AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 31:75–79 (1997)

Risks of Developing Noise-Induced Hearing Loss

in Employees of Urban Music Clubs

Erik Gunderson, BA,1 Jacqueline Moline, MD, MSc,2* and Peter Catalano, MD3

Noise-induced hearing loss has previously been reported among rock musicians. This study
sought to determine whether a hazard of noise-induced hearing loss exists for music club
employees other than musicians themselves. Sound levels at eight live-music clubs were
measured and symptoms of noise exposure in 31 music club employees were assessed by
questionnaire. The average sound level at the various clubs during performances ranged from
94.9 to 106.7 dBA. The overall sound level average, including both performance and ambient
levels, ranged from 91.9 to 99.8 dBA. Symptoms of noise exposure, such as tinnitus and
subjective hearing loss, correlated with sound intensity. Only 16% reported regular use of
hearing protection. We conclude that employees of music clubs are at substantial risk of
developing Noise-Induced Hearing Loss, due to chronic noise exposure which consistently
exceeded safe levels. Hearing protection is used much too infrequently. The development of
hearing conservation programs for this large group of workers is essential. Am. J. Ind. Med.
31:75–79 r 1997 Wiley-Liss, Inc.

KEY WORDS: noise-induced hearing loss; occupational; music sound levels

INTRODUCTION elastic inner ear compartments are stretched beyond their

limits and are physically torn by the impact of the noise
Hearing loss afflicts 28 million people in the United peak. In contrast to this mechanical type of injury, chronic
States, 10 million of whom became impaired at least in part exposure to noise between 90 and 140 dB results in
from exposure to loud sounds [Consensus Conference, permanent metabolic cochlear damage, called noise-induced
1990]. Hearing impairment has a major impact on an hearing loss (NIHL) [Clark, 1992]. The extent to which
individual’s ability to communicate. Even a mild hearing NIHL progresses depends on both the intensity and duration
impairment can adversely affect quality of life. of noise exposure, as well as differences in individual
Noise injures the hearing apparatus in the ear by two susceptibility [Consensus Conference, 1990; Clark, 1992].
distinct mechanisms. An intense noise peak exceeding 140 Initial exposures to sound levels within the 90 to
decibels (dB) can cause immediate and usually permanent 140-dB range result in a temporary threshold shift (TTS), a
hearing loss. This is termed acoustic trauma, whereby the transient hearing impairment in which there is an increase in
the hearing ‘‘threshold,’’ the quietest sound that can be
detected. Repeated TTS over the course of a few weeks to a
few years may lead to accumulated cellular damage, causing
1Department of Community Medicine, Division of Occupational and Environmen- a permanent threshold shift (PTS) [Consensus Conference,
tal Medicine, Mt. Sinai Medical Center, Medical Student, New York, NY. 1990; Clark, 1992]. Although TTS alone cannot predict the
2Department of Community Medicine, Division of Occupational and Environmen-

tal Medicine, Mt. Sinai Medical Center, New York, NY.

magnitude of PTS, it is believed to be an early indicator of
3Department of Otolaryngology, Mt. Sinai Medical Center, New York, NY. permanent damage [Luz et al., 1973].
Sponsored by NIEHS; CDC/NIOSH, grant number T42.CCT210425-02. The development of permanent hearing loss through
*Correspondence to: Dr. Jacqueline Moline, Mt. Sinai Medical Center, Depart- chronic exposure to excessive noise levels is of great
ment of Community Medicine, Box 1057, 1 Gustave L. Levy Place, New York, NY,
importance, because an estimated 20 million Americans are
10029.
exposed to hazardous noise levels on a regular basis
Accepted for publication 30 April 1996. [Consensus Conference, 1990]. Of these persons, 11 million

r 1997 Wiley-Liss, Inc.

