If you meet a smoker who has difficulty hearing you, the cigarette in their hand might have something to do with it.

A Japanese study suggests that smokers may be more likely to develop hearing loss than those who don’t smoke, reported Reuters.

For the study, researchers examined almost 50,000 healthy Japanese workers between the ages of 20-64.

At the start of the eight-year study, in which the participants had annual comprehensive hearing tests, about 19,000 of them were current smokers, 9,800 were former smokers and 21,000 had never smoked.

At the end of the study, 5,100 participants were found to have developed hearing loss.

Those who smoked were 60% more likely to develop high-frequency hearing loss than nonsmokers, making it difficult for them to make out what someone is saying in noisy environments. The same people were also 20% more likely to develop low-frequency hearing loss, meaning they would find it difficult to detect deep voices.

Huanhuan Hu, lead study author Huanhuan Hu of the Department of Epidemiology and Prevention at the National Center for Global Health and Medicine in Tokyo, told Reuters:

“The more one smokes, the higher the risk of hearing loss. Quitting smoking virtually eliminates the excess risk of hearing loss, even among quitters with short duration of cessation.

“Because the risk of hearing loss increases with the number of cigarettes smoked per day, if quitting is impossible people should still smoke as little as possible.”

Compared to nonsmokers, those who smoked:

- Up to 10 cigarettes a day: 40% more likely to develop high-frequency hearing loss and 10% more likely to develop low-frequency hearing loss.

- From 11 to 20 cigarettes a day: 60% more likely to develop high-frequency hearing loss and 20% more likely to develop low-frequency hearing loss.

- More than 20 cigarettes a day: 70% more likely to develop high-frequency hearing loss and 40% more likely to develop low-frequency hearing loss.

Hu said that the study wasn’t specifically designed to prove whether or not smoking might cause hearing loss, however, nicotine exposure could be a possible contributing factor to ear damage.

Nonetheless, hearing specialist Matteo Pezzoli of the San Lazzaro Hospital in Alba, Italy, insisted that there is growing evidence that smoking is a contributor to hearing loss.

“The study showed clearly that there is a direct link between the number of cigarettes smoked and the damage suffered,” Pezzoli told Reuters.

“To maintain the hearing we have when we’re young, in addition to quitting smoking it is also important to lead a healthier lifestyle and increase sporting activities,” Pezzoli added. “It is also very important to protect your ears from prolonged exposure to loud noise.”

Pezzoli was not involved in the Japanese study.