Chapter 1 34 examined in 925 normally-hearing and hearing-impaired working adults. NFR was assessed with the QEEW and hearing status with the national hearing test (Smits et al., 2006), a speech-in-noise test that was performed over the internet. Their regression analysis showed that poorer hearing was significantly associated with higher NFR. In the cross-sectional study by Juul Jensen et al. (2018), the relationship between NFR and tinnitus was examined in 32 hearing aid users of which 16 were suffering from tinnitus. NFR was assessed with a Danish translation of the QEEW and tinnitus with the Tinnitus Handicap Inventory. The authors reported that the degree of tinnitus severity was significantly associated with higher NFR. Finally, a randomized controlled trial has been reported by Gussenhoven et al. (2017) in a population of 136 hearing-impaired employees. The study evaluated the effectiveness of a vocational enablement protocol on NFR as compared to usual care for hearingimpaired employees.This protocol is amultidisciplinary programof care that consists of vocational andaudiological components, suchas an intake interview conducted by the psychologist or social worker and clinical occupational physician, the performance of pure-tone audiometry and a speech-in-noise test, and a multidisciplinary team meeting in which the technical, speech therapeutic, and psychosocial intervention options are discussed (Gussenhoven et al., 2012). The intervention of the control group consisted of any kind of another audiological revalidation. NFR had not significantly changed after 12 months follow-up, and there were no significant differences between the intervention and the control group (Gussenhoven et al., 2017). The authors concluded that NFRmay not adequately capture what is covered in the vocational enablement protocol. However, it is unclear how many employees received technical, speech therapeutic, and psychosocial interventions and thus which interventions did not influence NFR. Further, because the factors influencing NFR in hearing-impaired employees are not yet well understood, it is difficult to indicate which changes in degree of hearing loss could have an effect on NFR. Multiple studies have indicated work characteristics influencing NFR, such as the number of working hours ( Jansen et al., 2002; Verdonk et al., 2010), lack of participation in work decisions (Van Veldhoven & Broersen, 2003), and problems in the relationship with colleagues (Kiss et al., 2008; Van Veldhoven & Broersen, 2003). Highjobdemands and low job support are associatedwithhighNFRandmixed results are presented for job control (Kiss et al., 2008; Kraaijeveld et al., 2014; Sluiter et al., 2001; Sonnentag & Zijlstra, 2006; Van der Hulst et al., 2006). Job demands
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