Stage Monitoring with Hearing Loss

This article provides practical guidance for performers with hearing loss, as well as supporting knowledgeable audio engineers who are mixing monitors for an artist with hearing loss. For further discussion on the topic, please listen to the Talking Ears episode

Performing music in front of an audience has to be one of life’s greatest joys. For musicians, it is often also necessary for their living and to express themselves artistically. While stage monitoring is a notoriously difficult technical problem with many confounding factors, one significant barrier which is underdiscussed is the performer’s own hearing loss.

In clinical visits, the question often comes up: How can we sustain an active music performance schedule when your ears don’t hear the way others do, or the way they used to?

Adjusting stage monitoring for hearing loss is a highly individualized process that depends on the musical setting, the specific genre of music, the composition of the ensemble, and of course your specific hearing loss. Each poses different challenges and also opportunities to take advantage of various solutions, which may include:

• Audiogram-informed EQ and compression processing

• Spatial processing

• Ambient miking and talkback systems

• Purpose-built monitoring systems such as Sensaphonics’ 3DME and AVIOM’ Audiogram EQ

• Instrument-specific pickup and monitoring solutions

The goal with all of these methods is the same: to arrive at a clear and functional mix that delivers what you need to hear to perform.

Image credit: Eno, B., & Adriaanse, B. (2025). What art does: An unfinished theory.

This is a good time to mention that our hearing and monitoring also supports connection with the other important people in the room. Of course this includes the ensemble and anyone else who is on stage with you, but less obviously it includes the audience. A performance becomes a glorified rehearsal if we do not consider the audience. Working with musicians - and being performers ourselves - we know that the feedback from the audience is one of the main draws to the stage.

Another important goal is conserving the hearing that you have. Just because you already have hearing loss does not mean it is too late to practice safe listening and hearing-loss prevention techniques. Instead of preventing hearing loss, we shift focus to conserving residual hearing. This becomes increasingly important as hearing loss becomes more severe, since there is less hearing left to conserve and the impact of losing what remains can be profound.

Finally and possibly most importantly, the goal is to arrive at a musically pleasing monitoring solution. When barriers compound, the joy can quickly escape the live performances.

The Floor and the Ceiling of Sensorineural Hearing Loss

Hearing loss comes in several different types, with sensorineural hearing loss being the most common experienced in adults with sound exposure. For this reason, this discussion will focus on sensorineural hearing loss; however, if you or the artist you are working with has a conductive type of hearing loss, there may be a different set of recommendations beyond the scope of this article.

Reduced dynamic range is a hallmark of a sensorineural hearing loss. Dynamic range can be defined as the distance between the quietest audible sound and the loudest tolerated sound.

Analogy Time! You can think of a typical monitor mix like a tunnel that is wide enough to accommodate most, if not all, of the sound sources in a musical setting. The loudest to the quietest - the tallest to the shortest - fit comfortably through the tunnel when one’s dynamic range is in the normal swing of 90 to 120 dB.

Hearing loss, has two major effects on this dynamic range tunnel:

1. Loss of sensitivity to hearing thresholds. In our analogy, the floor of the tunnel is raised while the ceiling remains where it is. This means the loudest and tallest elements must be squeezed together with the quieter elements just to fit through the newly confined space.

2. On the other end of the spectrum, loudness intolerance (also known as recruitment or hyperacusis) is also common with most sensorineural hearing losses. These effectively lower the ceiling of the tunnel in the same places where the floor has been raised the most, creating a bottleneck that further complicates monitoring options.

Another barrier is that reliable performance requires control and consistency in environments where stage acoustics and setup can vary widely from venue to venue and night to night. These considerations tend to affect traditional wedge monitors more than in-ear monitors, though both systems have limitations in challenging circumstances.

In an ideal situation there would be a dedicated monitor engineer who understands your hearing loss, knows how to adjust for it in the mix, and is attentive enough to resolve issues that may arise during a performance. If this describes your situation, then share this article with them and reach out if we can support your team further.

