Preventive Medicine Reports · Published 2026-06-16 · DOI 10.1016/j.pmedr.2026.103546
Zhihao Shi, Genyuan Li, Zhehua Zhou
Objectives: To investigate the combined effect of low-level xylene and noise exposure on hearing impairment in Chinese manufacturing workers and to provide evidence for occupational hearing protection strategies in China. Methods: A cross-sectional survey was conducted among 899 workers (295 co-exposed, 604 noise-only) in Jiaxing City, China from 2023 to 2025. Workplace noise and xylene concentrations were monitored, and pure-tone audiometry was performed with age-gender correction. Binary logistic regression and stratified regression analysis were used to evaluate risk factors for high-frequency hearing loss (HFHL). Results: The HFHL prevalence was 5.76% in the combined exposure group and 2.48% in the noise-only group (P = 0.01). Logistic regression model shows that the combined exposure group had a 5.49-fold higher HFHL risk (P < 0.01). Hypertension, longer exposure duration, higher noise intensity and higher xylene concentration were independent risk factors for HFHL. Stratified analyses confirmed a higher HFHL risk in the combined exposure group across subgroups of age < 40/ ≥ 40 years, male workers, and exposure duration 0–5/6–10 years. Conclusions: Combined xylene and noise exposure exerts a significant synergistic ototoxic effect even when both exposures are within Chinese national occupational exposure limits.
Abstract from DOAJ. Public domain (CC0 1.0).
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Shi, Z., Li, G., Zhou, Z. (2026). Combined effects of xylene and noise exposure at realistic low levels on hearing impairment: a cross-sectional study in China. Preventive Medicine Reports. https://doi.org/10.1016/j.pmedr.2026.103546