Noise is a health risk. Recent findings suggest that leisure noise is a substantial danger especially to children, teenagers and young adults. Epidemiological studies of teenagers with no occupational noise exposure show an increasing number with a substantial and measurable irreversible inner ear damage. This is basically due to the wide spread exposition to very loud toys (pistols and squibs), crackers and exposure to electronically amplified music, e.g. from personal cassette players (PCP), at discos or concerts etc. Protection against irreversible ear damage by leisure noise has an important impact in preventive medical care. Therefore the general public must be informed that loud leisure activities may cause damage to the ear. In order to protect children, young people and adults, the legislature ought to set limits for sound levels in discos, concert halls and for music equipment and toys by establishing the necessary standards and regulations.

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This review concentrates on the effects of low frequency noise (LFN) up to 100 Hz on selected physiological parameters, subjective complaints and performance. The results of laboratory experiments and field studies are discussed in relation to the thresholds of hearing, of vibrotactile sensation and of aural pain. The effects of LFN may be mediated trough different ways. Temporary or permanent hearing threshold shifts seem to be due to acoustic stimuli above the individual hearing threshold. However, non-aural physiological and psychological effects may be caused by levels of low frequency noise below the individual hearing threshold. The dynamic range between the thresholds of hearing and of aural pain diminishes with decreasing frequency. This should be taken into account by the setting of limits concerning the health risks. Sufficient safety margins are recommended. The use of a frequency weighting with an attenuation of the low frequencies (e.g. G-weighting) does not seem to be appropriate for the evaluation of the health risks caused by LFN up to 100 Hz. It may be proposed to measure third octave band spectra or narrow band spectra. A comparison with the known human responses caused by the measured levels and frequencies could help to evaluate the health risks. Some proposals for further investigations were given: (1) experimental methods to discover the ways mediating the effects of low frequency noise, (2) consideration of the individual hearing threshold or hearing threshold shift and of the vibrotactile threshold in the low frequency range to be able to judge the effects, (3) consideration of combined body vibration caused by airborne low frequency noise or by other sources, (4) modelling to analyse the transmission of the acoustic energy from the input into the body to the structures containing sensors, (5) consideration of probable risk groups like children or pregnant women.

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Low frequency noise, the frequency range from about 10Hz to 200Hz, has been recognised as a special environmental noise problem, particularly to sensitive people in their homes. Conventional methods of assessing annoyance, typically based on A-weighted equivalent level, are inadequate for low frequency noise and lead to incorrect decisions by regulatory authorities. There have been a large number of laboratory measurements of annoyance by low frequency noise, each with different spectra and levels, making comparisons difficult, but the main conclusions are that annoyance of low frequencies increases rapidly with level. Additionally the A-weighted level underestimates the effects of low frequency noises. There is a possibility of learned aversion to low frequency noise, leading to annoyance and stress which may receive unsympathetic treatment from regulatory authorities. In particular, problems of the Hum often remain unresolved. An approximate estimate is that about 2.5% of the population may have a low frequency threshold which is at least 12dB more sensitive than the average threshold, corresponding to nearly 1,000,000 persons in the 50-59 year old age group in the EU-15 countries. This is the group which generates many complaints. Low frequency noise specific criteria have been introduced in some countries, but do not deal adequately with fluctuations. Validation of the criteria has been for a limited range of noises and subjects.

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The contradictory and confusing results in noise research on humans may partly be due to individual differences between the subjects participating in different studies. This review is based on a twelve year research on the role of neuroticism, extroversion and subjective noise sensitivity during mental work in noisy environment. Neurotic persons might show enhanced "arousability" i.e. their arousal level increases more in stress. Additional unfavorable factors for neurotics are worrying and anxiety, which might prevent them coping successfully with noise, or some other stressors during mental performance. In numerous experiments introverts have showed higher sensitivity to noise during mental performance compared to extroverts, while extroverts often cope with a boring task even by requesting short periods of noise during performance. Correlation analyses have regularly revealed a highly significant negative relation between extroversion and noise annoyance during mental processing. Numerous studies have shown that people with high noise sensitivity may be prevented from achieving the same work results as other people in noisy environment, thus leading to psycho­somatic, neurotic or other difficulties. Positive relation between noise annoyance and subjective noise sensitivity might be very strong. Our results have shown, after matching with the results of other relevant studies, that more stable personality, with extroversive tendencies and with a relatively lower subjective noise sensitivity measured with standard questionnaires, may be expected to better adapt to noise during mental performance, compared to people with opposite personality traits.

