Factors influencing the need for recovery in employees with hearing loss: a cross-sectional study of health administrative data

How to remain in working life with hearing loss - health factors for a sustainable work situation

BACKGROUND

Persons with hearing loss (HL) are a vulnerable group in working life. Studies have shown that they are more likely than the general population to be in part-time work, to be unemployed, receive disability pension, and to be on sick leave. Many workers with HL also experience unhealthy work conditions, such as jobs where they experience high demands combined with low control as well as safety concerns and social isolation. There is a lack of studies that focus on factors that promote a healthy, sustainable work situation for the target group.

OBJECTIVE

To investigate health factors that contribute to a sustainable work situation for employees with HL.

METHODS

The current study was a comparative, observational study with a cross-sectional design including a clinical population of adults with HL. Comparisons were made between workers with HL "in work" and workers with HL on "HL-related sick leave".

RESULTS

Seven health factors were identified. Those "in work" experienced a healthier work environment as well as lower levels of mental strain, hearing-related work characteristics and content, cognitively demanding work content, hearing-related symptoms, energy-demanding activities, and bodily aches and pain than those on "HL-related sick leave".

CONCLUSION

The results demonstrate a clear pattern regarding health factors for a sustainable working life. The type of job was not related to whether an individual was on sick leave or working. Rather, the work climate and the content of the work mattered.

Exploring Factors That Contribute to the Success of Rehabilitation With Hearing Aids

OBJECTIVES

Hearing aids are an essential and important part of hearing rehabilitation. The combination of technical data on hearing aids and individual rehabilitation needs can give insight into the factors that contribute to the success of rehabilitation. This study sets out to investigate if different subgroups of (comparable) hearing aids lead to differences in the success of rehabilitation, and whether these differences vary between different domains of auditory functioning.

DESIGN

This study explored the advantages of including patient-reported outcome measures (PROMs) in the process of purchasing new hearing aids in a large sample of successful hearing aid users. Subject data were obtained from 64 (commercial) hearing aid dispensers and 10 (noncommercial) audiological centers in the Netherlands. The PROM was a 32-item questionnaire and was used to determine the success of rehabilitation using hearing aids by measuring auditory disability over time. The items were mapped on six domains of auditory functioning: detection, discrimination, localization, speech in quiet, speech in noise, and noise tolerance, encompassing a variety of daily-life listening situations. Hearing aids were grouped by means of cluster analysis, resulting in nine subgroups. In total, 1149 subjects were included in this study. A general linear model was used to model the final PROM results. Model results were analyzed via a multifactor Analysis of Variance. Post hoc analyses provided detailed information on model variables.

RESULTS

Results showed a strong statistically significant effect of hearing aids on self-perceived auditory functioning in general. Clinically relevant differences were found for auditory domains including detection, speech in quiet, speech in noise, and localization. There was only a small, but significant, effect of the different subgroups of hearing aids on the final PROM results, where no differences were found between the auditory domains. Minor differences were found between results obtained in commercial and noncommercial settings, or between novice and experienced users. Severity of Hearing loss, age, gender, and hearing aid style (i.e., behind-the-ear versus receiver-in-canal type) did not have a clinically relevant effect on the final PROM results.

CONCLUSIONS

The use of hearing aids has a large positive effect on self-perceived auditory functioning. There was however no salient effect of the different subgroups of hearing aids on the final PROM results, indicating that technical properties of hearing aids only play a limited role in this respect. This study challenges the belief that premium devices outperform basic ones, highlighting the need for personalized rehabilitation strategies and the importance of evaluating factors contributing to successful rehabilitation for clinical practice.

The relationship between hearing status, listening effort, and the need for recovery in employees of a manufacturing company

OBJECTIVE

Hearing screening can be used to detect hearing loss, but its value for identifying employees with work functioning difficulties is unclear. The objective of this study was to assess the association between the hearing status measured with an occupational hearing-in-noise screening test, Listening Effort (LE), and Need For Recovery (NFR) in employees of a manufacturing company, and to examine whether these associations depend on the perceived noise level at the workplace.