Self-mixing, however, requires technical skills to understand the processing involved and access these controls from the stage during rehearsals and performances. Satellite units, standalone monitor mixers, touch screen remote control of wireless mixing boards, and app-based sound controls can reduce this barrier, but they require basic technical skills and - more importantly - a willingness to split attention between performance and technical production tasks.

It’s Not Just About Flipping the Audiogram

The first step in adjusting monitoring to accommodate hearing loss is understanding the audiogram, the term used to describe the hearing test results from diagnostic hearing testing.

Actually, the first step is obtaining an updated audiogram. When you meet with an audiologist, here are several things musicians should ask for based on the Clinical Consensus Document: Audiological Services for Musicians and Music Industry Personnel, published by the American Academy of Audiology (AAA) in January 2020.

Standard Audiograms test the octaves between 250 - 8000 Hz. Expanded Audiograms, as recommended by the AAA 2020 consensus document, test additional interoctaves and can cover 125 - 16000 Hz.

All available “Interoctaves” Standard audiometric testing is typically performed at octave intervals between 250 and 8000 Hz. In certain circumstances, additional frequencies are added at the half-octaves, including 750, 1500, 3000, and 6000 Hz. These are referred to as interoctaves in audiometric nomenclature. In musical terms they would be considered fifths. The purpose here is to obtain the highest possible resolution for test of a musician’s hearing status.

Extended High Frequencies 8000 Hz is not considered a particularly high frequency in audio engineering terms, but it is the highest frequency tested in standard audiometric exams. Extended high frequencies are available in many audiometers but are not always included in a standard hearing test unless medically indicated or specifically requested. According to the 2020 clinical consensus document, extended high frequency testing up to at least 16,000 Hz is important for musicians and audio engineers who want to understand the upper octave of their hearing.

There is also evidence that this frequency range is more sensitive to damage from sound exposure and may act as an early indicator of hearing injury that does not yet present in the standard audiometric frequencies.

Extended Low Frequency (125 Hz) Most audiometers are capable of testing 125 Hz, a full octave below the lowest standard audiometric frequency of 250 Hz, though it is not routinely tested. For audio engineers, stopping at 250 Hz can feel like being short-changed since that is barely outside the range of low mids. Still, accurate testing below 125 Hz may not be possible in certain clinical settings due to technical limitations of transducers and variability between test environments.

Speech In Noise Testing (QuickSIN) Our ability to parse complex sound settings is based on interplay between what our ears can take in (our hearing sensitivity) and how well our auditory brain can process the signals. Clinical we test this using speech in noise testing, which does exactly what it says on the tin: the patient is instructed to repeat numbers, words, or sentences with progressively more interfering background noise. Musical training tends to improve one’s score in these tests, but significant sensorineural hearing loss can quickly degrade these results.

Uncomfortable Loudness Levels (UCL) Uncomfortable Loudness Levels may help document loudness growth and perceived levels at suprathreshold intensities. Decreased UCLs may indicate decreased loudness tolerance or hyperacusis and may suggest the need for more aggressive compression (more on this shortly) in those ranges. In the authors’ experience, however, these test values are rarely directly translatable into monitoring processing and should be used with caution.

Demystifying the Audiogram

It is important to understand that your audiogram only shows your thresholds of hearing, indicated by a blue X for the left ear and red O for the right ear. These are the softest levels you are able to hear at each test frequency, with a normal range of -10 to 20 dB HL. However, practically all musical monitoring situations occur far above these thresholds. Music performance settings - from solo acoustic rehearsal to a full live band - occur in the range of 70 to 115 dB SPL with very few outliers on either end.

Because of this, the threshold of hearing is only a partial indicator of how to assist someone with hearing loss who wants to monitor music accurately at these higher levels. As discussed, dynamic range often reduces with sensorineural hearing loss so applying one-to-one gain using EQ may “flatten” an individual’s audiometric thresholds, the signal would quickly become harsh, painful, and potential damaging as inputting sounds exceed the quietest audible level.

