Figure 1: Proposed expanded noise reaction model characterizing the adverse health effects of environmental noise exposure. The direct pathway refers to effects on the auditory system by exposure to high levels of noise (e.g., hearing loss and tinnitus). The indirect pathway is associated with cognitive and emotional stress responses, leading to sympathetic and endocrine activation triggering alterations in cerebrocardiovascular risk factors. Additionally, chronic noise stress is associated with increased risk for psychological symptoms and disorders, which in turn impairs cerebrocardiovascular function. As a consequence, noise exposure may promote maladaptive coping mechanisms and decrease stress resistance, further negatively affecting cerebrocardiovascular function. Adapted from Babisch [7, 8] and Münzel et al. [5] with permission.