Hearing Health in Esports: The Competitive Advantage We Rarely Discuss
- Dr. Brian J
- 3 days ago
- 12 min read
By Dr. Brian James, AuD, CCC-A
Competitive gamers spend an extraordinary amount of time refining small advantages.
They adjust graphics settings to improve frame rates. They compare monitor response times, controller latency, mouse sensitivity and network speed. Serious players also pay more attention than ever to sleep, nutrition, posture, hand injuries and visual fatigue.
Hearing receives far less attention, even though sound is central to competitive play.
In games such as Fortnite, Call of Duty, Smash, Counter-Strike, Valorant and Rainbow Six Siege, players use sound to locate opponents, recognize weapons, follow movement and communicate with teammates. Even in games where sound is less tactical, players may spend several hours at a time wearing headphones while listening to music, dialogue, game effects and voice chat.
That combination of long sessions and uncertain listening levels raises a straightforward question:
Are gamers placing their hearing at risk without realizing it?
The honest answer is that we do not yet have enough research to describe the risk precisely.
We do, however, have enough evidence to take the subject seriously.
In 2025, the World Health Organization and International Telecommunication Union released the first global safe-listening standard created specifically for video gaming and esports. Until then, no international safe-listening standard addressed gaming devices and software as a distinct category.
That development is important, but it should not be interpreted as proof that gaming inevitably causes hearing loss. The issue is more nuanced. Sound exposure depends on how loudly someone listens, how long they listen, the type of sound involved and the person’s total exposure from gaming and other activities.
The concern is not gaming itself.
The concern is sound dose.
Why Sound Exposure Is Difficult to Judge
Most players determine volume by comfort. They move a slider until the game sounds clear, teammates are easy to understand and important cues can be heard.
Unfortunately, comfort is not a reliable measurement of hearing risk.
A volume setting of 50 percent on one headset may produce a very different sound level from 50 percent on another. Output can vary according to the computer or console, headset sensitivity, amplifier power, game settings, equalization, fit and the interaction between the headset and the listener’s ears.
A player may therefore believe that a setting is moderate without knowing the actual sound pressure level reaching the ear.
The ear also adapts. After listening for a while, a level that initially seemed loud may begin to feel normal. Players may then increase the volume again, particularly when the room is noisy or when quiet in-game cues are difficult to hear.
This can happen gradually during a tournament or a long evening of play. The player is not necessarily making a conscious decision to listen dangerously. He or she is simply trying to hear the game more clearly.
From an audiologic perspective, the important factors are sound intensity and duration. Higher levels use up a person’s recommended sound allowance more rapidly.
The WHO–ITU standard uses a weekly reference allowance of 80 dBA for 40 hours for adults and 75 dBA for 40 hours for children. These are exposure benchmarks rather than guarantees that every person below them will be completely protected or that everyone above them will experience damage.
The difference between 75, 80 and 85 dBA may not seem dramatic to a listener, but the sound energy rises rapidly. Under the equal-energy principle used in safe-listening guidance, a 3 dB increase represents approximately twice the sound energy. As the level rises, the amount of recommended listening time falls.
That means a player may be able to listen for many hours at one level but reach the same sound dose in a much shorter period at a higher setting.
This is one reason simple advice such as “keep the volume below 60 percent” has limitations. It is easy to remember, but device percentages are not calibrated sound-level measurements.
What the Research Actually Shows
The most substantial review of this subject was published in BMJ Public Health in 2024.
Researchers reviewed 14 studies involving more than 50,000 participants. The studies included measurements of gaming sound levels as well as investigations of hearing loss, tinnitus and gaming behavior. The authors concluded that the limited available evidence suggests gaming may be a common source of unsafe listening and could place some gamers at risk of sound-induced hearing loss or tinnitus. They were equally clear that additional research is needed.
That wording matters.
The review did not demonstrate that all gamers are damaging their hearing. It did not establish the percentage of gamers who will eventually develop hearing loss. It also did not show that an ordinary gaming session at a reasonable level is dangerous.
The research base remains relatively small, and the studies differ considerably in design. Some relied on self-reported listening habits. Others examined gaming-center attendance rather than directly measuring each participant’s headset exposure. Only a limited number measured sound output during gameplay, and even fewer examined hearing before and after exposure.
