Hearing Health on Hold: Why We Need Silent Options : The Hearing Journal

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Hearing Health on Hold: Why We Need Silent Options

Drinkwater, John JD, MBA

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The Hearing Journal 76(01):p 7,8,9, January 2023. | DOI: 10.1097/01.HJ.0000911304.65886.36
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The science is clear: stress is not healthy, and noise can cause stress. Many public places, such as department stores, grocery stores, cafes, and restaurants, play recorded background music and/or a marketing loop. When one calls a bank, insurance company, internet provider, or government office, chances are one is going to be put on hold with repetitive music and/or a marketing loop. Studies consistently show the public is divided over background music: some like it, some don’t, and some don’t notice it at all. A very high percentage of the hearing impaired have significantly greater difficulty. Even when played at safe levels, studies show significant members of the population consider it unwanted stressful noise.

www.shutterstock.com. Viewpoint, hold music, callback, silent options, PTSD, hyperacusis

Silence can reduce stress for many Americans, especially those with hearing impairments. On the other hand, one person’s noise is another person’s stress reducer; some hearing-impaired people find silence aggravates their condition and find relief from a little background sound. This can create a challenge for public health officials trying to provide a safe environment for all members of the public. Whenever possible, the public should be informed of risks and have freedom of choice, provided it doesn’t harm others.


Background music in public places. The Royal National Institute for Deaf People 1 commissioned “extensive research into what people think about background music, which is played in public places such as shops, restaurants, pubs and hotels. For many people background music is both irritating and frustrating.”

Noise is not limited to unsafe sound levels; it also encompasses unwanted sounds regardless of level. Among the findings: 34% of the general public found it annoying, and 36% never notice it (and presumably the remaining 30% enjoy background music). Younger people were less annoyed than older (21% versus 45%), and it varied by region where people live (21% to 46%). It also found variations based on gender and type of venue (grocery store, restaurant, etc.). The one constant was there are significant populations in each category: pro, con, or neutral.

The British Journal of General Practice published an article that found “Music is common in the GPs’ waiting room despite conflicting evidence of its effect on patients’ anxiety and stress.” 2 It found over 80% of participants found classical music relaxing, but only 61% of patients and 52% of staff wanted music. Those who didn’t want it were “overwhelmingly negative” with comments like, “I’d rather wait in the street than sit in a waiting room with music.”

Background music while on hold. The use of background music (which for purposes of this article includes music and/or marketing) is not limited to public places. As noted above, many entities put customers on hold with a repetitive music loop. It’s not unsafely loud; in fact, the level can often be controlled by the listener. But unlike music in public places, it’s not “background.” It has to be the dominant and loudest sound, no matter how soft you have the volume.

Pandora, the music marketing company, reviewed several studies 3, including the British Journal of General Practice study, and noted: “for two-thirds of respondents, volume control was crucial. This typically has less to do with high decibels that may damage hearing and more to do with whether music was in the background or foreground. Too often, foreground music is perceived as an additional stressor rather than a form of stress relief.”

A mobile carrier study 4 found that in a one-month period “more than half of Britons have become annoyed while waiting in a call centre queue and of those surveyed, 64 per cent say their frustration is increased further by music that is supposed to calm them down.”

Some people try to work while waiting on hold. However, if your work involves critical listening such as a sound engineer, translator, or composer, you have to stop working while on hold.

The health effects of background music. It does not seem there are material negative health impacts for those who either like background music in a particular setting, or don’t notice it. However, a Time article 5 reports for the members of the public negatively affected, “Noises cause stress, especially if we have little or no control. The body will excrete stress hormones like adrenaline and cortisol that lead to changes in the composition of our blood—and of our blood vessels, which actually have been shown to be stiffer after a single night of noise exposure.” A 2021 study 6 in Royal Society Open Science measured data from people with both hearing aids and smartphones to investigate the relationship between the ambient acoustic level and heart rate. It found, “increases in ambient sound pressure intensity are significantly related to increases in mean heart rate.”