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Critical to survival, and also to the organism's efficient management of the flow of information in the brain, is attentional selectivity; the ability to select one source of information to guide action whilst ignoring others that are irrelevant to the current behavioural goal. But such selectivity is not merely the inclusion of the relevant information and the complete neglect of irrelevant information. We discuss in this paper the way that all sound is processed in an obligatory fashion - whether relevant or irrelevant - and discuss the fate of sound in the case when it is irrelevant to the immediate mental task. Using the so-called irrelevant sound paradigm we show that unattended information is both registered and organised. This obligatory process of organisation compromises the efficiency of particular types of mental activity. We discuss how such interference comes about but the key emphasis is upon the possible beneficial effects of such processing-of-the-irrelevant, in allowing the switching of attention to be more facile and intelligent and in allowing the accumulation of evidence about statistical regularities in the auditory world (such as those helpful to the efficient perception, acquisition and use of language). In sum, we describe how purposeful processing based on directed attention is in a state of tension with the obligatory, automatic processing of the unattended. One of the consequences of this tension is typically manifested in auditory distraction, but the benefits of processing of the attended may considerably outweigh this disadvantage.

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Vibroacoustic disease (VAD) is a whole-body, systemic pathology, characterized by the abnormal proliferation of extra-cellular matrices, and caused by excessive exposure to low frequency noise (LFN). VAD has been observed in LFN-exposed professionals, such as, aircraft technicians, commercial and military pilots and cabin crewmembers, ship machinists, restaurant workers, and disk-jockeys. VAD has also been observed in several populations exposed to environmental LFN. This report summarizes what is known to date on VAD, LFN­induced pathology, and related issues. In 1987, the first autopsy of a deceased VAD patient was performed. The extent of LFN­induced damage was overwhelming, and the information obtained is, still today, guiding many of the associated and ongoing research projects. In 1992, LFN-exposed animal models began to be studied in order to gain a deeper knowledge of how tissues respond to this acoustic stressor. In both human and animal models, LFN exposure causes thickening of cardiovascular structures. Indeed, pericardial thickening with no inflammatory process, and in the absence of diastolic dysfunction, is the hallmark of VAD. Depressions, increased irritability and aggressiveness, a tendency for isolation, and decreased cognitive skills are all part of the clinical picture of VAD. LFN is a demonstrated genotoxic agent, inducing an increased frequency of sister chromatid exchanges in both human and animal models. The occurrence of malignancies among LFN-exposed humans, and of metaplastic and displastic appearances in LFN-exposed animals, clearly corroborates the mutagenic outcome of LFN exposure. The inadequacy of currently established legislation regarding noise assessments is a powerful hindrance to scientific advancement. VAD can never be fully recognized as an occupational and environmental pathology unless the agent of disease - LFN - is acknowledged and properly evaluated. The worldwide suffering of LFN-exposed individuals is staggering and it is unethical to maintain this status quo.

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The human perception of sound at frequencies below 200 Hz is reviewed. Knowledge about our perception of this frequency range is important, since much of the sound we are exposed to in our everyday environment contains significant energy in this range. Sound at 20-200 Hz is called low-frequency sound, while for sound below 20 Hz the term infrasound is used. The hearing becomes gradually less sensitive for decreasing frequency, but despite the general understanding that infrasound is inaudible, humans can perceive infrasound, if the level is sufficiently high. The ear is the primary organ for sensing infrasound, but at levels somewhat above the hearing threshold it is possible to feel vibrations in various parts of the body. The threshold of hearing is standardized for frequencies down to 20 Hz, but there is a reasonably good agreement between investigations below this frequency. It is not only the sensitivity but also the perceived character of a sound that changes with decreasing frequency. Pure tones become gradually less continuous, the tonal sensation ceases around 20 Hz, and below 10 Hz it is possible to perceive the single cycles of the sound. A sensation of pressure at the eardrums also occurs. The dynamic range of the auditory system decreases with decreasing frequency. This compression can be seen in the equal-loudness-level contours, and it implies that a slight increase in level can change the perceived loudness from barely audible to loud. Combined with the natural spread in thresholds, it may have the effect that a sound, which is inaudible to some people, may be loud to others. Some investigations give evidence of persons with an extraordinary sensitivity in the low and infrasonic frequency range, but further research is needed in order to confirm and explain this phenomenon.

