‘Hearing Impairment and the Enjoyment and Performance of Music’

Conference at Institute of Acoustics, Kingston University, 9 July 2015

Only six months into our project, we were pleased to be invited to talk at an Institute of Acoustics (IoA) conference on the topic of hearing aids and music. Delegates included audiologists, music therapists, technical consultants, acousticians, psychologists and, of course, hearing aid users themselves.

Opening the conference was Mike Wright, Chair of the Musical Acoustics Group at the IoA, who began by reminding us that there is a longstanding need to understand music listening for people with hearing impairments. He cited a famous quote by the deaf percussionist, Evelyn Glennie, about the nature of our senses:

“…in the Italian language… the verb ‘sentire’ means to hear and the same verb in the reflexive form ‘sentirsi’ means to feel. Deafness does not mean that you can’t hear, only that there is something wrong with the ears. Even someone who is totally deaf can still hear/feel sounds”. (Glennie, 2010)

In the first talk, Graham Frost, an audiologist and technical consultant, introduced principles about the effects of deafness on music perception. Deafness affects intensity or ‘loudness’ perception, but it also affects how we perceive frequency or ‘pitch’ and temporal aspects such as ‘rhythm’ or timing. For example, we recognise different instruments because they have different harmonic profiles and onset rise times. Music can also cause people with hearing impairments to experience tinnitus (ringing or buzzing in the ears), hyperacusis (extreme sensitivity to sounds) or diplacusis (experiencing different pitches or timings in each ear). Graham argued that we cannot predict the effects of deafness on music perception from standard audiometry alone, only measure thresholds of sound intensity. Every hearing loss is unique and can only be partially compensated for.

Next, acoustician Peter Mapp (Peter Mapp Associates) talked about assistive listening devices (ALDs) for music and speech. At home, listening to the TV or radio, many people can simply turn the volume up. However, in live settings, this is not possible and many people experience issues with reverb, and background noise. The good news is that many venues use T-loop, infrared and new Wi-Fi technology to feed sound directly to the hearing aid. The bad news is that not all venues are using the best microphone technology and this can affect both speech and music intelligibility. Manufacturers may be wary of Noise Regulations as they do not want to be sued for causing hearing damage from over-amplification!

Acoustician Carl Hopkins (University of Liverpool) then talked about a project which aimed to help musicians with hearing impairments access music by feeling vibrations. Carl showed how our sense of touch is far more limited than hearing. For this reason, the team identified the best pitch range for feeling vibrations on the skin of the hands and feet and also showed that hearing people are no less sensitive that deaf people to vibrations. Perhaps vibrations could be used to help all musicians in group performance? The researchers demonstrated the musical power of vibrations by playing a Beatles song ‘Day Tripper’ in separate, acoustically isolated rooms where instead of hearing each other, they could feel the vibrations of each other’s instruments. Click here to see the video.

After lunch, Music Therapist and Educator, Christine Rocca (Nordoff Robbins / Mary Hare Schools), presented a number of case studies from her work with children with cochlear implants (CIs), some of whom also wear hearing aids. The children at Mary Hare explore pitch glides and interval imitation in the context of familiar songs like ‘Humpty Dumpty’, often exploring major and minor intervals. The therapists and teachers use both recorded and live accompaniments for the children which helps them pick out their part. Christine highlighted that music is ‘multi-sensory’ and even very young babies can learn social ‘turn-taking’ and imitation skills by playing musical games.

On a similar theme, Janet McKenzie, a Speech and Language Therapist (SLT) at the Cambridge Hearing Implant Centre spoke about musical development in children and adults with CIs. For CI users, music is often a positive, unexpected outcome; people who had never previously experienced music are suddenly able to access musical rhythms and melodic shapes. In fact, due to changes in candidacy criteria, some people are now being implanted just so that they can access music and environmental sounds.

Stephen Dance from the London South Bank University shared his research on the hearing acuity of music students at the Royal Academy of Music. So far, 2,576 students have completed audiometric tests and the team have identified patterns of hearing loss attributed to noise induced hearing loss (NIHL) in musical settings. The findings showed that players of certain instruments such as the organ, percussion and brass are most at risk of hearing loss. There were also some lateralised effects; violinists’ and horn players’ left ears are affected more than their right, and piano accompanists have worse hearing in the right ear potentially as a result of working with singers. The ‘notch’ in the audiogram as a result of music-induced hearing loss seems to be at 6kHz rather than 4kHz for musicians but this could be consistent with different kinds of hearing loss.

