This paper discusses the concept of acoustic shock based on a literature review and the results of our own research into cases seen in both clinical and medicolegal practice. With the demise of traditional ‘metal bashing’ and ‘smoke stack’ heavy industries, there has been a decline in the incidence of noise-induced hearing loss and tinnitus in this form of employment. However, with the increasing establishment of call centre work, the emergence of acoustic shock has been noted. Acoustic shock is recognised as a clinical entity distinct from noise-induced hearing loss and acoustic trauma.

This article discusses clinical implications, medicolegal considerations in light of a recent high-profile court case and proposed criteria for diagnosis.

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.