Chapter 7 158 used for research purposes, they are not yet widely used in clinical practices or for assessing the performance on hearing-critical job tasks (Tufts et al., 2009). In the routinely healthcare data that was included for the study described in chapter 1, it was observed that a speech perception test in noise was performed in only half of the employees with hearing loss that visited an audiological center. Speech perception tests in noise have the potential to be used for specific purposes. First, comparing the performance in continuous noise versus in fluctuating noise provides information about howwell an individual is capable ofmaking use of relative silent periods in the noise. This may be relevant, for example, in employees that need to understand incomplete or distorted verbal messages at work, for example when there is a need for communication via radios or walkie-talkies (Cook & Hickey, 2003). Second, speech perception tests can be used to assess speech understanding from multiple directions (Darwin, 2008; Dirks & Wilson, 1969; Gnewikow et al., 2009; Grutters et al., 2007; Ricketts & Henry, 2002; Wagner et al., 2020). Although this method is not yet standardized, this may be particularly relevant in employees that need to understand messages from different directions, for example during business meetings. Third, speech perception tests can be used to evaluate the effect of hearing aids or hearing protectors. Speech perception tests are often performed under headphones, but can also be performed in a free field setting using hearing aids or hearing protectors (Duquesnoy & Plomp, 1983). During our studies, it was observed that performing a speech perception test in noise is part of routine clinical practices for the assessment of auditory fitness of locomotive engineers (chapter 6), but not for evaluating the effect of a speech reading training (chapter 4). This is understandable, because there is no standardized and validated speech perception test available that combines auditory with visual input that could be used for this purpose. The University Medical Center Utrecht has made video recordings of the sentence material of the speech perception sentences developed by (Versfeld et al., 2000). These recordings have not yet been validated. Questionnaires Several generic, health-related quality-of-life questionnaires are available, but most have been shown lack sensitivity in populations with hearing loss (Granberg, 2015). An explanation is that many of these questionnaires do not include communication
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