Editor’s note – Candice Costa was the coolest audiologist we ever knew. She passed away on March 23rd, 2014 nearly exactly 3 years after we interviewed her for this article. We will miss her forever. At least we feel good that through this interview we’re able to immortalize her sage advice for rockers of all ages of how to rock out without sacrificing your hearing. Candice told us she entered audiology because she like to help people, and so at least we can give her this chance to help for as long as our website stands.
Hearing loss and ringing ears from exposure to rock and roll can be the bane of a mature hipster’s existence! Although Beethoven was able to make his complete deafness in later life work for him, it is generally agreed that losing your hearing can really interfere with rocking out. So how do we rock without imperiling our precious ears? We put this and other important questions to Rocker’s favorite audiologist Candice J. Costa Au.D. CCC-A.

Rocker: First off, how do rock concerts and loud noises lead to hearing loss and ringing in the ears? Is it a sound level thing or longevity of sound thing that leads to hearing loss?

Candice: With any loud sound exposure and hearing there are two factors to consider: “how loud” and “how long”. As with any type of noise exposure, you must consider how long you are exposed to the loud sound. The louder the sound, the less time it takes to do potential damage to your hearing. For example, if you are exposed to a sound that is about 85 decibels (dB) you can be in that environment for 8 hours continuously before damage to your hearing can occur. As a point of reference, heavy traffic is roughly 85dB. For every 5dB that the sound level increases, your ‘safe exposure’ time is halved. So for an average rock concert the levels are often around 115dB, which would put the safe exposure time at roughly seven and a half minutes.
Rocker: Is ringing in the ears a sign that hearing loss in imminent or is it something that exists independent of hearing loss?
Candice:Ringing in the ears, or tinnitus, is not necessarily a sign that hearing loss is imminent. To some extent, most of us experience tinnitus every so often. However, chronic tinnitus which is constant or occurs regularly for intervals longer than 5 minutes in duration may be a sign of some co-existing hearing loss.
Rocker: Lots of times, people in nightclubs who do not have earplugs stuff toilet paper or bar napkins into their ears to muffle the noise. Does this really help? If you are stuck in a club without earplugs what is the best thing you can do to help yourself?
Candice: Sticking napkins, toilet paper or even pieces of cotton in your ears does very little to attenuate [reduce] the sound levels. From any of these methods you will get approximately 1dB of sound reduction which does very little to protect your ears if you are in a loud club. If you find yourself in a loud club without hearing protection the best option is to give your ears a break from the noise. Take a few minutes to find a spot where the noise levels are not as loud and let your ears “rest”.
Rocker: A lot of people seem to think that wearing earplugs is sissy stuff. I have met a lot of musicians who don’t seem to think they are cool. What do you say to them?
Candice: As I’ve told many musicians with whom I have worked, your most valuable instrument is your ears. Noise exposure is cumulative and noise-induced hearing loss is real. With a noise induced hearing loss, high-frequency sounds will affected, essentially making it difficult to hear certain notes – which can be a liability when playing with other musicians. Also, once you have a noise-induced hearing loss, it is irreversible. Once you’ve lost the ability to hear those sounds, they are gone and you can’t get it back.
Rocker: When going over the counter, there are a bunch of different types of earplugs one can get, are there ones you do and don’t recommend?
Candice: For musicians the best bet is a non-custom earplug designed for musicians such as the ER-20 from Etymotic Research. These earplugs provide slightly more even attention across all frequencies.

For going to clubs or live shows either the flanged type (which look like Christmas trees) or the foam plugs are effective at reducing the sound level. However proper insertion of these ear plugs is pivotal to getting the most hearing protection. Either of these types of earplugs provides slightly more high-frequency reduction, which can sometimes make music seem muddled; hence, the benefit of the ER-20 earplugs.

Rocker: If people are in bands, is there a volume at which they can practice at which is OK for their hearing or should they always be wearing earplugs? When on stage is it ever OK to not bother wearing earplugs?
Candice: Well, referring back to my previous answer, it depends on how long and how loud they are practicing. Typically in practice settings the levels are not as loud as at a show. So for a 2 hour practice, the sound level would have to be about 95dB. If it is louder than that, earplugs are definitely recommended.

Levels on stage are often louder from monitors, wedges, amplifiers and additional speakers. Given that it is not realistic to take a break every 7 minutes, earplugs are certainly recommended to reduce the sound level on stage. For every 5dB you can reduce the sound, you double your safe exposure time. So by wearing earplugs, if you can reduce the stage level even 15 dB, you can bring the level down to 100dB, which is one hour of continuous “safe” exposure time.

