“…Industrial noise containing sudden sound pressure peak levels may, however, pose an increased risk for noise-induced permanent threshold shift that cannot be predicted from continuous noise with equal energy (8,9,28,35,50,51,53). This possibility has been illustrated in laboratory studies on animals (17,31,43), but also contradictory and nonconclusive reports have been presented (3,9,16,19). Moreover, it has been suggested that simultaneous exposure to hand-arm vibration may also aggravate noise-induced permanent threshold shift (20,30,33,41,42,52).…”