When Listening Becomes More Than Hearing

At the moment, an interesting discussion is taking place in the Netherlands about sound levels at live concerts. Earlier this week, Blaudzun and OORMERK experimented with deliberately lowering the sound level during a concert at the Melkweg in Amsterdam. The ambition was clear and, in my view, very valuable: can we create a live music experience at lower sound levels, while maintaining the quality and impact of the music?

As a clinical physicist-audiologist, I strongly welcome that initiative. Reducing sound at the source matters. We know that simply continuing to make everything louder is not the way forward. So experimenting, learning and actively searching for better solutions is something I applaud. But science also teaches us to keep the discussion open. An important step in the right direction should not immediately become the solution. If we lower the volume of the music, does that automatically mean hearing protection is no longer useful? And perhaps the more interesting question is: what actually determines our total exposure to sound - and our experience of it?

Purely by coincidence, that question became very tangible for me last night in Berlin. This week, TRI2026 brought together professionals from all over the world working in tinnitus, hearing and sound. After several intense days of lectures, scientific discussions and presentations, the farewell event had another very important purpose: bringing people together. To meet, to connect, and to finally have some of those conversations that simply do not fit into a ten-minute presentation or a short coffee break.

About a hundred professionals gathered in one room for dinner. There was some background music, but nothing that struck me as particularly loud. And yet, at one point, I looked at my phone: almost 90 dB. Of course, my phone is not a calibrated sound level meter. So this was an observation, not a scientific measurement. But it made me stop and look around. Where was all that sound actually coming from? The loudspeakers? The music? The acoustics of the room? Or simply from a hundred people talking, laughing and gradually raising their voices because everyone was trying to understand everyone else?

The music wasn’t particularly loud. The room was.

And that stayed with me. Not as criticism of the event. The intention behind the evening was exactly what a good congress needs: human connection. But even at a professional meeting about hearing and tinnitus, the acoustic conditions can make that connection surprisingly difficult. Perhaps that tells us something.

Sound exposure is never only about the position of a volume control. It is also about duration, acoustics, background noise, the number of people in a room, our own vocal behaviour and the hearing protection we use. And hearing protection itself is not only about preventing excessive sound exposure. Appropriate, well-fitted earplugs with acoustic filters can also support communication in loud environments. They reduce the overall sound level while preserving the frequency characteristics of speech much better than simple, strongly occluding plugs. In some noisy environments, that can make speech more comfortable and easier to follow.

That is particularly relevant in a room where a hundred people are talking at the same time. So perhaps the discussion should never become: lower the sound or wear earplugs. Maybe it needs to remain an and-and discussion. Reduce sound at the source, improve room acoustics, think about exposure time, create environments in which people do not need to shout simply to understand each other, use appropriate hearing protection when needed, and think about how all these elements interact.

Interestingly, I was wearing my earplugs that evening. And this morning, when I woke up, I noticed tinnitus. What fascinated me was not only the tinnitus itself. It was my response to it. I noticed it almost like muscle soreness after physical exercise: there it is, without immediately becoming frightened by it.

That comparison made me think. After physiotherapy or an intensive workout, muscle soreness does not necessarily frighten us. We recognise that we have challenged the body. But that obviously does not mean that every pain signal should simply be ignored. If we continue to overload the body, again and again, without listening to what it is telling us, something different may happen. So where is that boundary? When is a sensation something we can notice without immediately interpreting it as a threat? And when is the same sensation a signal that deserves our attention? Perhaps that distinction is relevant not only to pain. Perhaps it is also relevant to tinnitus.

I don’t think we have all the answers. And maybe that is precisely why I find the question so interesting.

Something else happened during that same evening. Myriam Westcott and Carol MacDonalds were my table companions. At some point, the three of us made a very simple decision: we moved away from the noise and found a quieter place. And suddenly something changed. We could hear each other again. But perhaps more importantly, we could listen to each other.

We talked about tinnitus, acoustic shock and sound sensitivity, pain, ACT - Acceptance and Commitment Therapy - our work, the questions each of us is currently exploring, and also simply about life. About where we are. About what matters. About the human being behind the professional. When the noise disappeared, there was room for something else: time, attention, curiosity, depth and connection. And that struck me. Sometimes improving the conditions for hearing also improves the conditions for human connection.

Earlier that evening, I also had a fascinating conversation with Professor Lance McCracken, who works in Sweden and whose work in chronic pain, psychological flexibility and Acceptance and Commitment Therapy has had a major influence on the development of modern pain care.

Pain and tinnitus are obviously not the same. But I believe tinnitus care can learn a great deal from the journey chronic pain care has already travelled. Pain research has increasingly moved beyond the search for one mechanism, one body part or one intervention. It considers the body and the nervous system, but also behaviour, avoidance, attention, context, meaning, acceptance, psychological flexibility, and ultimately the question of how someone can continue to live a meaningful life, even when a symptom does not immediately disappear.

So I found myself wondering: what might tinnitus care learn from that journey?

Throughout TRI2026, I kept returning to the three perspectives that form my own Hearing Triptych: the ear, the brain, and the human experience.Perhaps we sometimes make the problem smaller than it really is when we ask which of those contains the answer. Is tinnitus in the ear? In the brain? In our response to it? What if those perspectives are not competing explanations at all? What if they are different parts of the same composition?

The biopsychosocial model itself is not new. Engel described it almost half a century ago. Perhaps the challenge now is not to invent another model, but to translate that complexity into audiology in a way that is easier to see, understand and use in everyday care.

For me, the Hearing Triptych is one way of doing that: not to replace the biopsychosocial perspective, but to make the connections between these different dimensions more tangible within tinnitus and hearing care.

And perhaps that brings me back to music. Maybe what we are looking for is not one perfect note. Maybe it is more like a choir. Every voice has its own part. One voice sings high, another low. Some voices carry the melody, others provide harmony, rhythm or depth. Each individual part matters. But imagine every singer performing only their own part, at their own volume, without listening to anyone else. It would not become music.

A choir works because people listen while they sing. They adjust. They make room. Sometimes one voice comes forward, sometimes another steps back. And together they search for balance.

Perhaps that is what we need too. Audiology has its voice. Neuroscience has its voice. Psychology has its voice. Pain research has something to teach us. Acoustics has something to teach us. Musicians and venues have something to teach us. Researchers have something to teach clinicians. Clinicians have something to teach researchers. And most importantly, people living with tinnitus, hyperacusis and sound sensitivity have their own indispensable voice in this choir.

We do not yet know exactly how all these parts should come together. But not having every answer cannot be a reason to do nothing. We already know enough to start moving: to reduce unnecessary sound exposure, improve acoustics, protect hearing, investigate the ear and the brain, explore behaviour, context and meaning, learn from other disciplines, and perhaps above all, become better at listening to one another.

Maybe the solution will not come from one discipline singing louder than all the others. Maybe it will emerge when the different voices begin to hear one another, adjust to one another and gradually find their balance.

And if that should turn out to be part of the solution, that would truly be music to my ears.