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Combined effect of smoking and occupational exposure to noise on hearing loss in steel factory workers
  1. T Mizoue1,
  2. T Miyamoto2,
  3. T Shimizu3
  1. 1Department of Clinical Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
  2. 2Nippon Steel Corporation Kimitsu Works
  3. 3Occupational Health Training Center, University of Occupational and Environmental Health, Japan
  1. Correspondence to:
 Dr T Mizoue, Department of Preventive Medicine, Faculty of Medical Sciences, Kyushu University, Japan;


Background: Evidence has accumulated concerning the adverse effects of smoking on hearing acuity, but it is not clear whether smoking modifies the association between exposure to noise and hearing loss.

Aims: To examine the synergistic effect of these variables on hearing.

Methods: Data used were derived from periodic health examinations for 4624 steel company workers in Japan and included audiometry testing and information on smoking habits. Occupational exposure to noise was determined based on company records. Logistic regression was used to examine the dose-response association between smoking and hearing loss. The Cochran-Mantel-Haenszel method was used to calculate the prevalence rate ratio (PRR) of hearing loss for each combination of smoking and noise exposure factors, taking non-smokers not exposed to occupational noise as a reference. The interaction between smoking and noise exposure was assessed using a synergistic index, which equals 1 when the joint effect is additive.

Results: Smoking was associated with increased odds of having high frequency hearing loss in a dose-response manner. The PRR for high frequency hearing loss among smokers exposed to occupational noise was 2.56 (95% CI 2.12 to 3.07), while the PRR for smokers not exposed to noise was 1.57 (95% CI 1.31 to 1.89) and the PRR for non-smokers exposed to noise was 1.77 (95% CI 1.36 to 2.30). The synergistic index was 1.16. Smoking was not associated with low frequency hearing loss.

Conclusions: Smoking may be a risk factor for high frequency hearing loss, and its combined effect on hearing with exposure to occupational noise is additive.

  • hearing loss
  • noise exposure
  • smoking
  • CI, confidence interval
  • PRR, prevalence rate ratio

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