Finally, we presented initial findings from our patient survey of two UK audiology clinics, one NHS, one private. The short questionnaire asked hearing aid (HA) users about their music listening experiences, effects on quality of life, and the extent to which they had discussed music listening with their audiologist. So far, results showed that HA users frequently experience problems with music listening and almost half of the sample reported that this negatively affects their quality of life. The most common problems reported were a lack of fidelity, difficulty hearing words in songs, and issues hearing at live music performances.  The data also suggested that most participants had never talked with audiologist about music listening, and for those that had, the outcomes had rarely been successful.

The closing discussion that followed raised many issues. Hearing aid manufacturers have responded to demand from the user market to make HAs small and discreet. This has meant that batteries are also smaller and less powerful (< 3 volts), while conversely, the digital signal processing contained within them for optimising speech amplification has become more and more complex. Multi-channel compression requires a lot of processing power and therefore battery power. Perhaps simpler processing would be better for music? One idea would be to set up a person’s HA for each instrument or the type of music they listen to the most. But, as Evelyn Glennie once told me, every acoustical situation is different and even the same instrument never sounds the same.

The group also discussed the problem of uptake for hearing aid users. There are 6 million people who would benefit from hearing aids in the UK alone but only 1.4 million wear them regularly. Many people find it difficult to take the time to adjust to the new sound world provided by their new HAs, which audiologists know to be beneficial in the longer term. Perhaps if HAs were designed for amplifying music as well as speech, more people would wear them?

If you have any thoughts or questions, or would to share your experiences of listening to music with hearing aids, please email us musicandhearingaids@leeds.ac.uk or join our Discussion Forum.


We are recruiting for a new research study

Do you use hearing aids?


We need participants for an interview study taking place between July – December 2015 about music listening.

We are recruiting hearing aid users interested in taking part in a study about music listening. Interviews will last for 1 hour and you will also receive an audiometric assessment at Sheffield Teaching Hospitals NHS Foundation Trust.

If you are interested, please email your answers to the following questions to musicandhearingaids@leeds.ac.uk:

  • What is your level of deafness?
  • Are you musically trained?
  • Has your hearing level changed over the last 2 months?
  • Have you experienced any of the following in the last 2 months: auditory processing disorders / auditory neuropathy / fluctuating hearing loss / recent acute hearing loss / ear infection / significant asymmetry in hearing loss / problematic tinnitus or hyperacusis?
  • Do you use one or two hearing aids?
  • Do you have a cochlear implant?
  • Is English your first language?

To take part, or if you have any questions, please email musicandhearingaids@leeds.ac.uk.

Many thanks,

Music and Hearing Aids Project Team

Music and Ménière’s Disease

Alan JacquesAlan Jacques is a musician based in Edinburgh. He was interested in talking about his experience of changes to his perception of music as a result of Ménière’s Disease, a rare progressive disorder of the inner ear. Read his story below:



“I am a retired psychiatrist living in Edinburgh.  I retired early with a view to pursuing a lifelong interest in music.  I am a pianist and gained the ATCL and LGSMD in Performance shortly after retiring.  My particular interests have always been in accompaniment and chamber music and I have considerable experience of public performance, both on the piano and as a choral singer and for a short period a not very competent choir conductor.  My musical abilities are circumscribed: I am a good sight-reader and enjoy the interpretative aspects of reproducing music, but I am poor at memorising, improvising, or creating music.  And I have never had much ability to ‘hear music in my head’.

“Looking back I wonder if I have always been hard of hearing in my right ear, since when Stereo arrived to the great excitement of musical teenagers I never could work out where the various instruments were.

“About twelve years ago (aged 58) I began to develop Ménière’s disease with all the usual symptoms of fullness in the ears, tinnitus, hearing impairment and severe dizzy turns, and the characteristic very variable course.  I am now moderately-to-severely deaf in both ears and constantly require hearing aids.  About two years into the illness I began to notice a problem with pitch perception – I wrongly accused a highly competent singer of singing the wrong note, for example.  I then noticed that I heard different pitches if I listened to a tuning fork in each ear.  I only recently learned that this is called diplacusis.  Like the illness, it was very variable.  At its worst, I couldn’t recognise music I was listening to because I was hearing all the wrong notes.  A striking example was a wedding I went to ten years ago where the choir sang Parry’s I Was Glad, which I have sung hundreds of times – I had to ask what it was they were singing.  At best there were times when everything got largely back to normal, though even then I noticed that when I moved from playing one piece to another it took me a few bars to register the tonality.