The evidence is therefore suggestive, not conclusive.
Still, several findings are difficult to dismiss.
Some studies identified preferred gaming levels that approached or exceeded commonly accepted safe-listening recommendations. Research involving gaming-center users also found associations between gaming behavior, tinnitus and hearing changes. Because these studies were observational, they cannot prove that gaming caused the outcomes. Other recreational noise, personal listening habits and unmeasured factors may have contributed.
The distinction between association and causation is essential. It is also not a reason to ignore the findings.
Much of hearing conservation is based on recognizing a plausible and preventable risk before every detail is known. We do not need to establish that every gamer will develop hearing loss before recommending better exposure monitoring and safer listening choices.
Gaming Audio Is Not the Same as Listening to Music
Video-game sound is complex.
A player may be hearing background music, environmental ambience, dialogue, voice chat, alerts, gunfire, collisions and explosions at the same time. The average level across a session may not fully represent the repeated peaks produced by weapons or other abrupt effects.
This is especially relevant in shooters and action games, where quiet positional information may be followed immediately by much louder sounds.
When players struggle to hear footsteps or other low-level cues, their natural response is often to raise the master volume. That may make the desired sound easier to detect, but it also increases everything else.
The better solution may be improved control over the audio mix.
A game that allows players to lower music, reduce unnecessary effects, control voice chat independently and adjust dynamic range may help them hear important information without increasing the entire signal. Good headset isolation can also reduce the temptation to overpower noise from the room.
This is one of the most interesting areas for future research. Safe listening in gaming should not be treated only as a player-behavior problem. It is also a hardware and software design issue.
Game developers and manufacturers have considerable influence over the way sound is presented.
Why the New WHO–ITU Standard Matters
The WHO–ITU standard recommends that gaming systems move beyond vague warnings and give users useful information about their actual exposure.
Among its recommendations are systems that can estimate sound dose, provide exposure warnings, make volume controls easily accessible and offer a headphone safety mode. The standard applies broadly to gaming consoles, computers, mobile devices, headphones, headsets and game software.
This approach is more practical than simply telling players to “turn it down.”
Most people respond better to meaningful feedback. A player who sees that a session has consumed a large portion of a weekly listening allowance may make a different decision than a player who sees only a volume percentage.
The concept is similar to fitness technology. Athletes now routinely track heart rate, sleep, training load and recovery. The purpose is not to frighten them away from exercise. It is to help them understand the effect of repeated exposure.
Sound-dose monitoring could do the same for gaming.
For the standard to make a real difference, however, it will need broad adoption. The information must also be understandable. A warning that is difficult to interpret or easy to dismiss will have little value during competitive play.
The strongest systems will likely provide feedback without interrupting the game unnecessarily. They might warn players before an extended session, show remaining exposure time at the current level or recommend a small volume reduction that significantly extends safe listening time.
Tinnitus Deserves More Attention
Tinnitus is often described as ringing in the ears, although people may also hear buzzing, hissing, humming or other sounds.
A brief episode after loud-sound exposure does not prove that permanent hearing loss has occurred. At the same time, recurring tinnitus after gaming should not be treated as normal.
It is information.
A player who repeatedly experiences ringing, muffled hearing or a feeling of fullness after using a headset may be listening at an excessive level, playing for too long or combining gaming with other significant noise exposure.
The appropriate response is not panic. It is to reduce the exposure and pay attention to whether the symptoms resolve.
Persistent tinnitus, one-sided symptoms, sudden hearing changes, dizziness, ear pain or drainage should be evaluated professionally. Sudden sensorineural hearing loss is a medical urgency and should not be dismissed as a temporary consequence of headset use.
One difficulty is that younger players may not volunteer these symptoms. They may assume that ringing after a long session is ordinary, or they may be reluctant to mention it because they fear losing access to the game.
Parents, coaches and esports organizers should therefore discuss hearing symptoms in the same matter-of-fact way they discuss headaches, wrist pain or visual fatigue.
Hearing Loss Is Not Always Obvious
Many people imagine hearing loss as an inability to hear quiet sounds. In reality, early auditory complaints may be more subtle.
