An etiologic paradigm of hearing loss for industrial workers is introduced as having two major components, one being occupational and the other extra-occupational. The extra-occupational factors include age, noise exposure outside the work place, trauma, ear disease and ototoxic drugs. The work-related factors include occupational noise, whole body vibration, work-related diseases and toxic exposures. Within this framework, a review of the epidemiology of hearing loss examines the possible relationships between hearing loss and these factors.