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The pediatric intensive care unit is an environment filled with dedicated caregivers, state-of-the-art monitors, and machines that collectively work to provide the best care possible for critically ill children. A previously unappreciated result of having these resources mingled together is the elevated level of environmental noise. Although the levels of noise do not reach OSHA levels (>85 dB for 8 continuous hours) that cause noise-induced hearing loss, the patients are exposed to continuous moderate noise levels that may cause hearing impairment if mixed with other ototoxic agents. In addition, these noise exposures may result in abnormalities in the stress response as well as in sleep patterns. This article reviews the physiology of hearing, the consequences of noise pollution as it relates to pediatric patients, and preventive measures used to reduce noise pollution in a pediatric intensive care setting. Considerations for further research efforts are also discussed.