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Traffic noise is the most important source of environmental annoyance. According to the Environmental Expert Council of Germany, severe annoyance persistent over prolonged periods of time is to be regarded as causing distress. Previously, extraaural noise effects were mostly assessed using a paradigm in which the sound level played the major role. On the basis of this paradigm the relatively low sound level of environmental noise was not considered to be a potential danger to health. In contrast to this numerous empirical results have shown long­term noise-induced health risks. Therefore a radical change of attitude - a change of paradigm - is necessary. For an immediate triggering of protective reactions (fight/flight or defeat reactions) the information conveyed by noise is very often more relevant than the sound level. It was shown recently that the first and fastest signal detection is mediated by a subcortical area - the amygdala. For this reason even during sleep the noise from aeroplanes or heavy goods vehicles may be categorised as danger signals and induce the release of stress hormones. In accordance with the noise stress hypothesis chronic stress hormone dysregulations as well as increases of established endogenous risk factors of ischaemic heart diseases have been observed under long-term environmental noise exposure. Therefore, an increased risk of myocardial infarction is to be expected. The results of individual studies on this subject in most cases do not reach statistical significance. However, according to the Environmental Expert Council, these studies show a consistent trend towards an increased cardiovascular risk if the daytime immission level exceeds 65 dB(A). Most of the previous studies on the extraaural effects of occupational noise have been invalidated by exposure misclassifications. In future studies on health effects of noise a correct exposure assessment is one of the most important preconditions.

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Stress is an unavoidable every-day phenomenon. Physiological coping with stress depends on the appropriate release of stress hormones as well as their alleviation at the termination of the stress. Despite quite a body of research indicating that stress affects inner ear function, this concept has found little application in otolaryngology. Today's evidence clearly indicates that the inner ear is equipped to detect stress hormones and some of these hormones have been shown to affect the inner ear function. Major stress control pathways shown to affect the inner ear include several third order axes, the hypothalamus-pituitary-adrenal axis, the hypothalamus-pituitary-thyroid axis and the hypothalamus-pituitary-gonadal axis whose functioning are interactive and inter-dependent. Less well-studied are the second order hypothalamus-pituitary control axis and its interaction with other hormones. To explore these we carried out a retrospective study on a series of Meniere's patients who had undergone a neurotomy of the vestibular nerve in the dept of ORL at the Hopital Nord, Marseille. Meniere's patients were particularly appropriate for this study since stress has long been recognised as a factor associated with the triggering of the symptoms of this pathology. Patients with acoustic neuroma and facial spasm were taken as a control population. We investigated the level of a battery of stress hormones including prolactin (3-endorphin and growth hormone. The blood sample was taken on the morning before surgery. The most striking observation was the presence of hyperprolactinemia in 30% of the Meniere patients (more than 20 µµg/l) with confirmation of prolactinoma in 6 patients. The level of O-endorphin could also be elevated. Horner, K.C., Guieu, R., Magnan, J., Chays, A. and Cazal, Y. Neuropysychopharmacology, (2001) 26:135-138. These observations suggest that neuroendocrinological feedback pathways controlling stress can be disturbed in Meniere's patients and depression of hypothalamic dopaminergic inhibition of prolactin secretion might be implicated. A further study on non-operated Meniere's patients presenting hyperprolactinemia and on dopamine agonist treatment, is needed in order to assess the role of stress in Meniere's patients. Progress in this domain could open the door towards integration of the stress concept into clinical management of various inner ear disorders.