A separate study 7 reported in Environmental Health Perspectives concluded when humans are exposed to stressful noise, it can produce “a human stressor. The auditory orienting response, startle reflex and defensive response translate sound stimuli into action and sometimes into stress induced bodily changes through fight or flight neural mechanisms. Efforts to prevent or minimize the harmful effects of noise have suffered from the lack of a full appreciation of the ways in which humans process and react to sound.”

Another article 8 notes high-frequency sounds on the phone may be particularly troublesome, as are sounds of poor quality. “Phone audio is designed to handle voices and only voices. Industry-standard compression and EQ, coupled with lossy codecs to reduce file size, means audio quality is reduced and this leads to bad-sounding music that increases noise stress.”

Background music’s effect on the hearing impaired. Background music can be especially difficult for those with hearing impairments, such as hearing loss, hyperacusis and tinnitus. The Royal Institute study 1 found a stunning 86% of hearing-impaired people found background music annoying. “For deaf and hard of hearing people background music often causes pain, discomfort and unnecessary distress.” The CDC estimates there are 40 Million Americans with hearing loss. 9 A Journal of the Royal Society of Medicine review of several articles 10 found between 8%-15% of the general population has some level of hyperacusis. It also found significant overlap: 40% of tinnitus patients also reported hyperacusis, and 86% of hyperacusis patients also reported tinnitus. The effects of tinnitus and hyperacusis “appear to increase at times of anxiety and stress.” The study continues, “For many patients, the first reaction to hyperacusis is to protect themselves with ear plugs, muffs or other devices. There is reason to believe that such strategies to decrease the intensity of sound entering the auditory system may further increase the central gain, exacerbating rather than improving the hyperacusis.”

Quiet Communities 11 reported those with conditions like hyperacusis can experience pain, fear, and fight-or-flight post-traumatic stress disorder (PTSD) responses to stressor sounds, regardless of level. For those with PTSD and hyperacusis 12, a sound may be linked…which means that every time they hear the noise, it automatically triggers the fight-or-flight response and fear, anger, and anxiety. A study published in 2022 co-funded by the Department of Defense and Veterans Affairs 13 found, “Tinnitus and PTSD are among the top service--connected disabilities within the Veterans Health Administration. There is considerable overlap between tinnitus-related distress and PTSD, including irritability and concentration problems. Participants with severe tinnitus demonstrated significantly greater reexperiencing, negative mood/cognitions, hyperarousal, and PTSD total severity.”

Millions of Americans, regardless of hearing impairement, experience unhealthy noise stress while on hold. The Royal National Institute for Deaf People study 1 said avoiding shops where music is played “is a common view shared by the majority of people who wear hearing aids.” For many people with disabilities, the main disadvantage 14 they experience does not stem directly from their bodies, but rather from their “unwelcome reception in the world, in terms of how physical structures, institutional norms, and social attitudes exclude and/or denigrate them.” The AMA Journal of Ethics 15 states, “Clinicians have responsibilities to recognize the authority of people with disabilities as experts about their own lives. The claims made by people with disabilities as well as entire disability communities are regularly diminished or not taken seriously.” Noise stress can be an insurmountable hurdle for some, and avoidance is a rational option. It’s analogous to making someone with asthma wait in a smoke-filled waiting room for 30 minutes before seeing their physician.

Those with hearing impairment and PTSD have to make a difficult choice between the significant discomfort, (which can cause anxiety long before one makes the call), the additional “you are trapped and can’t fight or flee” health risks while stuck on hold, the difficulty of focusing on and covering what they called about after someone picks up, the post call anxiety plus the added memory of yet another PTSD stressor, versus the benefit of waiting for someone to pick up. That can result in people avoiding routine, necessary, and even critical health care because they don’t have a safe way to have a meaningful dialog and discuss, ask questions, make sure they understand and confirm complicated coverage or costs with their insurer. The unfortunate truth is for many it may be healthier not to call. There are no records for how many people don’t call.


