Noise-induced hearing loss ranks among the most significant occupational health problems. In the United States, more than 1 million firefighters are at risk for noise-induced hearing loss due to exposure to hazardous levels of intermittent noise from sirens, air horns, and engines of emergency vehicles and fire trucks. Although irreversible, noise-induced hearing loss is entirely preventable through both engineering controls and personal protective equipment. This article describes occupational noise exposure, hearing loss, and strategies to prevent noise-induced hearing loss among firefighters.