Why are audiologists afraid of working with musicians? Part 3

This series of blogs covers a number of areas about why audiologists would rather not work with musicians (or engineers, or lawyers, or …).

Another reason, other than jargon, why audiologists may not want to work with musicians lies in the realm of temporary and permanent hearing loss.   This acronym of choice for temporary hearing loss is TTS which stands for Temporary Threshold Shift.  The other commonly seen acronym is PTS or Permanent Threshold Shift and, as the name, suggests is … “permanent”.

Following is a typical conversation between an audiologist and a musician:

Musician:  “I am so glad you could see me today.  Last week I sat in front of a loudspeaker while playing and my ears rang for three days.  I had some ringing in my ears for a couple of days.  They also felt numb or dead, but they are cool now.”

Audiologist:  “You mean that your hearing felt numb or dead- not your ears. Right?

Musician: “Don’t be a smart-ass.  You know what I meant!”

Audiologist:  “Let me take a look at your ears and then I will check your hearing.”


Audiologist:  “Your hearing is fine.  Go away!”

Musician:  “But, I read on the internet that I probably had some TTS.  Shouldn’t I be concerned?”

Audiologist:  “Yes you probably had TTS; No, you shouldn’t be concerned.  You are being silly. Go away!”

Musician: “##$&%*&))*^!!!!!!!!! You!!”


It’s no wonder that audiologists don’t like to work with musicians, despite the musicians’ colorful and creative language.

This is a case of a mismatch between what an audiologist considers to be important and what a musician considers to be important.  The musician’s hearing may have been affected by the loud music, albeit temporarily; the musician suffered from some tinnitus, and had a feeling of deadness in their ears… I mean hearing.  A musician’s livelihood depends on their hearing, so why are audiologists so cavalier about it?

Well, the audiologist was not cavalier about the musician’s hearing or the protection of hearing, but TTS is simply not an indicator of PTS.  Way back in the olden days of the 1960s and 1970s there were a lot of TTS studies being performed (and actually there still are).  It was “hoped” that a person who experiences a large TTS would be a person who was the most susceptible to PTS, but there is no evidence to support this contention.

It would be great to have a predictor of individual future PTS but so far we have nothing.  Even the proposed mechanisms of TTS are different than those of PTS.

The musician who seeks counsel and information regarding his TTS probably hasn’t read the literature.  So, a person who comes in to our office complaining of TTS is just being silly, right?

Well, not really, but I can understand this view.  TTS is as correlated to PTS as driving a red car is correlated to speeding tickets.  They may be related but it’s not a cause and effect relationship.  One can say that prior to having a PTS from long-term music (or noise) exposure, one must have first had TTS, but that’s about all one can say.

This is not just an issue for musicians.  Many of our clients come into the office having read in depth many of the comments and articles appearing on the internet, but musicians are typically the ones who come in to see us.  This is merely an information issue and will just take patience to work through.  It can be difficult- something that is so “intuitively true” must be true, but in this case it is not.

Or is it?  The data from the 1970s-1990s does seem to show that TTS is a benign artifact of experiences higher levels of noise or music, but more recent data that examines the neurological structures of the hearing mechanism (eg. a delayed wave I in ABR) indicates that TTS may not be as benign as the audiologist in the above conversation thinks…

About Marshall Chasin

Marshall Chasin, AuD, is a clinical and research audiologist who has a special interest in the prevention of hearing loss for musicians, as well as the treatment of those who have hearing loss. I have other special interests such as clarinet and karate, but those may come out in the blog over time.