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A total of twenty-five subjects were cloistered for a period of 70 hours, five at a time, in a hyperbaric chamber modified to simulate the conditions aboard the International Space Station (ISS). A recording of 72 dBA background noise from the ISS service module was used to simulate noise conditions on the ISS. Two groups experienced the background noise throughout the experiment, two other groups experienced the noise only during the day, and one control group was cloistered in a quiet environment. All subjects completed a battery of cognitive tests nine times throughout the experiment. The data showed little or no effect of noise on reasoning, perceptual decision-making, memory, vigilance, mood, or subjective indices of fatigue. Our results suggest that the level of noise on the space station should not affect cognitive performance, at least over a period of several days.

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Noise is a health risk. The only scientifically established adverse health effect of noise is noise­induced hearing loss (NIHL). Besides noise may affect quality of life and cause annoyance and sleep disturbance. The present scientific evidence of potential non-auditory effects of noise on health is quite weak. Whether health promotion works in relation to noise may be reflected by permanent hearing threshold shift development in population studies. Hearing impairment continues to be the most prevalent disability in Western societies. The National Institute of Occupational Safety and Health (NIOSH) still rates noise induced hearing loss among the top ten work-related problems. Recent studies report that employees continue to develop noise induced hearing loss although to a lesser extent than before, in spite of occupational hearing conservation programmes. Besides socio-acusis and leisure noise seem to be an increasing hazard to hearing, also in young children and adolescents. This seems partly related to acute leisure noise exposure (e.g. toy pistols, amplified music). However, population studies increasingly find non­normal high-frequency hearing including the characteristic NIHL-"notch" around 6kHz also in subjects who do not report noise exposure incidents or activities. Today 12.5% of US children 6-19 years show a noise-"notch" in one or both ears (n= 5249, Niskar et al 2001). A Norwegian county audiometry survey on adults > 20 years (n=51.975) showed mean unscreened thresholds +10dB at 6kHz for both genders even for the youngest age group 20-24 years (Borchgrevink et al 2001). Accordingly, the present health promotion initiatives seem insufficient in relation to noise and noise-induced hearing loss.

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The contribution of noise exposure to fatigue at work was studied in a survey study and three field studies. The survey study was based on a questionnaire covering symptoms and work place exposure answered by 50 000 state employees. Noise exposure was also estimated from their type of job and self-rated noise exposure. Fatigue and headache were found to be more common among the noise exposed groups even after control for the effects of other critical variables. Study 2 compared reaction times before and after a week's work in high noise exposure and one in low exposure exposure in a group of aeroplane mechanics. Reaction times were prolonged after work in the noise week, whereas an opposite trend was seen in the control week. Study 3 showed a gradual increase of reaction times during a week of noise exposure in a group of aeroplane technicians. Study 4 compared reaction times and subjective fatigue among naval crews on a day with low and a day with high noise exposure. In one of the studied boat types the development of fatigue during the work day was accentuated on the day with high exposure.

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Low frequency noise (20-200 Hz) is emitted by numerous sources in the society. As low frequencies propagate with little attenuation through walls and windows, many people may be exposed to low frequency noise in their dwellings. Sleep disturbance, especially with regard to time to fall asleep and tiredness in the morning, are commonly reported in case studies on low frequency noise. However, the number of studies where sleep disturbance is investigated in relation to the low frequencies in the noise is limited. Based on findings from available epidemiological and experimental studies, the review gives indications that sleep disturbance due to low frequency noise warrants further concern.

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The review provides an overview of epidemiological studies that were carried out in the field of community noise and cardiovascular risk. The studies and their characteristics are listed in the tables. Risk estimates derived from the individual studies are given for 5 dB(A) categories of the average A-weighted sound pressure level during the day. The noise sources considered in the studies are road and aircraft noise. The health endpoints are mean blood pressure, hypertension and ischaemic heart disease, including myocardial infarction. Study subjects are children and adults. The evidence of an association between transportation noise and cardiovascular risk has increased since the previous review published in Noise and Health in the year 2000.