METHODS

Employees of coatings and paints manufacturing company were included. Their hearing status was assessed with an occupational hearing-in-noise screening test. An online survey was used to assess their LE, NFR, and the perceived noise level at the workplace. Responses from 143 employees were analyzed (mean age = 53 years) using hierarchical multiple regression analysis with the outcomes LE and NFR.

RESULTS

Regression analysis-with adjustments for gender, age, educational level, health status, pace/amount of work, job variety, and work pleasure-revealed that hearing status was significantly associated with LE, but the interaction between hearing status and the perceived noise level was not. Hearing status nor the interaction between hearing status and the perceived noise level was significantly associated with NFR.

CONCLUSION

The results confirm that poorer hearing is associated with higher LE, but not with higher NFR. These associations were unrelated to the perceived noise level at the workplace. Therefore, the value of occupational hearing screening appears to be early identification of hearing loss in employees, but not identification of work functioning difficulties.

The Effects of Tinnitus and Tinnitus Annoyance on Need for Recovery After Work: Results of the Netherlands Longitudinal Study on Hearing

OBJECTIVES

The first aim of this study was to examine the relationship between having tinnitus and the need for recovery after work (NFR). The second aim was to investigate whether the level of tinnitus annoyance is associated with NFR.

DESIGN

Data from the 5- and 10-year follow-up measurement rounds of the Netherlands Longitudinal Study on Hearing (NL-SH) were used in a cross-sectional analyses. The NL-SH is a web-based prospective cohort study and includes participants aged 18 to 70 years at baseline. For this study, we included only participants who worked at least 12 hours/week and were under the age of 65 years. Participants completed questionnaires on demographic, socioeconomic, psychosocial, hearing-related, and work-related characteristics. In addition, participants answered questions about hearing ability and tinnitus and performed an online digit-triplet speech recognition in noise test to measure the speech reception threshold (SRT) in noise. Participants were asked if (1) they suffer from tinnitus and (2) to rate tinnitus annoyance on a 0-100 numeric rating scale. A linear mixed model was used (1) to estimate the overall (i.e., cross-sectional) association between having tinnitus and NFR and (2) to estimate the overall association between the level of tinnitus annoyance and NFR. The models were checked for effect modification and confounding of factors known to be associated with either tinnitus or NFR and available in the NL-SH.

RESULTS

The study sample comprised 770 unique participants in total; 686 and 335 participants at 5- and 10-year follow-up, respectively. Distress, somatization, and self-reported hearing disability appeared to be confounding factors in the analysis of having tinnitus and NFR. After adjusting for these factors, participants with tinnitus had a 2.5% higher NFR (95% confidence interval: -0.9 to 5.9; p = 0.15). In the analysis of tinnitus annoyance and NFR, SRT was an effect modifier. Distress, somatization, depression, and self-reported hearing disability were confounders. After adjustment for effect modification and confounding, tinnitus annoyance was not significantly associated with NFR ( p = 0.79 for tinnitus annoyance).

CONCLUSIONS

This study showed that having tinnitus was not associated with a higher NFR. Also, higher levels of tinnitus annoyance were not associated with a higher NFR. NFR was associated with the psychological factors distress, somatization, and depression, which are known to be intricately related to tinnitus. A longitudinal study design is recommended as it can assess the sequence of events, which might help disentangle the association between tinnitus, NFR, and psychological factors.

Hearing Impairment and Allostatic Load in Older Adults

Importance

Allostatic load, the cumulative strain that results from the chronic stress response, is associated with poor health outcomes. Increased cognitive load and impaired communication associated with hearing loss could potentially be associated with higher allostatic load, but few studies to date have quantified this association.

Objective

To investigate if audiometric hearing loss is associated with allostatic load and evaluate if the association varies by demographic factors.

Design, Setting, Participants

This cross-sectional survey used nationally representative data from the National Health and Nutrition Examination Survey. Audiometric testing was conducted from 2003 to 2004 (ages 20-69 years) and 2009 to 2010 (70 years or older). The study was restricted to participants aged 50 years or older, and the analysis was stratified based on cycle. The data were analyzed between October 2021 and October 2022.