A gamer may hear normally in a quiet room but struggle to separate voice chat from game sound. Another player may have difficulty localizing opponents or following speech when spectators and nearby players are talking. Some people report sound sensitivity or tinnitus even when a conventional audiogram remains within normal limits.
These complaints do not automatically indicate permanent cochlear damage, and they should not be self-diagnosed. They do demonstrate that hearing health involves more than passing a basic screening.
For competitive gamers, auditory performance may include:
Detecting low-level sounds
Distinguishing one sound from another
Understanding speech in noise
Determining where a sound originated
Processing several auditory signals at once
Sustaining attention during long sessions
There is surprisingly little research examining these abilities in esports athletes.
Most current discussions focus on the possibility of hearing damage. That is appropriate, but incomplete. We should also be asking whether hearing status, auditory processing and listening fatigue affect performance.
Does Louder Sound Improve Competitive Performance?
Players often assume that raising the volume provides an advantage.
Up to a point, increasing the level of a quiet signal may make it easier to detect. Beyond that point, however, louder is not always clearer.
High levels can make competing sounds more intrusive. Explosions and weapon effects may mask footsteps or voice communication. Listening effort may increase, especially during long sessions. The player may feel that the game is more intense without receiving more useful information.
The ideal setting is not the loudest tolerable level. It is the lowest level that provides the information necessary to play effectively.
That distinction should be explored experimentally.
Researchers could compare performance across different listening levels while measuring sound exposure, localization, speech understanding, reaction time and player fatigue. They could also test whether an improved audio mix allows players to maintain performance at a lower overall level.
This would move the discussion beyond hearing conservation and into performance science.
It may turn out that safer audio is not a competitive disadvantage at all. In some circumstances, it may improve clarity.
Practical Advice for Players
Until sound-dose monitoring becomes standard, players have to rely on less precise methods. Even so, several habits can reduce unnecessary exposure.
Start a session at a lower level rather than beginning loud and trying to reduce it later. Once the auditory system adapts to a high setting, turning it down may make the game seem temporarily dull even when the lower setting is adequate.
Adjust the audio mix before increasing the master volume. Lower music or nonessential effects and balance voice chat separately.
Use a headset that fits well and provides reasonable isolation. A player in a noisy room may keep increasing the volume simply to overpower nearby conversations, televisions or other gaming stations.
Take periods of genuine quiet. Removing the headset but immediately listening to loud music on a phone does not provide much relief from cumulative sound exposure.
Pay attention to what happens after the session. Tinnitus, muffled hearing and sound sensitivity are more useful warning signs than the position of a volume slider.
Finally, consider the entire day’s exposure. Gaming is only one source of sound. Concerts, power tools, firearms, sporting events, marching band, vehicle noise and personal music listening all contribute to the total dose.
What Parents Can Do
Parents do not need to treat headsets as inherently harmful. They should, however, recognize that listening level and session length matter.
For younger players, practical supervision may include checking whether device-level protections are available, helping balance game and chat audio, encouraging breaks and asking directly about ringing or muffled hearing.
A well-fitting headset may be preferable to one that allows substantial outside noise to enter, because the child may not need to raise the volume as much. Noise cancellation can be helpful in some settings for the same reason, although it does not make high-volume listening safe.
Parents should also be cautious about assuming that a child is safe because the device is set below a certain percentage. Without knowing the headset output, that number has limited meaning.
The goal is not to create anxiety around gaming. It is to teach the same kind of responsible habit we expect around sun exposure, sports injuries or protective equipment.
Children can enjoy gaming while learning that their hearing is a resource worth protecting.
What Esports Programs and Gaming Venues Should Consider
Organized esports creates both a responsibility and an opportunity.
Unlike home gaming, a venue or school program can establish consistent equipment, settings and operating practices. It can also educate many players at once.
Reasonable measures could include:
Starting stations at a moderate default volume
Preventing headsets from automatically returning to maximum output
Providing independent controls for game sound and voice chat
Including hearing health in player orientation
Encouraging quiet breaks during long events
Identifying a quieter area away from the main competition floor
Monitoring environmental sound during crowded tournaments
Training staff to respond appropriately when a player reports tinnitus or muffled hearing
Giving parents clear information during youth events
Venues should avoid presenting themselves as able to guarantee that every headset exposure is safe unless sound levels are actually being measured and controlled.