Next, we need to address the upside-down elephant in the room: the audiogram’s Y axis is inverted and displays low intensities at the top and high intensities at the bottom. In this way, a hearing loss is shown as a lowering of the threshold. This is, in a word, confusing. So when we “flip” the audiogram (us the audiometric thresholds to inform EQ and dynamic processing decisions) we are normalizing the orientation to the rest of our audio processing displays.

How Can Hearing Aids Teach Us To Mix Monitors for Performers with Hearing loss??

Here we can take some lessons from hearing aid design. Modern hearing aids use complex prescriptive target levels based on decades of research, feedback, and technological advances. While these exceed the scope of this article, we can start with a simple 1/2 or 1/3 gain rule which was historically used as a starting point for amplification fittings.

For example, if a person has a 60 dB hearing threshold, a third-gain rule would apply 20 dB of gain at that frequency, while a half-gain rule would apply 30 dB of gain. The goal was audibility without discomfort.

Modern digital hearing aids instead rely on wide dynamic range compression (WDRC). Compression ratios as low as 1.2:1 or 1.5:1 may be applied across most or all of the signal range.

In other words - and this may make some audio engineers cringe - the compression threshold may be set very low, perhaps at the point of audibility, with the understanding that the compressor will be providing gain reduction nearly continuously. If you find yourself wondering about attack and release times, how the dynamics of music are affected, or how pumping and harmonic distortion are minimized, then you are beginning to understand why music often sounds unsatisfying to musicians through modern hearing aids.

Another reason hearing aids often fall short for music listening is the additional processing designed to improve speech understanding. These systems often include:

• Digital noise reduction

• Feedback suppression

• Speech-focus processing

• Adaptive directional microphones

These algorithms attempt to emphasize speech while reducing noise. However, it does not take much imagination to see how this can be counterproductive for musical sources. For instance, an active noise reduction algorithm may hear the sizzle of a jazz drummer’s ride cymbal as unwanted noise and reduce it unnecessarily.

Speech-focus algorithms are actively seeking spoken language and reducing everything else. For instance, the long sustained tone of a flute, woodwind, or operatic singer may be mislabeled as unwanted feedback and the hearing aid may actively suppress them using phase- or pitch-shift algorithms, which can create unpleasant and unmusical effects.

To summarize, traditional hearing aid gain staging is a helpful analogy for mixing monitors for hearing loss, but the advanced processing inherent in modern hearing aids can be counterproductive when the primary source is music.

Solutions: Traditional Mix Management

The primary solution—and something consistent across all options—is traditional mix management. We are taught early on that if something is buried, it is wise to reduce the interference and turn down the overpowering elements instead of turning up the target source. In other words, focus and simplify the mix.

It can be helpful to divide signals into three categories: (1) Focal Sources, such as your own voice and instruments; (2) Rhythm and Pitch References, such as drums, bass, and click track; and (3) Color/Optional Sources, such as horns, strings, and aux percussion. While these color elements add genre-defining favor to the overall musical setting, they are often not mission-critical to a performer’s ability to execute their part. For performers with hearing loss, optional sources can often be muted or significantly reduced.

To Be Continued…

In the next part of this series, we’ll dive into additional audiogram-informed EQ and dynamics processing, spatial processing, ambient miking, and purpose-built monitoring systems.

If you have any questions before the next section is released, feel free to contact us. Each case is unique and needs individualized attention, and since we’ve seen thousands of cases we can likely help get you on the right track.

Rickie Mazzotta - Sound Profile Interview

Rickie Mazzotta

Drummer and founding member of the explosive and influential band mewithoutYou.

As the group is entering their final year touring, Rickie shares advice and opens up about his recent experiences with Tinnitus and hearing loss: “It is life altering. It happens without warning. It is something to take as seriously as you take your craft.”

Photo credit: Nick Karp

Earmark: What (or who) first drew you towards music making?