“Things have got steadily worse particularly in the last two or three years and I appear to be now permanently at the worst level.  If I play a note several times I can sing an approximation to it, but if a tune is played I cannot recognise it unless by inspired guesswork.  I cannot recognise chords, can’t tell major from minor, cannot understand modulations, and have great difficulty even in guessing what instrument is playing in broadcast or recorded music.  Concerts are a no-go area, because they just sound like an awful cacophony. This is not just a problem caused by my hearing impairment itself, for I hear the noise of music.  It’s that my cochlea is sending the wrong messages to my brain.  Interestingly I sometimes hear a note related to the note I am playing (e.g. a fifth out), but more often it is just a pitch-less noise.

“My musical brain is as far as I know working perfectly well, indeed possibly overworking.  MRI scans and neurological tests confirm that this is a purely cochlear problem.  What I am noticing about the mental element in ‘hearing’ music is that my brain is, as it were, ironing out the messages it is getting, so simplifying what I appreciate.  When the music modulates I ‘hear’ it in the first key until it finally gets through that I’m in the wrong zone.  The other example of my brain being creative is in the difference between familiar and unfamiliar music I am playing.  With very familiar music I somehow imagine that I am hearing the tunes and some of the harmony, but if I try to play an unfamiliar score it is completely meaningless.

“I have continued to play throughout my illness and my teachers say I am producing a more than acceptable and improving musical performance.  To me it is a noisy clatter.  I had to give up all ensemble playing two years ago, but this was actually more to do with the fact that I had had to cancel two performances because of Ménière’s dizzy spells and, the last straw, had a dizzy attack in the middle of a public recital and had to terminate the performance.  I am now concentrating on solo playing and for example am now on my fourth cycle of studying the Beethoven sonatas and am performing them one at a time at a local little music club.  In the past year I have found it necessary to stick almost entirely to music that I know to some extent – I simply can’t make sense of unfamiliar music.  I surprise myself with how much I enjoy playing, though I do wonder how much of that is a lifelong habit rather than present experience.

“I would be interested in meeting or corresponding with other musicians with similar problems.  I gather that diplacusis is a much commoner problem than I thought – a survey of British orchestral musicians is said to have reported it in 5% of respondents with 12% experiencing distortion (Laitinen & Poulsen, 2008). I know that the needs of hard-of-hearing and deaf musicians are at last being addressed, but I guess I am not the only musician who has this severe form of ‘cochlear amusia’.  I have only located one other person with the problem through the Ménière’s Society (he had felt forced to give up his musical life), but I intend to try again.

Alan Jacques

June 2015

Laitinen, H., & Poulsen, T. (2008). Questionnaire investigation of musicians’ use of hearing
protectors, self reported hearing disorders, and their experience of their working environment. International Journal of Audiology, 47(4), 160-168.

It seems to me that music perception is a very complex process. Our brain works hard to make sense of musical information and, when things go wrong, our auditory brain can to some extent ‘fill in the gaps’ but not perfectly.

Alan’s story reminded me that the amplification of acoustic sound and music using hearing aids is only one part of the process – there is always a person at the end of the technology.

If you want more information about Ménière’s disease, please see the Ménière’s Society website.

Or to share your experiences, click to our Discussion Forum and tell us more.


Hearing aids at the Thackray Medical Museum

Thackray logoGoing back in time: hearing aids through the decades

In March this year, just a few weeks into our project ‘Hearing aids for music’, the project team visited the Thackray Medical Museum in Leeds.

We wanted to learn something about the history of hearing aids from the important collection of amplification and audiology equipment housed there.

But we also had another agenda… We wanted to see if there was any evidence in the collection of hearing aids having been used to amplify music – not just speech.

Read more

‘Hearing aids for music’ project secures £250k AHRC funding

ahrc-logoThe School of Music at the University of Leeds is celebrating as Dr Alinka Greasley has secured a significant research grant from the Arts and Humanities Research Council.

Dr Alinka Greasley is a Music Psychologist who has secured an award of £247,295 for a project that will explore the music listening behaviour of people with hearing impairments.

The three year interdisciplinary project will bring together researchers in the fields of music psychology and clinical audiology and represents the first large-scale systematic investigation of how music listening experiences are affected by deafness and the use of hearing aids.

She will lead the project accompanied by Co-Investigator Dr Harriet Crook, from Sheffield Teaching Hospitals NHS Foundation Trust and Dr Robert Fulford, Post Doctoral Research Fellow in Music Psychology at the University of Leeds.

The research will benefit from the input of a highly esteemed advisory panel consisting of academics and practitioners with expertise in auditory processing, signal processing, HA fitting, HA manufacturing, hearing therapy and deaf education.