Another option would be to use in-the-ear monitors, or IEMs which are custom fit for each musician and allows them to hear the mix at a safe level in the ears which significantly reduces the levels on stage since they eliminate the need for wedges and monitors.

Rocker: How do musicians earplugs (custom fitted) differ from the ones people can usually just buy in a store? How much will they cost on the average? Are they worth buying for people who are not musicians and worth the extra cost?
Candice: Musician’s earplugs differ significantly from store-bought earplugs. These plugs are custom molded to the ear and have a filter that reduces the overall sound level evenly.The filter makes all frequencies reduced the same amount, rather than having significant high-frequency reduction found in the store-bought plugs. I like to explain them as, wearing musicians earplugs are like turning the volume down on a stereo system, you still hear all of the frequencies you want to hear, but at a safer level.

For non-musicians who are frequent concert-goers they are definitely worth the investment since they sound better and are significantly more comfortable than foam or flanged plugs. Typical pricing for these plugs is around $200.
Rocker: What about iPods? Is there a certain volume you are risking your hearing with when you go over it? Are there types of headphones (ear buds, etc.) that are less likely to cause hearing damage than others?
Candice: iPods, as with any personal audio device have the potential to do damage to your hearing if they are listened to at full volume for hours at a time. The maximum level of a typical MP3 player is about 105dB, which would make safe exposure time at full volume only about 30 minutes.

The headphones used with the MP3 player also make a difference. The type that fit over the ears tend to be the most safe since some of the sound can leak out of the phone and not go directly into your ear. Ear buds, if they fit well have the potential to do the most damage since the sound is going directly into the ear with little leakage. For in the ear styles, the type with a soft tip which fits more snuggly is better, since that type works to reduce the outside noise, which means you do not have to put the volume up as loud.
Rocker: If you already have some ringing in your ears, is there anything you can do to make it stop? What are the treatments for long term and short term tinnitus/ hearing loss?
Candice: In short, there is no “cure” for tinnitus. If you experience chronic tinnitus, it is unlikely that it will “go away”. Focus should be on ways to have the tinnitus not affect you in a major way. Some tips for reducing the impact of tinnitus would be to avoid complete silence (it will make the tinnitus more noticeable), reduce stress and decrease noise exposure.
Rocker: I’ve heard that some medications can produce or increase ringing in the ears. If your ears are ringing from medication, is it creating damage to your hearing or is it just a sign of damage? Should it go away after going of medication or are you risking being stuck with the problem for life?
Candice: Yes, there are over 400 medications that can cause or exacerbate tinnitus, if this occurs you should contact your physician to discuss this side effect. Tinnitus will not damage your hearing, but often individuals with hearing loss will experience tinnitus. Typically if tinnitus is a side effect of medication, it will often resolve once the medication is discontinued.
Rocker: Do listening to certain instruments or types of music do more damage than others? Or is it always really about volume. Like, if someone played an electric guitar vs say, a bassoon at the same volume would it have the same chance of inflicting hearing damage?
Candice: Again, it is about the level and how many hours of continuous exposure. There have been some studies indicated that instruments that resonate the skull (such as brass or wind instruments) can cause more hearing damage. Drums tend to be prime offenders as well, since they produce loud impact sounds.
Rocker: What is going on in the world of hearing aids? Is there evidence that one day soon they will be able to just fix your ears rather than wearing an aid? Or can they do that now?
Candice: Well that is a question that would take most of this interview, as hearing aid technology is constantly evolving. But it should be noted that no mater how sophisticated a hearing aid, it cannot replace all of the functionality of a “normal” human ear. Hearing aids are not like eye-glasses that can restore 20/20 vision.
There is always ongoing research in restoring impaired hearing, but at the current time there has only been some success in animal models.
Rocker: When it comes to hearing aids I think people often see ads on TV for ones like Miracle Ear that tout their invisibility, but are there others that strive to be stylish or could be worn as a kind of hip, futuristic accessory? Do you have a pick for the sexiest hearing aid?
Candice: Well, there are quite a few hip hearing aids out there these days. Many of the Receiver-in-the Ear style (which feature a small piece behind the ear with a near invisible wire leading to the ear canal) are considered to be “in” right now. They are small, stylish, come in a variety of colors, they definitely are not your grandparent’s hearing aid!