Awareness and attitudes towards ear health in classical music students-advancing education and care for professional ear users

Abstract

Background and aim: Classical music students, as a key group of professional ear users (PEUs), rely heavily on their auditory perception, making ear health critical to their education and careers. However, significant gaps in their knowledge of hearing health and protection have been previously identified, while data on non-noise-related risk factors and broader aspects of ear health remain scarce. This study aimed to evaluate classical music students' knowledge of ear health, including ear anatomy, common ear disorders, and non-noise-related risk factors such as ototoxic medications and cardiovascular risk factors, as well as attitudes toward specialized ear health care. The goal was to inform the development of tailored educational programs and evaluate the need for specialized ear health care in performing arts medicine.

Methods: A questionnaire specifically designed for the purpose of the present study (Professional Ear User Questionnaire) was distributed to classical music students at music schools in Switzerland and Germany, as well as to medical and general students at a Swiss university. Statistical analyses, including Fisher's exact test and principal component analysis, explored response patterns and identified factors influencing ear health knowledge and behavior.

Results: Data were collected from 209 music students and two control groups of 65 medical students and 40 general students. Significant gaps in ear health knowledge were identified, with only 37.8% familiar with common ear disorders. A total of 52.4% rarely or never used hearing protection, despite 84.4% expressing concerns about potential hearing deterioration. Many were unaware of non-noise-related risk factors, such as ototoxic medications. Only 27.4% knew of an ear specialist for PEUs, yet 72.1% preferred a hearing exam at a specialized clinic.

Conclusion: The study highlights the need for comprehensive ear health education tailored to the unique needs of classical music students and other PEUs. Educational programs should cover both noise and non-noise-related risk factors and promote early hearing protection. The preference for specialized care underscores the importance of establishing dedicated ear health clinics for PEUs. Collaborations between (university) music schools, healthcare providers, and policymakers is crucial to protect the ear health of music students, musicians, and other PEUs, ensuring their ability to perform without preventable ear disorders.

Keywords: auditory system; health education; hearing; music education; performing arts medicine; prevention; survey.

Figure 1

Answer distribution in the professional ear user questionnaire of music students (n = 209; A), medical students (n = 65; B), and general students (n = 40; C). Answer distributions to questions irrelevant or not applicable to medical and general students are shown in light colors (Q13, Q19–22). The figure includes a statistical comparison of the answer distributions of medical and general students compared to music students, with significance levels indicated by asterisks (*, p < 0.05; **, p < 0.01; ***, p < 0.001; ****, p < 0.0001). The x-axis represents the percentage of students in each response category: “Strongly disagree/Never,” “Disagree/Rarely,” “Agree/Often,” and “Strongly agree/Very often.”

Figure 2

Principal component analysis (PCA) of responses from music students (n = 209) to the professional ear user questionnaire. The component matrix displays the factor loadings for each question, indicating the degree to which each question (Q) correlates with each factor. A higher absolute value of a loading indicates a stronger association between the item and the factor. The heatmap color scale ranges from 0 (low correlation, dark blue) to 1 (high correlation, yellow).