title: Exacerbation of noise-induced hearing loss by co-exposure to workplace chemicals.
abstract: BACKGROUND
  : Numerous organic solvents applied in industry, like toluene, styrene, xylene and n-hexane have been demonstrated to impair hearing in animals. However, the effects of exposure to a given organic solvent and the interaction of noise and solvents on hearing in humans are still not fully recognized.
  
  
  METHODS
  : The study was aimed to assess the effects of occupational exposure to solvents alone or in combination with noise on hearing in 1117 employees of yacht, ship, plastic, shoe, and paint and lacquer industry. These persons were exposed either to the mixture of organic solvents with xylene as the main component, or predominantly to styrene, or to the mixture of n-hexane and toluene. Detailed questionnaire data and pure-tone audiometry were compared with data of the reference group that included white collar workers, exposed neither to solvents nor noise and metal factory workers exposed to noise only. In all statistics, the confounding factors were recognized as gender, age, exposure to noise, and other variables occurring at a different rate in study and reference group.
  
  
  RESULTS
  : Odds ratio (OR) of hearing loss related with the particular exposure to chemicals was 2.4 (95%CI 1.59-3.74) in case of solvent mixture, 3.9 (95%CI 2.4-6.2) in case of styrene and 5.3 (95%CI 2.6-10.9) in case of n-hexane and toluene exposure. The odds of developing hearing loss substantially increased in the case of combined exposure to organic solvents and noise as compared to isolated exposure to each of these hazards. The highest OR (over 20-fold) was demonstrated in subgroups of subjects exposed simultaneously to noise and two ototoxic solvents (i.e. styrene and toluene or n-hexane and toluene). The mean hearing thresholds were significantly higher in the solvent-exposed groups than in the reference group. The differences in thresholds were observed at high frequencies in the solvent mixture- and n-hexane + toluene-exposed groups and at all frequencies in the styrene-exposed group. A positive linear relationship existed between exposure to solvents and hearing thresholds at high frequencies.
  
  
  CONCLUSIONS
  : The results of the study provide the epidemiological evidence that exposure to organic solvents in humans is associated with an increased risk of hearing loss. The simultaneous exposure to organic solvents and noise seems to enhance the hearing deficit if compared with isolated exposures.
authors.affiliation: Nofer Institute of Occupational Medicine, Department of Physical Hazards, 8 St. Teresa Str, 90-950 Lodz, Poland.
authors.forename: Mariola
authors.initials: M
authors.lastname: Sliwinska-Kowalska
authors.forename: Ewa
authors.initials: E
authors.lastname: Zamyslowska-Szmytke
authors.forename: Wieslaw
authors.initials: W
authors.lastname: Szymczak
authors.forename: Piotr
authors.initials: P
authors.lastname: Kotylo
authors.forename: Marta
authors.initials: M
authors.lastname: Fiszer
authors.forename: Wiktor
authors.initials: W
authors.lastname: Wesolowski
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Pawlaczyk-Luszczynska