Chapter 1 36 Methods Design We performed a single center study with an observational and cross-sectional design at the Amsterdam University Medical Center (UMC). Factors potentially influencing NFR were derived from hearing assessments performed at the hospital and a hearing survey that was completed at home. All variables were derived from patient files. Participants We retrospectively identified patients referred to Amsterdam UMC’s ENT-Audiology department (location AMC) by their occupational physician. All patients were thus referred fromoccupational healthcare. Eligiblepatients visited thehospital between2004 and 2019, were aged between 18 and 67, underwent pure-tone and speech audiometry, and completed the hearing survey prior to their hospital visit. Patients were included regardless of the cause of their hearing loss. For patients with multiple referrals, the data were included belonging to the first referral with a completed questionnaire and hearing evaluation. Toprevent bias, patientswere excluded if theywere referred to thehospital for a fitness for job assessment by their employer. The reason is that hearing loss complaints might be experienced or reported differently if continuation of the job depends on it. All patients received a letter with information about the study. Because of the retrospective study design, an opt-out procedure was performed. A total of 646 patients were identified of being referred to the ENT-Audiology department by their occupational physician (Figure 1). Patients referred to the department to determine fitness for their job (n = 283) were not eligible for the study, as were patients older than 67 (n = 2). Further, patients were excluded that declined to participate (n = 6) or had an incomplete patient file, specifically missing pure-tone audiometry (n = 4), missing survey (n = 20), or incomplete survey (n = 37).
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