Rickie: I got into listening to and subsequently attempting to play music when I was in about sixth or seventh grade. I was a pre-teen when the grunge explosion hit in 92-93 and as an avid MTV watcher, I was a ripe candidate for being the target audience. I was largely influenced by that type of “alternative” rock music and had an uncle who would get me records and take me to concerts as well as a best friend who shared in the same interests. For its time, it was fresh and unique, deviating from the L.A. glam scene that dominated the mainstream. I wasn’t sure how I fit in with all my classmates at school so it seemed like a natural pairing - grunge was about just wearing whatever you wanted and writing songs however you wanted. It also appeared to me that anybody could do it, you didn’t need costumes or even that much skill to get going.

My parents got me a boombox for my 13th birthday alongside Nirvana’s “In Utero” and the Smashing Pumpkins “Siamese Dream” on CD. A year later I would get a drum kit and start to play along to all types of LPs that my Dad had laying around. One particular performance left an impression on me; Nirvana in December of 93 on MTV’s Live and Loud. Dave Grohl was playing so hard and the whole vibe of the performance kind of stuck a chord with me and really put the idea in my head that I wanted to be a drummer; It didn’t hurt that my main boy at the time got a guitar for Christmas. But all in all, growing up in the Lollapalooza era with so many great bands was what set me on the course of being a musician.

Is there someone who inspires you, musically?

This is always one of the hardest questions to answer, it never really is just one musician or album that inspired/inspires me but the sum of many parts fusing together. When I started taking drums seriously, Jimmy Chamberlain was my go to guru, Dave Grohl too. I ripped so many things from their playing, heck, all the people I am about to mention I took all I could from. With how they presented their art, there was never anything that felt too impossible to emulate even though, at times, it was fairly technical, especially being a self taught drummer. As I progressed and got older, Abe Cunningham from the Deftones really pushed me to play harder and be dedicated to keeping a certain level of intensity while performing. Brendan Canty of Fugazi introduced me to elements of rhythm I was not familiar with that added many volumes to my musical knowledge. My Dad always use to tell me that whenever I was around somebody who knew more than me that I was to “pick their brains” and using music as my primary form of entertainment, I always soaked as much as I could when I listened. As of now, being almost 40, every day it changes. It could be Jerry Garcia on a Friday and then Kim Deal come Monday morning with so many other artists and genres in-between. I really do not have any boundaries of where I pull from (even though I am have almost exclusively been talking about “rock music”). If it is audible and makes me feel something, it is fair game to drive my creativity.

What is your current monitoring setup used when performing and rehearsing?

This current tour, with Thrice, I was forced to make the jump to custom molded in ear monitors, using Westone ES30 earphones. Prior to that, the past year and a half I was using generic in ears that were my introduction into the “in ear world”. And before all of that, I was using a standard stage monitor, almost exclusively on my left side. I would say foolishly but I truly didn’t know any other way to do it. My reason for waiting so long probably had something to do with the initial cost it takes to get an IEM set up and just being a creature of “whatever is easiest” habit. Looking back now, with what I know and now feel, it would have been worth it from day one. I do understand however that it is not necessarily practical for people starting out.

Hearing Conservation is a general term that means "maintaining one’s current hearing health by reducing the risk of acquiring hearing damage from noise/music exposure." How do you think Hearing Conservation plays into your career and life?

Hearing Conservation right now in my life is as important as having a pair of drumsticks on stage with me. Without going into too much detail, over the past six months, I have had several health issues that called into question whether or not I could ever perform on a stage again. The ones that pertain most to the job that I do with mewithoutYou are moderate hearing loss and the development of Tinnitus. I guess I thought it was dorky to wear ear plugs on stage or that the show’s energy wouldn’t be the same. I used to think that I couldn’t feel the music when we were all playing together. I had a litany of excuses as to why I wasn’t blessing my future self with the gift of pure silence. What is the old saying about hindsight? Had I only gotten used to protecting my ears whenever I practiced, that may have translated over to the live show and potentially, I wouldn’t have gotten myself mixed up with the never ending ringing that is now in my ears/brain. Things changed almost on a dime with my entire way of living and how I treat myself and what I put in my body. The conservation and preservation of what I am left to work with physically, here on earth, is paramount to my well being. So please, if you are reading this, take all aspects of your health seriously - you never know when the bottom may drop out on you.

