Lead and noise, via different mechanisms, may damage hearing ability, and, in some cases, cause severe and irreversible damage. To explore possible independent and synergistic effects of lead and noise on auditory function, the authors conducted a cross-sectional study in two lead-battery manufacturing factories. Lead and noise were the two most common sources of occupational exposures in the factories. Blood lead level, ambient lead concentration, noise exposure level, and hearing thresholds of 339 lead-battery workers-including clerical and managerial staffs-were measured. The authors obtained demographics and working histories via an interview-based structured questionnaire. A total of 220 lead-battery workers were exposed to high levels of lead and noise; their average blood lead concentration was 56.9 microg/dl, and their average noise exposure level was 86.0 dBALeq. Multivariate analysis, in which possible risk factors of hearing ability were considered, demonstrated a significant correlation between a high, long-term lead exposure index (defined by duration of employment and ambient lead concentration) and decreased hearing ability. In contrast, such a correlation between short-term lead exposure (defined by blood lead level) and hearing ability was not significant. Furthermore, neither noise exposure level alone nor the interaction between noise exposure level and short- or long-term lead exposure was correlated significantly with hearing ability. The present study raises an important, but typically ignored, issue: lead exposure might precipitate a more severe auditory than noise-exposure effect. The preservation of workers' hearing ability requires that preventive measures be taken against noise exposure, which is as essential as measures taken against lead exposure.