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Possible contributing factors include: Reduced blood flow to the inner ear Increased oxidative stress Damage to delicate hearing structures Smoking combined with loud noise exposure may further increase the likelihood of hearing damage over time

However, they constitute the best available evidence and values are similar to those obtained in other studies.18 With regard to lung cancer, when risks were taken from the meta-analysis performed in the Surgeon General's Report in 2006, only data from studies conducted in Europe were used (see Table 7.4 of the report)