Pesticide exposure has been linked to adverse effects on auditory health, impacting both peripheral and central auditory systems. Studies suggest that organophosphate, carbamate, organochlorine, and pyrethroid pesticides disrupt auditory processing through oxidative stress, neuroinflammation, and interference with cholinergic signaling. These disruptions may compromise sensory hair cells, spiral ganglion neurons, and auditory pathways, impairing precise signal transmission. The auditory efferent system, responsible for cochlear protection and auditory signal modulation, appears particularly susceptible to pesticide-induced alterations. This system relies on cholinergic transmission to regulate cochlear amplification and selective attention, functions that may be disrupted by pesticide exposure. Evidence from epidemiological and experimental studies highlights the potential for long-term auditory dysfunction in populations exposed to pesticides, with agricultural workers and their families facing elevated risks due to prolonged contact with agrochemicals. This review integrates findings on pesticide exposure and its implications for auditory health, discussing potential peripheral and central ototoxicity pathways. The cumulative effects of chronic exposure are emphasized, including the gradual degradation of auditory processing capabilities. Additionally, the need for targeted interventions, such as audiological monitoring and enhanced safety protocols, is addressed. Further research is critical to elucidate the mechanisms underlying pesticide-induced auditory damage and identify protective strategies. Such investigations can inform evidence-based policies to mitigate the public health impact of pesticide exposure while maintaining agricultural productivity. A multidisciplinary approach is essential to safeguard auditory health in vulnerable populations exposed to these environmental hazards.