The Effects of Earphone Use and Environmental Lead Exposure on Hearing Loss in the Korean Population: Data Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES), 2010-2013

PLoS One. 2016 Dec 28;11(12):e0168718. doi: 10.1371/journal.pone.0168718. eCollection 2016.


Background: Although previous studies have reported that frequent earphone use and lead exposure are risk factors for hearing loss, most of these studies were limited to small populations or animal experiments. Several studies that presented the joint effect of combined exposure of noise and heavy metal on hearing loss were also mainly conducted on occupational workers exposed to high concentration.

Objectives: We investigated both the individual and joint effects of earphone use and environmental lead exposure on hearing loss in the Korean general population.

Methods: We analyzed data from 7,596 Koreans provided by the Korea National Health and Nutrition Examination Survey (KNHANES) during the period 2010-2013. The pure-tone average (PTA) of hearing thresholds at 2, 3, and 4 kHz frequencies was computed, and hearing loss was defined as a PTA ≥ 25 dB in one or both ears.

Results: A dose-response relationship in hearing loss with earphone use time and blood lead level is observed after adjustment for confounding factors. With a 1-hour increase in earphone use time and 1 μg/dL increase in blood lead concentration, the odds of hearing loss increased by 1.19 and 1.43 times, respectively. For hearing loss, the additive and multiplicative effect of earphone use and blood lead level were not statistically significant.

Conclusions: Earphone use and environmental lead exposure have an individual effect on hearing loss in the general population. However, the estimated joint effect of earphone use and lead exposure was not statistically significant.

MeSH terms

  • Adult
  • Environmental Exposure / adverse effects*
  • Female
  • Health Surveys*
  • Hearing Loss / blood
  • Hearing Loss / chemically induced
  • Hearing Loss / epidemiology*
  • Hearing Loss / etiology*
  • Humans
  • Lead / blood
  • Lead / pharmacology*
  • Male
  • Middle Aged
  • Nutrition Surveys*
  • Republic of Korea / epidemiology
  • Time Factors
  • Young Adult


  • Lead

Grant support

This study was supported by grants from The Korea University (K1508311). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.