With the summer festival season about to get underway, scientists have discovered that one of the best way to preserve your hearing at them is to stay off the booze.
A new study reveals that men who don't wear earplugs and take drugs or booze suffer the worst hearing loss outdoors.
A study of more than 50 revellers found men were more prone to hearing loss and ringing in the ears, or tinnitus.
They tended to spend more time near loudspeakers when they were consuming alcohol. The same did not apply to women.
Dr Veronique Kraaijenga, of University Medical Centre Utrecht, the Netherlands, said the problems were thought to be temporary, although she could not be sure.
She added: "Physicians should consider these factors to raise awareness about the combined risk of attending music festivals without using earplugs while consuming alcohol or drugs."
The findings were based on 18 men and 33 women aged between 21 and 33 who attended an outdoor music festival in Amsterdam in September, 2015, and 25 of whom were asked to wear earplugs.
It is the first study of its kind to identify the three factors associated with an increased risk of hearing loss after a concert.
Dr Kraaijenga said those who went to the four and a half hour event and did not use earplugs were more likely to suffer if they drank, took drugs - and were male.
She said: "With increasing intake of alcohol, the amount of time spent near loudspeakers increased.
"The intention to use earplugs was associated with the loudness and appreciation of music and the speech perception with earplugs.
"Not using earplugs and consumption of alcohol were identified as associated with a TTS (temporary threshold shift) in both ears."
The study published in JAMA Otolaryngology - Head & Neck Surgery said little is known about the hearing loss–associated behaviour of music festival revellers.
Dr Kraaijenga said during the past two decades, the frequency of hearing loss among young people has increased. Going to music concerts, clubs and festivals may be part of the reason.
She added: "Noise-induced hearing loss because of recreational noise exposure may be reduced by using earplugs."
Unprotected participants reported significantly worse hearing performance and tinnitus after the festival visit.
Before and after the festival visit, hearing evaluations took place in an adjacent studio.
Audiogram tests across a range of frequencies were performed, with a loss of hearing calculated as an average across three and four kHz.
Dr Kraaijenga said: "The threshold shift was assumed to be temporary; however, no follow-up audiometry was performed to confirm this assumption."
After the visit, participants completed a questionnaire concerning their behaviour during the festival.
This asked about alcohol and drug use, time spent near stages and loudspeakers, loudness of music, subjective hearing loss and tinnitus.
Dr Kraaijenga said: "Alcohol and drug use are known to occur at music festivals.
"Their influence on the development of temporary threshold shifts and permanent threshold shifts at a younger age enhance the effect of music on noise induced hearing loss (NIHL).
"Thus, music venue attendees are more likely to develop NIHL at a noisy music venue when using alcohol and drugs than are attendees who do not simultaneously use these substances."
In the study a total of 11 participants (22%) reported the use of drugs and 49 (96%) alcohol.
Dr Kraaijenga said: "The present study identified factors associated withNIHL at an outdoor music festival.
"Non-use of earplugs was the most important factor, followed by alcohol and drug use during the festival and male sex."