Chapter 1 16 the middle ear can be examined in more detail via tympanometry (Rose, 2011). Additionally, the middle ear muscle reflex can be assessed by measuring the response to a high level acoustic stimulus presented in the ear canal (Schairer et al., 2013). Assessment of the hearing function Pure-tone audiometry can be used to assess hearing sensitivity by determining ear specific hearing thresholds at different frequencies (Vogel et al., 2007). Based on this assessment, the degree of hearing loss can be determined (see Table 1). When the degree of higher loss is higher, the difficulties with performing auditory tasks are presumed to be more severe. However, pure-tone audiometry only assesses the ability to detect sounds in a quiet environment and this has been shown to poorly predict other functional hearing abilities (Shub et al., 2020; Tufts et al., 2009). For themedical diagnosis of hearing loss, pure-tone audiometry is necessary, but it does not suffice for the prediction of the consequences of hearing loss on everyday activities. Table 1. Presumed difficulties based on the severity of the hearing loss Degree of hearing loss Pure-tone thresholds Presumed difficulties with performing auditory tasks Normal -10 to 15 dB HL - Mild 15 to 35 dB HL Difficulties with hearing/understanding soft speech, speech at a larger distance, or speech in noisy environments Moderate 35 to 60 dB HL Difficulties with hearing/understanding speech at a normal level, even at close distance or in quiet environments. Possible difficulties with making phone calls Severe 60 to 90 dB HL Difficulties with understanding loud speech, hearing sirens of emergency cars, hearing industrial sounds, and hearing the sound of a closing door Profound >90 dB HL Speech understanding is impossible based on acoustic information only This table was derived from the protocol of the Dutch Board for Occupational Medicine (NVAB) ‘hearing loss and tinnitus’ and was translated to English.The pure-tone thresholds represent the average values of the hearing thresholds at 1000, 2000 and 4000 Hz for the better ear. Assessment of personal and environmental factors Hearing-related coping behavior The Communication Profile for the Hearing Impaired (CPHI) has been developed to assess the coping behavior of individuals with hearing loss (Mokkink et al., 2009). The questionnaire distinguishes adequate coping behavior, such as asking for a
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