76 Gunderson et al.

are exposed in the workplace [Bahadori and Bohne, 1993], calibrated TK-3 portable dosimeter (A-weighted). To approxi-
making occupational noise exposure the most common mate the bartenders’ exposure, the dosimeter was worn by an
cause of NIHL [Consensus Conference, 1990]. Standards set investigator standing near the midpoint of the bar. With the
by the Occupational Safety and Health Administration dosimeter microphone clipped to a shirt collar, noise expo-
(OSHA) limit the maximum allowable exposure in the sure was measured for a minimum of 30 min while the band
workplace without the use of hearing protection to a time- played, and for at least 10 min during intermissions or before
weighted average (TWA) of 90 dB in the A scale (dBA) for the start of the performance, to determine ambient noise
an 8-hr period, with a 5-dBA trading ratio (i.e., a 5-dBA levels. To validate the testing protocol, a bartender wore the
increase or decrease in volume results in the halving or dosimeter on one occasion. These data were used for
doubling, respectively, of permissible exposure time) [De- comparison with data collected by an investigator on a
partment of Labor Occupational Noise Standard, 1983]. different night while the same band performed at the same
Further interpretation of OSHA standards indicates that venue.
exposure to sound levels above 115 dBA are not permissible The dosimeter automatically calculated the average
for any length of time [Department of Labor Occupational sound level during the exposure time (Lavg) and determined
Noise Standard, 1983]. the peak sound pulse of 0.1-sec duration. The distance
Many studies in the past have examined the sound between the midpoint of the bar and the stage speakers was
levels of live music and their corresponding effects on estimated by counting the number of paces between the two
hearing among musicians and patrons. A review of all points. Sixteen paces corresponded approximately to 10 m.
published data found the geometric mean of sound levels in When working conditions were not busy, all available
concert halls and arenas to be 103.4 dBA [Clark, 1991; employees were asked to complete a questionnaire. Thirty-
one of 32 responded (24 bartenders, 4 waiters or waitresses,
Flugrath, 1969; Dey, 1970]. In several occupational studies
3 sound or lighting personnel), giving a participation rate of
of sound level exposure of rock and roll musicians, noise
97%. Information obtained from the questionnaire included
levels have ranged between 90 and 130 dBA [Speaks et al.,
the total length of all previous nightclub employment, the
1970; Jerger and Jerger, 1970; Axelsson and Lindgren,
typical daily and weekly work hours, the use of hearing
1978]. Other workers in addition to musicians are exposed to
protection, and the degree to which the employees experi-
loud music in music halls and rock clubs. There are more
enced symptoms of noise exposure.
than 300,000 bartenders and 1.4 million waiters and wait-
Statistical analysis of dosimetry data was carried out
resses in the United States, many of whom work in music
using the JMPt statistical package (SAS Institute, JMPt
clubs [U.S. Bureau of the Census. Statistical Abstract of the
User’s Guide, Version 2, 1989). analysis involving ordinal
United States, 1994]. The exposure of these individuals
questionnaire data was performed using the Mantel-
varies from that of employees of concert halls or the patrons Haenszel test of the SASt statistical package (SAS Institute,
of live music venues, because it is continuous and lacks SAS/SATt User’s Guide, Version 6, 1989).
periods of time for recovery. However, no published studies
have measured the noise intensity in bars and clubs which
feature live music and examined the effect of such exposure RESULTS
on bartenders, waiters and waitresses, or sound and lighting
personnel. Dosimetry Data
To determine whether music club employees are at risk
of developing NIHL, this study assessed the noise exposure Three to four sound level measurements made during
of these workers. Such information is essential for making band performances as well as during intermissions were
averaged. In addition, an overall sound level average for
recommendations on the use of hearing protection and could
each club was determined by averaging all performance
aid in the prevention of hearing loss in this large group of
and ambient levels. These results are depicted in Figure 1
workers.
with a generalized classification of the music genre played
during the nights of data collection: jazz, hip-hop, blues,
METHODS rock, hard rock, and amplified-acoustic rock. The overall
average sound level at all clubs exceeded the OSHA
Eight New York City music clubs that feature live bands standard of 90 dBA and ranged from 91.9 to 99.8 dBA (jazz
comprised the study sites. Venues were chosen to include 92.7; hip-hop 95.0; blues 99.2; rock 98.3, 91.9, 97.8; hard
various club sizes as well as different genres of music, such rock 99.8; and amplified acoustic rock 92.7). The average
as jazz, blues, hip-hop, rock, hard-rock, and amplified- performance sound levels ranged from 94.9 to 106.7 dBA.
acoustic rock. Each club was visited three to four times Performance sound levels at all venues were greater than
between 9 PM and 2 AM during the time when the bands the average ambient sound levels, which ranged from 83.7
were playing, and sound levels were measured with a to 97.1 dBA.
 Noise-Induced Hearing Loss in Music Club Workers 77

