their contract extended.

Various hearing aid manufacturers came out with really neat advertising campaigns that tried to put things in perspective. I believe that it was Siemens (now Sivantos) that came out with a great poster that said “What is more visible- your hearing loss or hearing aid?”.   Of course they hit it on the head, and even today I wish that I had a copy of that poster.  It did however underscore the push-pull, love-hate relationship between hearing aids and what they looked like.

Times have changed but not as much as many would have us believe. It is true that hearing aids can now be seated deeply in the ear canal (and this was really the case since the late 1980s with the introduction of the Phillips Peri-tympanic aid, that we would now call an IIC).

Courtesy of www.appstechnews.com

A long way to go!



This miniaturization was the big push in the late 1980s and 1990s and indeed there are some acoustic advantages of deep canal or deep CIC hearing aid fittings that went along with the miniaturization. I actually edited a book on this topic called CIC Handbook and among other things, a deep canal fitting (with or without a deeply set lateral end of the hearing aid) would provide significantly more amplification than  what the 2 cc coupler response could show.

I recall an instance where I “faked” an ER-15 musicians’ earplug and had the earmold lab design it as a fake cover over their canal hearing aids. To the unsuspecting public, the musician was merely wearing earplugs.

With the advent of digital technology and wireless compatibility, hearing aids became larger again, but not for too long. Mini BTE and RIC hearing aids quickly became the norm and at least as far as the non-occluding version, was made possible by advanced feedback (phase shifting) management systems.

If the musician or other performing artist wanted to hide their hearing aids, it could be easily done by arranging a few wisps of hair, here and there.

And then we had a new set of problems- digital hearing aids could handle speech as an input but could not handle the higher levels of music without significant distortion. So even if a musician would agree to wear hearing aids, they (understandably) would not wear them while performing or listening to music.  Click here for more on this technical limitation of digital hearing aids can be found at .

In the last 8-10 years, digital hearing aids have almost caught up with the improved fidelity of the old style analog hearing aids of the late 1980s. The 1988 K-AMP is considered the best of all hearing aids for music because it had a rock solid front end that did not distort with the higher level inputs characteristic of music.  It is still available from some sources such as General Hearing and is still available as a PSAP as the Bean from Etymotic.

Recent innovations by a number of hearing aid manufacturers have successfully addressed this problem and are now offering technologies that can transduce the higher level inputs of music without appreciable distortion…. So hard of hearing musicians are now starting to wear their hearing aids again in public venues while performing.

There has been an understandable 20-year hiatus for many hard of hearing musicians not wanting to wear hearing aids- first the larger size, and then the limitation in digital technology. And of course, what would an employer or conductor think of a musician wearing hearing aids?

Figure courtesy of www.slideshare.net

Figure courtesy of www.slideshare.net

The last hurdle is still there. Laws are in place to protect the hard of hearing musician but in many cases battles need to be waged by the musician (and their unions and audiologists) to maintain their rights.  Not all performing artists are up to that task and many unions are not as aware as they should be.  I spend as much time educating union officials about their members’ rights as I do in actually helping the performing artist win their case.

We are not there yet despite having laws on the books.  The realm of the performing artist is still very much back in the mid-20th century (and, in some cases, the 19th century).  Miniaturization is one way to do an end-run around the issue, but the issue still remains.

I am not sure that we are as advanced with our human rights when it comes to the performing artists as we should be, or we think we are.

We do have many great tools are our disposal, but none better than hard of hearing musicians who have gone “public” about their hearing difficulties are have come out the other side. The next entry in this blog series is from one, of many musicians who has gone “public” and we will hear his story.


Photo courtesy of www.appstechnews.com

Years ago I wrote an article called “My wrist sings the blues”. I think it may have been in the now defunct journal Hearing Instruments which was the predecessor of Hearing Review.  This was a long time ago when the alphabet only had 24 letters and pi only had 7 decimal places.

The idea behind the article is that non-hearing related injuries in musicians can occur as a result of improper monitoring. Too much hearing protection can be as bad (or maybe even worse) than too little hearing protection.  An incorrect level of monitoring can result in wrist or arm strain and result in long-term chronic injuries that may be career threatening.

Photograph courtesy of www.LondonHandTherapy.co.uk

Photograph courtesy of LondonHandTherapy.co.uk

I was reminded of this fact when I saw a musician this week for a re-evaluation.  She is an accomplished viola player and even though this wasn’t reported (or asked about) in the initial consultation, she had been having left arm and wrist pain.  (I won’t make that mistake again).  During the appointment we were in the process of making several adjustments and she reported that she no longer had any problems with her left arm.

Wrist pain. Figure courtesy of www.orhopedicalliance.net

Wrist pain. Figure courtesy of www.orthopedicalliance.net

While I cannot take any direct credit for this (and no EMG studies were performed) she was quite delighted and intuitively felt that she had a better sense of her viola playing and thought that she wasn’t “pushing things” as much as she normally does. She is a retired physician and plays about three times a week, so her music is very important to her.

I had a case like this many years ago where a drummer had read in the popular music magazines of the day that he should be wearing hearing protection. Being an intelligent soul who wanted to ensure that his musical career would last as long as possible, he started wearing his father’s industrial strength hearing protection.  Six months later he noted significant wrist and arm pain.

By the time I had seen this musician, he could barely hold his drum sticks and his EMG (muscular activity) was off the scale. You don’t have to be Mead Killion to figure this one out! The industrial strength hearing protection was sufficient enough to cause him to lose his monitoring ability of his high hat and rim shots; simply stated, this drummer was overplaying because of the loss of monitoring.



103 dB SPL


113 dB SPL


104 dB SPL


He was fitted with the proper form of hearing protection (namely the ER-25 musicians’ earplugs) which provided 10-15 LESS high frequency attenuation. With the improved (high frequency) monitoring, his playing level was reduced and EMG activity returned to normal.  The table shows the measured sound pressure level (SPL) generated while the musician was hitting a practice pad with an “average” playing level with no hearing protection and then with the properly fit ER25 musicians’ earplugs showing no measureable difference.  In contrast, when he was wearing the industrial strength hearing protection (i.e., deeply seated foam earplugs), the average playing level was about 10 dB greater.