That is another area where the new standard may eventually help. As compatible hardware and software become available, venues may be able to monitor exposure more consistently across stations.
In the meantime, the priority should be reducing obvious and unnecessary risk.
The Research We Still Need
The current literature is useful, but it leaves many unanswered questions.
We need studies that measure actual headphone output over complete gaming sessions rather than relying primarily on self-reported volume. We need to know how exposure differs by game, headset, platform and player experience.
Youth esports deserves particular attention because children may begin gaming regularly at an early age and continue for many years.
Tournament settings should be studied separately from home play. A competition may involve greater background noise, longer sessions, elevated stress, spectators and repeated adjustments to headset volume.
Researchers should also examine impulse-heavy audio. An average level may not describe the full exposure produced by repeated gunfire and explosions.
Other worthwhile questions include:
Do experienced competitors listen at higher levels than casual players?
Does fatigue lead players to increase the volume?
How accurately do gamers estimate their own listening levels?
Do sound-dose warnings change behavior?
Can players maintain performance at lower levels when the audio mix is optimized?
Does hearing status affect localization or competitive decision-making?
Are tinnitus and speech-in-noise complaints more common in frequent gamers?
Which hearing-conservation messages are most likely to be accepted rather than ignored?
Longitudinal research would be especially valuable. Following players over several years would help determine whether measured gaming exposure predicts later changes in hearing or tinnitus.
At present, we have more reason for concern than we have certainty.
That is exactly why careful research is needed.
A Role for Audiologists
Audiologists should become more familiar with gaming as a listening activity.
A clinician who asks only about concerts, firearms, occupational noise and music players may overlook a major part of a younger patient’s weekly sound exposure.
Questions about gaming do not have to be complicated:
How often do you play?
How long are the sessions?
Do you use headphones?
Do you increase the volume when the room becomes noisy?
Do your ears ring afterward?
Does hearing seem muffled when you stop?
Do you have difficulty understanding teammates or locating sounds?
These questions can reveal relevant habits without assuming that gaming is the cause of every complaint.
Audiologists can also help players understand the difference between volume preference and measured exposure. When symptoms are present, a comprehensive evaluation may include more than pure-tone thresholds, depending on the history and clinical findings.
The profession also has an opportunity to collaborate with game developers, headset manufacturers, schools, esports leagues and gaming venues.
Safe-listening systems will be more effective when they are informed by auditory science and designed around the way players actually use them.
The Conversation Needs Better Balance
Discussions about technology and health often move toward one of two extremes.
One side insists that there is no problem until permanent harm has been proven beyond doubt. The other presents a possible risk as an established crisis.
Neither approach helps gamers.
The evidence does not support telling every player that a headset will damage his or her hearing. It also does not support ignoring repeated high-level exposure simply because the research is incomplete.
A more reasonable conclusion is that some gaming patterns may create unnecessary auditory risk, particularly when high volume is combined with long sessions. The risk can likely be reduced through better player habits, improved audio design and exposure-monitoring tools.
The WHO and ITU have now placed gaming within the global safe-listening conversation. That should encourage better research and more thoughtful product design.
For esports, this is not an argument against competition.
It is an argument for treating hearing as part of player health and performance.
Gamers already understand the value of protecting the tools they depend on. They maintain their computers, replace worn controllers and monitor every part of the system that might affect the next match.
Their hearing deserves the same attention.
Dr. Brian James, AuD, CCC-A, is a clinical audiologist and co-owner of The Vault Family & Event Gaming Center in Portsmouth, Ohio. His work brings together clinical hearing science, gaming technology, youth esports, and practical hearing-health education.
References
Dillard LK, Mulas P, Der C, Fu X, Chadha S. Risk of sound-induced hearing loss from exposure to video gaming or esports: a systematic scoping review. BMJ Public Health. 2024;2:e000253.
World Health Organization and International Telecommunication Union. Global Standard for Safe Listening Video Gameplay and Esports. Geneva: WHO and ITU; 2025.
International Telecommunication Union. New WHO/ITU standard aims to prevent hearing loss among gamers. Published March 3, 2025.
World Health Organization. New WHO and ITU standard aims to prevent hearing loss among gamers. Published February 28, 2025.
