[The problem of severe noise induced hearing loss (author's transl)].

It can be observed that even after severe and long-lasting occupational exposure to noise the hardness of hearing caused by that noise is usually only low or medium-grade. Therefore the question is being examined whether there are any particular causal conditions for those rare cases in which the hardness of hearing caused by noise is more than medium-grade. High noise levels and high frequencies, together with continual constrained physical posture during work, seem to be such conditions according to the statistical evaluation of a wide range of observation data. In such cases the expert is required to assume a highly critical attitude. The diagnosis and in particular the simulation and aggravation tests call for improvement by way of an objectification.