Broadway Soundcheck: Noise Level Awareness and Hearing Protection Behaviors and Perceptions in Nashville’s Live Music District

Objective: Recreational noise exposure is a common preventable cause of hearing loss, yet most evidence on hearing protection behaviors and noise risk perception in music venues comes from surveys conducted away from the listening environment, limiting insight into how patrons perceive and respond to real-time noise exposure. This study assessed hearing protection behaviors and perceptions among patrons actively exposed to high sound levels and piloted an educational tool designed to address patrons’ ability to recognize hazardous noise levels in a music district. Study Design: Cross-sectional survey. Setting: Live music entertainment district. Patients: Adult patrons. Intervention: Participants estimated noise levels before and after exposure to a decibel chart educational tool. Main Outcome Measure: Accuracy of participant-estimated sound levels compared with measured sound levels. Secondary outcomes included hearing protection use, self-reported hearing symptoms, and acceptance of free earplugs. Results: The median measured noise level was 95.0 dBA Leq (IQR: 91.3–97.0). Before education, participants underestimated sound levels by a median of 14.5 dBA Leq (IQR: –80.0 to 5.75; P = 0.030). After education, there was no significant difference between estimated and measured noise levels. Most participants (62.9%) reported postexposure hearing symptoms, and 74.3% never used hearing protection. The free earplug acceptance rate was 42.9%, and no variables independently predicted earplug acceptance. Conclusion: Noise levels exceeded recommended limits. Most participants underestimated sound levels and reported never using earplugs. A decibel chart tool improved estimation accuracy. On-site decibel feedback and free earplugs may promote hearing health practices in music settings.