To determine sociodemographic factors associated with occupational, recreational and firearm-related noise exposure.

This nationally representative, multistage, stratified, cluster cross-sectional study sampled eligible National Health and Nutrition Examination Survey participants aged 20–69 years (n = 4675) about exposure to occupational and recreational noise and recurrent firearm usage, using a weighted multivariate logistic regression analysis.

Thirty-four per cent of participants had exposure to occupational noise and 12 per cent to recreational noise, and 13 per cent repeatedly used firearms. Males were more likely than females to have exposure to all three noise types (adjusted odds ratio range = 2.63–14.09). Hispanics and Asians were less likely to have exposure to the three noise types than Whites. Blacks were less likely than Whites to have occupational and recurrent firearm noise exposure. Those with insurance were 26 per cent less likely to have exposure to occupational noise than those without insurance (adjusted odds ratio = 0.74, 95 per cent confidence interval = 0.60–0.93).

Whites, males and uninsured people are more likely to have exposure to potentially hazardous loud noise.

The diagnosis ‘acoustic shock’ has been made increasingly in the health care industry in recent years. This paper aims to question the validity of acoustic shock as an organic pathological entity.

The experiences of 16 individuals diagnosed as having acoustic shock, within a medico-legal practice, are reviewed.

The commonest symptom was otalgia, followed by noise sensitivity, tinnitus, hearing disturbance and dizziness.

The presence of noise-limiting technology in the workplace, the variation in the nature of the acoustic incident involved (ranging from a shriek, through feedback noise, to a male voice), and the marked variation in the time of symptom onset (following the acoustic incident) all suggest that the condition termed acoustic shock is predominantly psychogenic. Cases of pseudohypacusis indicate that malingering is a factor in some cases. Clusters of acoustic shock events occurring in the same call centres suggest that hysteria may play a part. The condition is usually only seen when work-related issues are apparent.