Part I: Factors inflencing professional functioning 33 Introduction Hearing loss is a common occupational malady (Backenroth-Ohsako et al., 2003; May, 2000). Prevalence estimates vary from 7 to 31 percent and increase with age and exposure to noise (Hasson et al., 2010; Masterson et al., 2016; May, 2000; Nelson et al., 2005). It is estimated that 3 percent of theDutchwork force experiences difficulties in their job due to their hearing loss (Sorgdrager, 2015).These difficulties often result in greater levels of fatigue, fear, social isolation, and psychophysiological stress, caused by the fact that hearing loss goes along with increased listening effort during activities, such as communicating in background noise or localizing sounds (Hornsby & Kipp, 2016; Kramer et al., 2006; Morata et al., 2005; Ohlenforst et al., 2017; Svinndal et al., 2018). Adverse implications for work are sick leave due to mental distress, unemployment, and earlier retirement (Danermark & Gellerstedt, 2004; Hasson et al., 2011; Kramer et al., 2006; Punch, 2016). The degree of hearing loss is significantly associated with need for recovery (NFR) (Nachtegaal et al., 2009), a measure that can contribute to early identification of occupational diseases (De Croon et al., 2003; Moriguchi et al., 2010; Sluiter et al., 2003; Sluiter, 1999). NFR has been defined as the need to recuperate from work- induced fatigue, primarily experienced after a day of work ( Jansen et al., 2002; Van Veldhoven & Broersen, 2003). The degree of NFR is determined by the intensity of mental and physical work-induced fatigue and by the period required to return to a normal level of functioning. NFR can be measured with the validated Questionnaire on the Experience and Evaluation of Work (QEEW), which includes 11 dichotomous statements, such as ‘I find it hard to relax at the end of a working day’ and ‘When I get home, people should leave me alone for some time’ (Van Veldhoven & Broersen, 2003). NFR is a predictor of work stress, subjective health problems, and sick leave (De Croon et al., 2003; Sluiter et al., 2003). In line with the International Classification of Functioning, Disability and Health (ICF) (Organization, 2001), NFR has been described to be a complex construct that is influenced by disease specific, personal, and environmental factors (Gommans et al., 2015). Despite the importance of the outcome NFR both from health and economic perspectives, the studies examining NFR in patients with hearing loss are scarce. To our knowledge, three studies have been reported so far. In the cross-sectional study by Nachtegaal et al. (2009), the relationship between NFR and hearing status was
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