The impact of background music for the large segment of the public negatively affected by noise can vary greatly from annoyance to overwhelming stress, anger, and anxiety. For those negatively affected by music/marketing, silence can be used to “calm, quiet moments to tap into a different part of the nervous system that helps shut down our bodies’ physical response to stress,” says Cleveland Clinic health psychologist Amy Sullivan, PsyD, ABPP. 16 Silence can help one concentrate, be creative, provide a sense of calm, increase production of new brain cells and increase patience. 17 Healthy Hearing notes, “noise is what aggravates hyperacusis, whereas quiet promotes healing.” 18

But silence is not the answer for everyone, even some with severe hearing impairment. According to the American Tinnitus Association 19, some of those who suffer from tinnitus benefit from Sound Therapy (pleasant or calming sounds that diminish the presence of tinnitus).

To summarize, the public is divided about background music among pro, con, and don’t care/notice, with many hearing-impaired people significantly helped by silence.


What is the correct policy when a sound’s level in and of itself is not unsafe, and large segments of the public can have widely varying positive, neutral, or negative health responses.

Background music in public places presents unique and difficult challenges balancing the desires of people with different views who share the same space and sound at the same time. Fortunately, it is much less difficult to address differing personal views and health concerns about background music on hold. There are easy, low-cost solutions available to everyone that promote public health.

For years, an internet website company has provided callers with the option to “press # for silence” while on hold. What a concept! One is able to wait peacefully, with no anxiety or stress, and when connected is able to conduct business in a relaxed, focused, and professional manner.

Another silent option is the automatic callback option 20 “that allows callers to request a callback if there are no agents available to pick up their call. Once the caller requests a callback, the call is terminated. However, it keeps the caller’s phone number in the queue. When the phone number reaches the front of the queue, it automatically calls back and connects to a designated support agent.” Some systems have an automatic callback if the caller just hangs up.

The silent options are equitable and fair: everyone waits their turn in line, and everyone can choose what they prefer. Unlike many solutions, these technologies are widely available and there is negligible cost.


The public, and especially the hearing impaired, should be provided with silent options while on hold. It’s critical for the health care industry not to force patients to experience noise stress while on hold. It aggravates their condition, reduces their access to care, and results in avoidance. However, most insurers, banks, mobile carriers, and other -national companies have not utilized these inclusive, equitable, and negligible cost options. It is respectfully suggested that Health and Human Services, Consumer Affairs, Veterans Affairs, the FCC, and other government entities all have jurisdiction and can regulate this area for the public health.


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8. Musician’s HQ Why Does Hold Music Sound So Bad/Annoying? Retrieved from: https://musicianshq.com/why-does-hold-music-sound-so-bad/
9. Centers for Disease Control and Prevention 2020 Vital Signs: Too Lound! For Too Long! Retrieved from: https://www.cdc.gov/vitalsigns/hearingloss/index.html
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12. PTSDUK Hyperacusis and PTSD. Retrieved from: https://www.ptsduk.org/hyperacusis-and-ptsd/
13. Moring JC, Straud CL, Penzien DB, et al. 2022 PTSD symptoms and tinnitus severity: An analysis of veterans with posttraumatic headaches Health Psychology 41 178 183 https://doi.org/10.1037/hea0001113
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16. Health Essentials 2020 An Ode to Silence: Why You Need It in Your Life. Retrieved from: https://health.clevelandclinic.org/why-you-need-more-silence-in-your-life/
17. Whisper Room Inc 2020 7 Benefits of Silence: Why We Need Less Noise. Retrieved from: https://whisperroom.com/tips/7-benefits-of-silence-why-we-need-less-noise/
18. Cohen J 2022 Hyperacusis: Yes, hearing can hurt. Retrieved from: https://www.healthyhearing.com/report/53076-Hyperacusis-when-ordinary-loud-sounds-hurt-your-ears
19. American Tinnitus Association Sound Therapy. Retrieved from: https://www.ata.org/about-tinnitus/sound-therapy/
20. Live Agent Automatic Callback. Retrieved from: https://www.liveagent.com/features/automatic-callback/
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