Musical training is known to modify cortical organization. Here, we show that such modifications extend to subcortical sensory structures and generalize to processing of speech. Musicians had earlier and larger brainstem responses than nonmusician controls to both speech and music stimuli presented in auditory and audiovisual conditions, evident as early as 10 ms after acoustic onset. Phase-locking to stimulus periodicity, which likely underlies perception of pitch, was enhanced in musicians and strongly correlated with length of musical practice. In addition, viewing videos of speech (lip-reading) and music (instrument being played) enhanced temporal and frequency encoding in the auditory brainstem, particularly in musicians. These findings demonstrate practice-related changes in the early sensory encoding of auditory and audiovisual information.