Occupational Medicine

p. 48–53Background: Smoking has been shown to have adverse effects on hearing, but it’s unclear whether smoking interacts with known causes of hearing loss such as noise exposure and ageing. Aims: To examine the hypothesis that smoking, noise and age jointly affect hearing acuity. Methods: This cross-sectional study was carried out in 535 male adult workers of a metal processing factory. Pure-tone audiometric tests were utilized to assess hearing loss. Noise exposure assessment was based on a job exposure matrix constructed with industrial hygienist scoring and job titles. Each participant answered questionnaires about socio-demographic, life-style, occupational and health-related data. Analysis of the possible underlying biological model was undertaken assessing departures from additivity using measures of the size of the interaction present. Results: Age and occupational noise exposures were, separately, positively associated with hearing loss. For all the factors combined the estimated effect on hearing loss was higher than the sum of the effects fromeach isolated variable, especially for smoking and noise among those 20–40 years of age, and for smoking and age among those non-exposed to occupational noise. Conclusions: The synergistic effect of smoking, noise exposure and age on hearing loss, found in this study, is consistent with the biological interaction. Furthermore, it is possible that distinct ototoxic substances in the chemical composition of mainstream smoke may synergistically affect hearing when in combination with noise exposure, which needs to be examined in future studies