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In several recent investigations it could be demonstrated that the free cortisol response to awakening can serve as an useful index of the adrenocortical activity. When measured with strict reference to the time of awakening the assessment of this endocrine response is able to uncover subtle changes in hypothalamus-pituitary-adrenal (HPA) axis activity, which are, for instance, related to persisting pain, burnout and chronic stress. Furthermore, it has been suggested that the HPA axis might serve as an indicator of allostatic load in subjects exposed to prolonged environmental noise. In the present paper four separate studies with a total of 509 adult subjects were combined in order to provide reliable information on normal values for the free cortisol response to awakening. Corresponding with earlier findings, a mean cortisol increase of about 50% within the first 30 minutes after awakening was observed. The intraindividual stability over time was shown to be remarkably high with correlations up to r=.63 (for the area under the response curve). Furthermore, the cortisol rise after awakening is rather consistent, with responder rates of about 75%. Gender significantly influenced early morning free cortisol levels. Although women showed a virtually identical cortisol increase after awakening compared to men, a significantly delayed decrease was observed. Confirming and extending previous findings, the present study strongly suggests that neither age, nor the use of oral contraceptives, habitual smoking, time of awakening, sleep duration or using / not using an alarm clock have a considerable impact on free cortisol levels after awakening. The cortisol awakening response can be assessed under a wide variety of clinical and field settings, since it is non-invasive, inexpensive and easy-to-employ. The present data provide normal values and information on potential confounds which should facilitate investigations into the endocrine consequences of prolonged exposure to environmental noise.

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Noise attenuation against military noises has been measured in several cases under practical field conditions. Commercial and military versions of earmuff noise attenuation were measured against rifle noise. All the tested earmuffs attenuated the C-weighted peak level to less than 135 dB, which is less than the proposed recommendation value. Combat and shooting exercises create a risk of hearing damage, reaching a peak level of 180 dB. Measurements were done during attack exercises with blank and normal cartridges and during a defence exercise with normal cartridges. The noise exposure levels were relatively moderate (outside the ear 95­97 dB, in ear canal 82-85 dB) for military exercises. Peak levels of 110-120 dB for military trainers were measured in the ear canal during the conscript use of small-bore weapons. Combat vehicles and tanks are noisy, and for noise control during their use headgear with communication properties is worn. Noise inside such headgear was found to reach up to 120 dB, and the noise doses varied between 90 and 105 dB. Noise was also measured for aviation pilots in Finnish jet fighters. The cockpit values averaged 96 dB - 100 dB over the flight, whereas noise in the ear canal averaged 88 dB - 95 dB. The analyses indicated that radio noise is 4-10 dB higher inside the helmet than the background noise is, when measured as equivalent noise. The technicians on the ground were exposed to noise levels varying from 93 to 97 dB over the day. In practice, hearing protectors attenuate noise by 10-30 dB, depending on the frequency content of the noise sources. However, the difference when measured outside and inside hearing protectors varies by 5-10 dB because communication increases the noise level at the entrance of ear the canal. Currently the best protection for soldiers seems to be active noise cancellation ear muffs that are equipped for communication purposes and worn during the entire military exercise.

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In several laboratory animal studies, it has been documented that the hearing, vision, and brain can be injured due to exposure to organic solvents. This finding formed the background for a pilot study (n = 16) aimed at identifying new ways of qualifying diagnostics, treatment, and rehabilitation of patients suffering from brain injury due to exposure to organic solvents, also referred to as toxic encephalopathy. Diagnosing toxic encephalopathy is complicated because the symptoms of this type of diffuse brain injury are non-specific. So, it was initially hypothesised that some of the difficulties involved in diagnosing toxic encephalopathy could be minimized by extending the diagnostic procedure. Apart from clinical interviewing and neuropsychological testing, the diagnosis should include the examination of hearing and vision. This will help in achieving new measures that could improve in diagnosing toxic encephalopathy with more certainty. On the basis of ranking, only one patient in the pilot study was considered to have a normal neuropsychological test profile, which was defined as a test profile without any marked deviations when compared with a normal population. A total of 10 patients were considered to have "discrete problems." These patients had a test profile showing either a few strikingly negative results or an array of results slightly below the expected level when compared with a normal population. A total of four patients were considered to suffer from "moderate problems" and one patient from "severe problems." The patients with "moderate problems" and "severe problems" showed consistent negative results and an unambiguous negative test profile. However, the overall results of all neuropsychological examinations performed revealed a dispersed picture. Quite remarkably, all the 13 patients who had their hearing examined showed a loss of hearing, 7 patients complained about tinnitus, and all patients had a history of exposure to both noise and organic solvents, which had not been observed at the initial examination, but seemed to have serious implications for their prognosis and future life.

