(132) Why Patrons Don't Use Hearing Protection: A Qualitative Study in a Live Music District

Introduction: Exposure to high intensity recreational noise is a well established risk factor for noise-induced hearing loss, yet hearing protection use remains uncommon in live music settings. Otolaryngologists are increasingly positioned to address hearing conservation beyond the clinic through education and prevention focused interventions. This study aims to identify factors influencing hearing protection behaviors by examining patrons’ perceptions of (1) personal use of hearing protection, (2) others’ use of hearing protection, and (3) drivers of hearing protection behaviors in a high noise entertainment district.

Methods: A qualitative study was conducted at live music venues along Lower Broadway in Nashville, Tennessee. Seventy-two adult patrons (median age 28 years; IQR 23–50) participated. No specific interventions were given. Patrons were interviewed and responded to three open-ended questions regarding hearing protection use. Thematic frequencies and qualitative patterns describing perceptions of personal and others’ hearing protection use, as well as behavioral drivers, were identified using a seven-theme coding framework independently applied by two reviewers.

Results: For perceptions of personal hearing protection use, leading themes were “Apathy or Dismissiveness” (27.8%) and “Perceived Risk & Knowledge Gaps” (23.6%). For perceptions of others’ hearing protection use, leading themes were “Perceived Risk & Knowledge Gaps” (43.1%) and “Comfort, Design, and Physical Barriers” (33.3%). For drivers of hearing protection behaviors, the leading theme was “Motivational and Behavioral Drivers” (79.2%), with frequent codes being “education” (27.8%), “evident or diagnosed hearing loss” (12.5%), and “free distribution” (11.1%).

Conclusions: Indifference, discomfort, and limited knowledge emerged as key barriers to hearing protection use, while education and improved accessibility facilitated use. These findings highlight opportunities for targeted education, policy, and venue based interventions in recreational music settings to prevent noise-induced hearing loss.