You've been performing with the dynamic, eclectic, and energetic band mewithoutYou for close to 2 decades now. Has your approach to performance changed as you have grown increasingly aware of your hearing health?

Well, being that this is the first tour since my hearing has changed, I am at the infantile stages of how my approach is morphing. For starters, I am using the custom molds as well as shotgun style ear muffs over top of my outer ears; it could be overkill but it's worth my peace of mind. I used to hit as hard as I could - that is no longer happening. I am giving what I think is enough to serve the music. Also, overall, I believe it is making us a better band. I am not flying through songs at a break-neck speed but rather trying to be more true to the original album tempos. That alone has reigned in how loud I am playing and I know the rest of the band appreciates it. On stage, it still feels like I am moving with a purpose even though I am not thrashing around and beating the hell out of my drums the way I used to. It feels good to embrace change, I have no other choice. Luckily, the little tweaks that I am making aren’t totally deviant from my “former self” so I would put this down on paper, strangely, as a win.

Is there anything you would like to impress upon your younger self, or someone just starting down the path of a touring musician?

Yes, yes and yes, this is the main reason I am taking the time to write these responses. Screw talking about bands I love or how I got into playing music, none of that matters compared to the conservation aspect of one’s auditory health. I wish that when I was 17 somebody would have steered me down the right path of always practicing my instrument with ear protection. Even more so, when I started touring, that there had been an old head who was suffering from Tinnitus to impart their learned wisdom upon me. You hear about things like hearing loss and Tinnitus, they may seem abstract or distant or like it can’t happen to you but HEAR ME NOW, nothing can prepare you for the actual physical feelings and distress that you may experience if you are unfortunate enough to catch either. It is life altering. It happens without warning. It is something to take as seriously as you take your craft. If you are playing live music and doing it fairly regularly, there is a good chance you will develop T - I call it T because I hate giving it a name - if I could call it Gollum I would but that would be giving it too much power 😎. It took me months to actual wrap my brain around what was happening inside of me. The developments of said conditions were directly related to the work I do and the habits I developed. It took me a crazy amount of money and a ton of visits to indifferent doctors and specialists to start to even figure it out. It wasn’t until I met Frank [Wartinger] at Earmark Hearing Conservation that I began to become “okay” with the crystal sounds that perpetually meet me when I wake in the morning, lay down for bed at night and those that visit me all the moments in between. As I understand it, there is no cure; you may search high and low in a state of panic but will be met with no magic pills or procedures to disarm the hissing. You may take on a feeling of hopelessness if you let it eat you alive; it does have the power to consume your every thought if you let it. Granted, T has many ranges and forms, it is possible to adjust over time, just takes a lot of patience, discipline and the rewiring of your daily activities and habits. Is that the position you want to put yourself in?

Please really take what I am saying to heart. While you have the ability to correct the bad form of not protecting your ears (at practice, at concerts, at the movies, at sporting events, loud parties, etc), change your ways while it is still possible. Your future self will appreciate it more than you could ever imagine.

Though this may seem morbid, it’s not, I am doing alright. I was issued the warning shot. It could be much worse and I acknowledge that. Thankfully, in my current state, doing all that I can to be health conscious and having Frank help me cope and understand the changes in my body. He has provided me with a road map of tools and techniques so that I am able to continue doing what I love with a gang of friends that I love. In 2020 I am 100 percent committed to closing out the final year of my tenure in mewithoutYou with a bang! Not a loud one of course 😉. If you made it this far, thanks for reading and remember one thing - take care of your ears, people!

Sound Profile are a series interviews focusing on the key element at the heart of Music Audiology: the musician. Frank Wartinger, Au.D., and Earmark Hearing Conservation are dedicated to improving the hearing health of all musicians throughout and the Philadelphia region.