General discussion 157 communication in noise and detecting (warning) sounds. These questions provide a broad, qualitative overview of the auditory work demands for employees with hearing loss. This part of the ACHW has not yet been standardized nor validated and no reference values are available, but this information has proven to be highly important in clinical use. Other aspects of the working environment can be assessed with generic questionnaires, such as theQuestionnaire on the Experience and Evaluation ofWork (QEEW) (Van Veldhoven et al., 2015).TheQEEWscales can provide an impression of several aspects of the working environment of employees with hearing loss, such as the relationship with the supervisor or colleagues and the pace and amount of work. Especially when considering the NFR, it seems to be relevant to take the influence of work characteristics into account. For example, in chapter 2, the scales score ‘pace and amount of work’ and ‘work pleasure’ were found to significantly explain variations in NFR. The QEEW has been shown to have high content validity and internal consistency and some studies have been performed to assess the longitudinal validity of QEEW scales (Van Veldhoven et al., 2015). Although the QEEW has not been developed nor validated specifically for employees with hearing loss, it can be used to provide a general impression of work characteristics. Assessment of activities and participation Hearing tests Speech audiometry, assessing the perception of monosyllabic words in a quiet listening environment, is often used for clinical or research purposes (Tufts et al., 2009). However, difficulties with speech understanding are particularly experienced innoisy environments.Therefore, speechperception tests innoise are recommended, such as the digits-in-noise test (Smits et al. 2013) and the Occupational Ear Check (OEC) (Sheikh Rashid and Dreschler 2018) for screening purposes. For diagnostic and evaluative purposes, the ability to understand speech in noise at work may even closer be simulated using speech perception tests that contain everyday sentences as speech stimuli, such as the Dutch sentences developed by Plomp and Mimpen (1979), or the VU98 speech material, developed by Versfeld et al. (2000). Also, the outcome of a speech perception test in noise can be used to estimate the impact of hearing loss on speech understanding in a specific work environment (Soli, AmanoKusumoto, et al., 2018). Although, speech perception tests in noise are increasingly
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