Noise-induced hearing loss is an occupational hazard among musicians, and it's not just members of heavy metal bands who are vulnerable.

Professional musicians are almost four times as likely to develop hearing loss as a result of their repeated and close exposure to loud sounds, according to a new study. They are also nearly 60% more likely to develop the incessant ringing in the ears known as tinnitus as a result of their job.

Researchers looked at health records of seven million German citizens from three German health insurance providers. Some 2,227 of this group identified themselves as employed as professional musicians.

Prolonged exposure to music at close range can cause the same sorts of deficits seen in industrial workers.

During the four years of the study, roughly 284,000 cases of hearing loss were registered on the database; 238 of the cases were among professional musicians.

One of the most common causes of noise-induced hearing loss is a sudden very loud noise, such as an explosion or gunfire, but hearing loss often develops gradually: repeated long-term exposure to industrial noise, for example, has been clearly linked to hearing damage, including the inability to hear the full range of sound.

Being exposed to music had long been believed to improve hearing, but this study disproves that and shows how prolonged exposure to music at close range can cause the same sorts of deficits seen in industrial workers.

“Our data suggest that in professional musicians the risks of music induced hearing loss outweigh the potential benefits for hearing ability, as reported by [other researchers],” the authors conclude.

Even after the researchers adjusted for age and other influential factors, such as sex and whether a person lived in a noisy urban area, professional musicians were still more likely to have noise induced hearing loss than the general public.

Professional musicians should use protective in-ear devices, particularly when practicing, whether they are playing in rock bands or orchestras, and whenever sound amplifiers are used. The researchers suggest that to reduce the risk, sound shields might also be installed between different sections of an orchestra, “Given the number of professional musicians and the severity of the outcome, leading to occupational disability and severe loss of quality of life, hearing loss in [this group] is of high public health importance.”

The study is published in Occupational & Environmental Medicine.