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Different scientific groups have studied and continue to study the health impacts of physical and chemical agents in the environment. In most cases, every study group has considered the health effect as being solely due to the air pollutant(s) under investigation, for example air pollution without due regard for the simultaneous presence of noise pollution whereas both have an impact on the cardiovascular system. Or in the case of noise studies the contribution of solvent, asphyxiant or metal exposures has not been considered, which can have an impact on hearing impairment. One can, therefore, question the stringency of the available evidence of epidemiological studies in both fields to warrant the consideration of air pollutants as confounding or aggravating factors in studies of specific effects due to noise (and vice versa). In this paper we weigh the existing evidence on the association of noise and air pollutant exposure and associated health impacts. In forthcoming publications, the authors will consider the influence of other factors, which can confound noise studies but are currently not included in the analysis.

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A new stress model, the Allostatic Load Model, refers to the ability to achieve stability through change. The various biological functions activated during stress serve an important role in the organism's adaptation to the environment by protecting and restoring the body but may, under certain conditions, also have health damaging consequences. Two different psychoneu­roendocrine stress systems are of particular interest: (1) the sympathetic adrenal medullary (SAM) and (2) the hypothalamic pituitary adrenocortical (HPA) systems. Sustained activation of the SAM system with overexposure to epinephrine (adrenaline) and norepinephrine (noradrenaline) is considered to contribute to the development of cardiovascular disease (CVD). Chronic stress exposure influencing the HPA-axis is associated with metabolic changes which also increase the risk of CVD but, in addition, also contribute to impaired immune function, diabetes, depressive symptoms and cognitive disturbances. The present paper is focused on the possible biological pathways between environmental stress and somatic illness, including the role of environmental stress for the development of musculoskeletal disorders. It is concluded that the SAM and the HPA systems play an important role in linking environmental stress to various negative health outcomes and that knowledge about these psychobiological pathways is of considerable importance for the possibilities to prevent and treat environmentally induced ill health.

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The psychobiology of stress has received increasing attention throughout the past two decades. Physiological pathways and subjective response patterns are described in more details aiming at a better understanding of the pathways leading to health or disease under prolonged periods of stress. Technical advances in the laboratory have significantly contributed to this development. One of these methodological advances is the measurement of cortisol in saliva which has promoted psychobiological stress research both in the laboratory and in the field. The present paper provides a brief methodological background and the use of salivary cortisol assessment as an indicator of stress in human studies from this research centre. It is suggested that research on health consequences of noise exposure should include salivary cortisol as a sensitive measure of allostatic load.

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Noise immissions with predominant low frequency sound components may exert considerably disturbing effects in dwellings. This applies in particular to sounds which are excitated by transmission of structure-borne noise, and to low frequency sounds emitted by ventilators. Exposed persons usually declare such immissions as being "intolerable" even at very low A­weighted sound levels. If mechanical vibrations in the frequency range below 20 Hz (ground-borne vibrations) affect dwelling rooms, the annoying effects are perceived only by a small portion of exposed individuals as a physical effect. For the most part the immissions are observed as vibratory effects on the building and on objects inside the dwelling. The disturbing effects of vibration frequencies above 20 Hz (structure-borne sound) are determined by the airborne sound field generated inside a particular room and its given surface and extension.

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In recent years, the measurement of stress hormones including adrenaline, noradrenaline and cortisol has been widely used to study the possible increase in cardiovascular risk of noise exposed subjects. Since endocrine changes manifesting in physiological disorders come first in the chain of cause-effect for perceived noise stress, noise effects in stress hormones may therefore be detected in populations after relatively short periods of noise exposure. This makes stress hormones a useful stress indicator, but regarding a risk assessment, the interpretation of endocrine noise effects is often a qualitative one rather than a quantitative one. Stress hormones can be used in noise studies to study mechanisms of physiological reactions to noise and to identify vulnerable groups. A review is given about findings in stress hormones from laboratory, occupational and environmental studies.