employment: recent (,3 years), intermediate (3–10 years),

and long-term (.10 years).
Employees who worked in louder clubs were found to
experience more symptoms of noise exposure (tinnitus) after
work (p 5 0.01) and were more likely to perceive a hearing
deficit after work (p 5 0.04) (Fig. 2).
Recent employees perceived more hearing loss after
work than did employees of longer duration (p 5 0.04). The
relationship between tinnitus after work and employment
duration approached statistical significance (p 5 0.11).
Fifty-five percent (17/31) of employees felt that they
could not hear as well in general since becoming employed
at a music club. Hearing difficulty was not associated with
club sound level (p 5 0.95), duration of employment (p 5
0.70), or the use of hearing protection (p 5 0.842). Fifty-five
percent (17/31) of employees reported the use of hearing
protection never/rarely (0–25%), 29% (9/31) reported hear-
ing protection use sometimes (25–75%), and 16% (5/31)
FIGURE 1. Average sound levels measured at New York City 1994 survey of
reported hearing protection use often/always (75%–100%).
music clubs with different genres of music. (1) blues, (2) hip-hop, (3) rock, (4)
No employees were observed wearing hearing protection
amplified acoustic rock, (5) rock, (6) jazz, (7) rock, (8) hard rock.
during data collection.

Peak sound levels exceeded 115 dBA, the OSHA DISCUSSION

maximum allowable exposure limit without protection,
during 2 of 3 (67%) of hard rock performance measure- This study demonstrates that employees of urban music
ments, 3 of 9 (33%) of rock, and 1 of 4 (25%) of blues clubs which feature live bands are exposed to noise levels
measurements. Peaks did not exceed 115 dBA at jazz, that consistently exceed safe levels. The average perfor-
hip-hop, or amplified-acoustic rock performances, nor did mance sound levels ranged from 94.9 to 106.7 dBA. Using
they exceed 115 dBA during any ambient sound level the 5-dBA trading ratio of OSHA standards for permissible
measurements. exposure time above 90 dBA, the allowable exposure times
The clubs varied in size and had maximum oc- during performances would range from approximately 4 hr
cupancies ranging from approximately 150 to 2,000 people. to ,1 hr at the loudest venue [Department of Labor
The distance from the midpoint of the bar to the stage Occupational Noise Standard, 1983]. In addition, ambient
speakers ranged from 6 to 52 paces (3.8 to 32.5 m). There sound levels ranged from 83.7 to 97.1, showing that
was no relationship between distance from the noise source substantial noise exposure may occur even when the band is
and noise level among clubs (r 5 0.54, p 5 0.4069). not performing. This finding suggests that noise exposure
Noise exposure of a bartender who wore the dosimeter may also be excessive in music clubs that do not feature live
was comparable to that of an investigator on a different bands, thus further increasing the numbers of workers in the
occasion during a performance by the same band at the bar and restaurant industry at potential risk of NIHL.
same venue. The investigator stood at the midpoint of the Overall sound levels ranged from 91.9 to 99.8 dBA,
bar. Sound levels measured by the bartender and exceeding the 90-dBA limit set by OSHA for the maximum
investigator, respectively, were as follows: ambient levels allowable noise exposure in the workplace without the use
(94.3 and 95.6 dBA), performance levels (98.8 and 96.6 of hearing protection. The average sound levels of the
dBA), peak levels (116.3 and 113.5 dBA). different clubs were not related to distance of the bar from
the stage speakers. This suggests that club size is not a risk
Questionnaire Data factor for NIHL. Sound levels were more dependent on the
genre of music. Sound levels of jazz, hip-hop, and amplified-
The degree to which employees experienced tinnitus acoustic rock performances were lower than levels for blues,
(ringing) and the perception of hearing deficit immediately rock, and hard rock. Furthermore, performances of these
after work were grouped into three categories: never/rarely louder genres were the only instances where peak levels
(0–25%), sometimes (25–75%), often/always (75–100%). exceeded 115 dBA.
The Mantel-Haenszel test was used to compare these criteria It is important to note that the sound levels reported here
to the average volume of the clubs: low (,93 dBA), medium were measured by an investigator standing at the midpoint
(93–98 dBA), high (.98 dBA), and to the duration of of the bar. Comparison of investigator exposure to that of a
78 Gunderson et al.

FIGURE 2. a: Percentage of employees with symptoms of noise exposure after work. b: Percentage of employees experiencing hearing loss after work.

