General discussion 155 Hearing assessment Assessment of the hearing function Pure-tone audiometry is widely used for the diagnosis of hearing loss (Fredriksson et al., 2016). Also, auditory inclusion and exclusion criteria for employment are commonly based on pure-tone thresholds (Tufts et al., 2009). It is easy to administer and reliable for the assessment of the hearing function. However, it has been shown to poorly predict other aspects of auditory functioning (Forshaw&Hamilton, 1997; Laroche et al., 2003; Tufts et al., 2009). The same was found in the studies of this thesis. For example, only moderate associates were found between the outcome of pure-tone audiometry and the signal detection test that was developed in chapter 6. The latter shows that the ability to detect auditory warning signals in the ambient noise of a simulated train cabin cannot be accurately predicted with the outcome of pure-tone audiometry. The finding that pure-tone audiometry is a poor predictor of aspects of auditory functioning can be explained by the fact that pure-tone thresholds are established by presenting simple tones, monaurally, in a quiet environment, whereas auditory job tasks often require more complex signals to be heard, such as speech. Frequently, spatial hearing is important and many jobs are performed in environments with noise and/or reverberation. In addition, some workers may and others may not be able to compensate for their hearing loss by relying on other senses (sight, touch), skills, and experience. Therefore, other diagnostic instruments are required to predict the consequences of hearing loss on everyday activities and societal involvement. Although common practice, it does not seem to be adequate to use pure-tone thresholds as the sole criterion to assess the performance of hearingcritical job tasks (Tufts et al., 2009). Assessment of personal and environmental factors Coping behavior in adults with hearing loss can be assessed with the CPHI. The Dutch CPHI (Mokkink et al., 2009) has been translated from the American-English version (Demorest & Erdman, 1987). Factor analysis has confirmed the structure of this Dutch questionnaire (Mokkink et al., 2009). This study also describes mean scale scores of 399 adults with hearing loss aged from 20 to 86. The original Dutch CPHI contains 52 questions. Using IRT modelling, a short CPHI form was developed including 35 questions (Lidwine B. Mokkink et al., 2010). This study describes mean scores of an additional 408 adults.
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