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Noise-induced hearing loss is initially a clinical diagnosis, depending on the demonstration of a sensorineural hearing loss (usually high-tone, with or without a notch on the audiogram) coupled with an appropriate history of significant noise exposure. Alternative causes of hearing loss must be excluded and a history of familial hearing loss, noisy hobbies or exposure to drugs toxic to the inner ear (such as streptomycin) should be sought. If no other cause is apparent the diagnosis can usually be made with confidence.