Which Type of Headphones Is Less Likely to Harm Hearing? Evidence on Volume, Sound Pressure at the Eardrum, and Noise Cancellation

Headphones and Hearing: What Really Needs to Be Managed

The conclusion in one sentence

Hearing protection should prioritize reducing the sound pressure that reaches the eardrum and managing exposure duration, while making effective use of over-ear designs and noise cancellation to reduce the need to turn up the volume in noisy environments (PMID: 28953238；PMID: 17485978).

Distinguishing causes of harm from factors that influence exposure

When people ask which type of headphones is safer, the most common misunderstanding is to treat “headphone design” and “actual sound exposure” as the same thing. The central point in Professor Ching-Shun Lin’s original article is that, whether sound originates inside or outside the ear, the factor directly associated with hearing damage is the sound pressure applied to the eardrum. The available evidence confirms that sound pressure and exposure duration are the core risk factors. If actual exposure is the same, a label such as earbud, in-ear, or over-ear is not enough to declare that one category must be harmful or safe (PMID: 28953238).

Headphone design, however, should not be excluded from risk management. The reason is not that a particular shape automatically causes harm. Rather, different designs vary in how well they block environmental noise and can therefore influence the listening volume a user ultimately selects. Research shows that in noisy environments, the preferred listening level with earbuds is generally higher than with over-ear headphones; adding noise cancellation to an over-ear design can reduce that preferred level still further (PMID: 17485978). Another study observed a consistent pattern, with higher output from earbuds (PMID: 29471612).

A more precise formulation is therefore that sound pressure and exposure duration are the primary determinants of the risk of injury, while headphone design can influence that risk indirectly and systematically by changing the actual sound pressure in the ear canal (PMID: 28953238；PMID: 17485978). This also explains why Professor Lin emphasizes the pressure borne by the eardrum while expressing a preference for over-ear headphones, especially noise-canceling models. These positions are not contradictory: one describes the mechanism of injury, and the other describes a practical way to reduce everyday exposure.

Why noisy environments deserve particular attention

The noisier the surroundings, the more likely people are to increase headphone output so that they can hear the content clearly. In this situation, a design that blocks external noise offers more than comfort: it reduces the need to overpower background sound with a higher listening volume. Comparative research supports this point. In noisy environments, preferred listening levels are lower with over-ear headphones than with earbuds, and noise cancellation can lower the preferred level for over-ear headphones even further (PMID: 17485978).

Having noise cancellation does not mean that volume and listening time can be ignored. Its appropriate role is to reduce the need to turn up the volume; the endpoints that still require management are the sound pressure reaching the eardrum and the duration of exposure (PMID: 28953238). Likewise, over-ear headphones are not inherently exempt from risk. If a user continues listening at high output for long periods, the form factor alone cannot eliminate harm. Equipment choice and listening habits should be treated as parts of the same protective strategy, not as substitutes for each other.

In-ear headphones and earwax: how far the evidence goes

Professor Lin’s original article also cautions that in-ear headphones may push earwax inward and consequently reduce hearing. This is a practical concern worth noting. However, among the materials included in this review, no study directly compared in-ear headphone use with impacted earwax or hearing loss. The evidence should therefore currently be described as insufficient; a possibility should not be presented as an established causal relationship.

Insufficient evidence does not mean that the absence of risk has been proven. Nor does it justify the opposite claim that in-ear headphones necessarily cause earwax problems. A more defensible boundary of knowledge is this: research on noise exposure supports the importance of sound pressure and exposure duration (PMID: 28953238), whereas direct studies capable of determining whether in-ear headphones cause impacted earwax are still lacking. These are separate questions. They should not be conflated, and indirect evidence should not be used to manufacture certainty.

Turning the evidence into principles for choosing headphones

For people who often listen in noisy environments, prioritizing over-ear headphones or noise-canceling designs that effectively block environmental sound is consistent with the direction of current evidence, because such designs are more likely to reduce the preferred volume needed for listening (PMID: 17485978). For users of earbuds or in-ear headphones, the point is not to panic because of the product category. It is to prevent background noise from driving a sustained increase in output and to focus on actual sound pressure and exposure duration (PMID: 28953238；PMID: 29471612).

Overall, the main direction of Professor Lin’s original article is consistent with the literature: combining an over-ear design with noise cancellation helps reduce preferred listening volume in noisy environments, and sound pressure is central to assessing risk. The scientific boundary that should be added is that headphone design, although not the sole determinant, can affect actual exposure and therefore cannot be ignored. The claim that in-ear headphones push earwax inward should remain an open question pending direct research (PMID: 17485978；PMID: 28953238).