Chapter 7 166 Occupational physicians can also contribute to early recognition of hearing loss. In line with the protocol of the Dutch Board for Occupational Medicine (NVAB) entitled ‘hearing loss and tinnitus’, we advocate alertness for hearing loss as an underlying cause of increasedNFRand associatedoccupational andhealthproblems. Occupational physicians should perform a hearing screening in employees that present with psychological complains, such as complaints about fatigue, depression, anxiety, or burn-out. In case of a suspicion work functioning difficulties due to hearing loss, even if the hearing loss is expected to be mild, the employee should be referred to an audiological center for extensive audiological assessment. The studies in this thesis add to the body of evidence suggesting that the outcome of traditional hearing assessments are only a poor predictor of work functioning difficulties (Forshaw & Hamilton, 1997; Laroche et al., 2003; Tufts et al., 2009). Therefore, we recommend to not suffice with pure-tone audiometry for the diagnosis of employees with hearing loss or for assessment of auditory fitness. Further assessment is required, including other tests, such as speech perception tests in noise, and questionnaires. The results described in chapter 3 and 4 point out to a potential benefit of aural rehabilitation. We believe that a broad and multidisciplinary protocol for aural rehabilitation should be accessible for all employees with hearing loss. For example, an audiologist, occupational physician, social worker, and a speech therapist may be involved. Also, explicit support for using adequate PA may be useful, as well as educating employers and colleagues, and stimulating work adjustments. Measuring the effects of aural rehabilitation primarily of importance for evaluation of the individual results, but is also is important to be able to showing the additional value of aural rehabilitation to health care insurance companies and to improve the quality of aural rehabilitation services. A first step towards validly and uniformly evaluating the effects of aural rehabilitationwouldbe toperformaidedmeasurements and questionnaires after finishing the aural rehabilitation. For example, the SSQ, ACHW, and QEEW could be used.
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