In recent years, it has been postulated that cigarette smoking can aggravate noise-induced hearing loss. In this study, we aimed to assess the effect of concurrent exposure to cigarette smoke and occupational noise on binaural hearing impairment (BHI). In an analytic study on the workers of a large wagon manufacturing company in 2007, 622 male workers (252 smokers and 370 non-smokers, matched for other variables) participated and their BHI was compared. BHI was significantly higher in smokers than in non-smokers (odds ratio= 5.6, P < 0.001, 95% CI =3.4-9.4). Logistic regression confirmed this significant difference as well, and showed a direct relationship between the amount of BHI and pack/years of smoking. Cigarette smoking accompanied by exposure to workplace noise may play a role in causing binaural hearing impairment, so giving up or decreasing the amount of smoking may prevent or at least delay binaural hearing impairment, and eventually reduce its compensation costs.