Environmental noise in space vehicles, caused by onboard equipment and crew activities, has generated concerns for crew health and safety since early U.S. space missions. The International Space Station (ISS) provides a unique environment where acoustic conditions can be monitored while crewmembers from the U.S. and their international partners work and live for as long as 6 to 12 consecutive months. This review of acoustic dosimetry data collected to date reveals that the noise exposure limits of NASAs stringent noise constraint flight rule have been exceeded in 41% of these dosimetry measurements since ISS Increment 17 (2008), with undefined impacts to crew. These measurements do not take into account the effects of hearing protection devices worn by the crew. The purpose of this paper is to provide an update on ISS noise exposure monitoring approaches and hearing conservation strategies that include acoustic dosimetry data collected since the ISS Increment 55 mission (April 2018). Future directions and recommendations for the ISS noise exposure monitoring program will also be presented, including research initiatives aimed at better defining the impact of ISS noise on crew health and performance.