A critical bibliography of published articles concerning the effects of noise exposure on hearing has been compiled for the NIH. The review concentrated on articles published over the last 14 years; however, historical highlights of the past 50 years or so were included for continuity. This paper attempts to summarize in tutorial fashion the results of that review with regard to auditory physiology in general and explores some of the current issues with specific reference to acoustic injury. To date, most of the effort toward understanding acoustic injury has been focused on the auditory periphery; the emphasis is clear simply from the number of papers published in that area. On the other hand, the response of the central nervous system to noise exposure or to any type of damage in the periphery is essentially unknown. It would seem that it is now time to assume a more balanced approach and recognize the importance of the CNS with regard to understanding the overall consequences of acoustic injury.