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Impulse noise causes evidently more severe hearing loss than steady state noise. The additional effect of occupational impulse noise on hearing has been shown to be from 5 to 12 dB at 4 kHz audiometric frequency. Reported cases for compensated for hearing loss are prevalent in occupations where noise is impulsive. For impulse noise two measurement methods have been proposed: the peak level method and energy evaluation method. The applicability of the peak level method is difficult as even the recurrent impulses have different time and frequency characteristics. Various national risk criteria differ from international risk criteria. In France the maximum A-weighted peak level is 135 dB, and in the United Kingdom the C-weighted peak sound pressure is limited to 200 Pa (140 dB). This criterion of unweighted 200 Pa (140 dB) is used in European Union (EU) directive 86/188 and ISO 1999-1990 regardless of the number of impulses. The American Conference of Governmental Industrial Hygienists (ACGIH) has recommended that no exposure in excess of a C-weighted peak sound pressure level of 140 dB should be permitted. At work places these norms do not cause any practical consequences since the impulses seldom exceed 140 dB peak level. In several occupations the impulses are so rapid that they contribute only a minimal amount to the energy content of noise. These impulses can damage the inner ear even though they cause reduced awareness of the hazard of noise. Based to the present knowledge it is evident that there is the inadequacy of the equal energy principle in modelling the risk for hearing loss. The hearing protectors attenuate industrial impulse noise effectively due to the high frequency contents of impulses. Directive regarding the exposure of workers to the risks arising from noise requires that in risk assessment attention should be paid also to impulsive noise. So far there is no valid method to combine steady state and impulse noise. A statistical method for the measurements of industrial impulse noise is needed to get a preferably single number for risk assessment. There is an urgent task to develop risk assessment method and risk criteria for impulsive noise to meet the requirements of the upcoming European Union noise directive.

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Industrial hearing loss has generally been associated with noise exposure, but there is a growing awareness that industrial solvents can have an adverse effect on the auditory and vestibular systems in man. Both animal experiments and human studies point to an ototoxic effect of industrial solvents, as well as some central auditory and vestibular disturbances. This review examines the research from the last four decades in an attempt to get an overview of the available evidence. Research shows that industrial solvents are ototoxic in rats. The majority of the solvents studied cause a loss of auditory sensitivity in the mid-frequencies in rats, affecting outer hair cells in the order OHC ₃ > OHC ₂ > OHC ₁ . Inner hair cells are generally unaffected. Spiral ganglion cells are most vulnerable to trichloroethylene. Simultaneous exposure to solvents and noise results in a synergistic effect; the pattern of trauma mirrors that due to solvent exposure rather than noise, but is more enhanced. There is a critical level when synergy occurs. The effects of solvents on the vestibular system are neurotoxic and influence the vestibulo-oculomotor system in both animals and humans; humans also present with problems in postural sway. There is a strong suggestion from human studies that solvents are ototoxic in man, but findings show that both the peripheral and central auditory pathways can be affected. Hearing losses can be in the high frequency region or can affect a wider range of frequencies. Hearing loss and balance disturbances can occur at levels below permitted levels of exposure. The synergistic effect of combined exposure to solvents and noise has also been noted in humans, resulting in greater hearing losses than would be expected from exposure to noise and solvents alone. The findings from both human and animal studies indicate that exposure to industrial solvents or to industrial solvents and noise can have an adverse effect on hearing and balance. The implications for industry and hearing conservation are far reaching.

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A review of the literature studying possible correlations between hearing function and cardiovascular disease (CVD) reveals a complex and somewhat contradictory picture. Most studies favor the concept of an association between hearing loss and CVD. The issue of interactions between noise-induced hearing loss and CVD, as well as between age-related hearing loss and CVD, has been discussed in numerous publications. The present study utilizes information from an epidemiological study of elderly people in Gothenburg, Sweden. We found a probable correlation between high systolic blood pressure and hearing loss in the low and mid frequencies in elderly women, 79 years old. A tendency of a similar correlation was also found in a group of 85-year-old women. An association between high diastolic blood pressure and low- and mid-frequency hearing loss was also found in the group of women aged 85 years. No consistent associations between blood pressure or hypertension and auditory function were found in 70- and 75-year-old women or in men 70 to 85 years old.

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