In 1873 consecutive patients referred for compensation assessment for presumed industrial hearing loss, 281 (15% had an average difference in hearing threshold between the ears of 15 dB at 1, 2 and 4 kHz. An unrelated cause was found in 115 (6% It was due to trauma in 37 (2% unexplained in 32 (1.7% and attributed to noise exposure in 97 (5.2% The possible mechanisms for noise as a cause are discussed and include shielding of one ear from noise, unequal recovery after severe noise exposure, and unequal sensitivity of the ears. After extensive investigation, including X-rays, vestibular tests and some myelograms, no treatable disorder was discovered. © 1979 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.