bartender who wore the dosimeter under similar conditions hr or more after cessation of excessive noise exposure
suggests that this method of data collection is representative [Sataloff and Sataloff, 1987]. For employees who work
of bartender exposure. The noise exposure of waiters and regularly, it is possible that there is insufficient time between
waitresses, and of sound and lighting personnel, may vary work shifts for the temporary deficit to improve. Although
from bartender exposure, because these workers usually the damage is not permanent, employees might perceive
spend more time near the stage where sound levels are such a continuous deficit as general hearing loss.
higher. Hearing protection is used much too infrequently by
Immediately after their work shifts, employees of bartenders and waitpersons; only 16% use hearing protec-
louder clubs experienced more symptoms of excessive noise tion regularly, while 55% reported never or rarely using
exposure, such as tinnitus and the perception of a temporary protection. This finding might explain why the use of
hearing deficit. This finding suggests that their occupational hearing protection was not related to the perception of a
noise exposure has an adverse physiological effect on general hearing deficit. Hearing protectors must be worn for
hearing, and that the degree of this effect is related to sound a very high proportion of the exposure time for them to
intensity [Mollar, 1977; Okada et al., 1991]. afford worthwhile protection [Else, 1973]. A larger sample
Recently employed workers were more likely to per- size may be useful for further examination of this relation-
ceive a temporary hearing deficit after work. Similar trends ship.
existed with tinnitus and duration of employment that might Future projects should include audiograms to determine
reach significance in a study with greater statistical power.
the prevalence of permanent damage. By screening employ-
This is consistent with the findings of Taylor et al. [1965],
ees for a 4,000-Hz audiometric notch, the common initial
who demonstrated that more recent employees with indus-
finding during the progression of NIHL [Sataloff and
trial noise exposure experienced the most tinnitus. Long-
Sataloff, 1987], more extensive hearing loss could be
term employees may have become desensitized to percep-
prevented. In addition, audiometric examination after em-
tions of hearing deficit or tinnitus after work, or these
ployee work shifts would be useful to detect the presence of
employees may have experienced permanent threshold shift
a TTS. Employees with normal hearing who are at risk for
(PTS).
future permanent damage would be identified. Hearing
Fifty-five percent of employees surveyed felt that they
protection could be implemented even before permanent
generally could not hear as well as previously since becom-
deficit occurs.
ing employed at a music club. The finding that this general
hearing deficit was not related to club sound levels might be
attributable to the fact that even the ‘‘low’’-level clubs had CONCLUSION
average sound levels that exceeded 90 dBA. It is unclear
why the perception of hearing deficit was not related to Noise-induced hearing loss is one of the 10 leading
duration of employment. It is possible that newer employees work-related disorders [CDC, 1983]. This disorder, which
perceive the temporary threshold shift (TTS) after work as a greatly interferes with an individual’s sense of well being
general deficit. Temporary threshold shifts generally last 24 and ability to communicate, is entirely preventable.
 Noise-Induced Hearing Loss in Music Club Workers 79

Employees of music clubs that feature live and/or Clark WW (1991): Noise exposure from leisure activities: A review. J
Acoust Soc Am 90:175–181.
recorded music experience chronic noise exposure ranging
from 91.9 to 99.8 dBA during their work shifts. At time- Clark WW (1992): Hearing: The effects of noise. Otolaryngol Head Neck
weighted exposure levels of .90 dBA, OSHA requires that Surg 106:669–676.
employees wear hearing protection. However, OSHA does Consensus Conference (1990): Noise and hearing loss. JAMA 263:3185–
not regulate these establishments with regard to employee 3190.
noise exposure. Unfortunately, routine inspections by OSHA
Department of Labor (1983): Department of Labor Occupational Noise
are virtually nonexistent in industry and are even rarer for Standard. Code of Federal Regulations 29 CFR 1910:95.
small businesses such as the music facilities in this study.
Consequently, hearing protection is used infrequently by the Dey FL (1970): Auditory fatigue and predicted permanent hearing defects
from rock-and-roll music. N Engl J Med 282:467–470.
workers of these establishments, and symptoms of excessive
noise exposure are common. More than 50% surveyed felt Else D (1973): A note on protection afforded by hearing protectors—
that they generally could not hear as well since becoming Implications of the energy principle. Ann Occup Hyg 16:81–83.
employed at a music club. Hearing conservation programs Flugrath JM (1969): Modern-day rock-and-roll music and damage-risk
need to be developed for the employees of music clubs. criteria. J Acoust Soc Am 45:704–711.
Providing education about the risks of NIHL and the
Jerger J, Jerger S (1970): Temporary threshold shift in rock-and-roll
necessity of regular use of hearing protection is essential for musicians. J Speech Hear Res 13:221–224.
the prevention of hearing loss in this large group of workers.
Luz GA, Fletcher JL, Fravel WJ, Mosko JD (1973): The relation between
temporary threshold shift and permanent threshold shift in rhesus monkeys
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viewpoints. Scand J Work Environ Health 3:73–79.
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B.S., and Katherine Gleaton in the preparation of this vessels after rock music exposure. Acta Otolaryngol (Stockh) (Suppl) 486:
61–65.
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