Exposure

A 4-frequency (0.5-4.0 kHz) pure tone average was calculated in the better-hearing ear and modeled continuously and categorically (<25 dB hearing level [dB HL], no hearing loss; 26-40 dB HL, mild hearing loss; ≥41 dB HL, moderate or greater hearing loss).

Main Outcome and Measures

Allostatic load score (ALS) was defined using laboratory measurements of 8 biomarkers (systolic/diastolic blood pressure, body mass index [calculated as weight in kilograms divided by height in meters squared], and total serum and high-density lipoprotein cholesterol, glycohemoglobin, albumin, and C-reactive protein levels). Each biomarker was assigned a point if it was in the highest risk quartile based on statistical distribution and then summed to yield the ALS (range, 0-8). Linear regression models adjusted for demographic and clinical covariates. Sensitivity analysis included using clinical cut points for ALS and subgroup stratification.

Results

In 1412 participants (mean [SD] age, 59.7 [5.9] years; 293 women [51.9%]; 130 [23.0%] Hispanic, 89 [15.8%] non-Hispanic Black, and 318 [55.3%] non-Hispanic White individuals), a modest association was suggested between hearing loss and ALS (ages 50-69 years: β = 0.19 [95% CI, 0.02-0.36] per 10 dB HL; 70 years or older: β = 0.10 [95% CI, 0.02-0.18] per 10 dB HL) among non-hearing aid users. Results were not clearly reflected in the sensitivity analysis with clinical cut points for ALS or modeling hearing loss categorically. Sex-based stratifications identified a stronger association among male individuals (men 70 years or older: β = 0.22 [95% CI, 0.12-0.32] per 10 dB HL; women: β = 0.08 [95% CI, -0.04 to 0.20] per 10 dB HL).

Conclusion and Relevance

The study findings did not clearly support an association between hearing loss and ALS. While hearing loss has been shown to be associated with increased risk for numerous health comorbidities, its association with the chronic stress response and allostasis may be less than that of other health conditions.

Impact of hearing impairment and cochlear implantation on productivity and social well-being in a professionally active but severely hearing-impaired group: protocol of the 'Hear again, work again' longitudinal prospective cohort study

INTRODUCTION

Severe hearing loss is a sensory deficit with considerable impact on the patient's daily life and on society. Previous research has established occupational obstacles in professionally active patients with hearing loss. However, studies investigating the impact of severe hearing loss and cochlear implantation (CI) on work performance using a quantitative and longitudinal study design and validated questionnaires are lacking. This study aims to answer the following research question: 'What is the impact of unilateral and bilateral severe hearing loss and CI on the cost for society, health state, employment, productivity and social well-being?'. We hypothesise hearing impairment to influence work performance. After establishing the impact, we will be able to enhance the support of hearing impaired patients to maintain employed.

METHODS AND ANALYSIS

A total of 200 professionally active adults between 18 and 65 years old with severe hearing loss will be included for assessment at baseline and reassessment at 3, 6 and 12 months. The following four study groups are included: bilateral severely hearing impaired participants without CI (1) and with CI (2) and unilateral severely hearing impaired participants in acute (3) and chronic (4) setting. The primary outcome of this study is the change in index score on the Work Limitations Questionnaire, which evaluates the degree of limitations and health-related productivity loss. Secondary outcome measures include audiometric and cognitive evaluations and validated questionnaires evaluating employment, work productivity, quality of life and direct healthcare costs. Linear mixed models will assess the evolution in time and the difference in evolution between groups.

ETHICS AND DISSEMINATION

This study protocol (project ID 2021-0306) received ethical approval from the ethics committee of the Antwerp University Hospital on 22 November 2021. Our findings will be disseminated by peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05196022.

Factors associated with change in the need for recovery and subjective listening effort in employees with hearing loss receiving aural rehabilitation

OBJECTIVE

Compared to normally-hearing employees, those with hearing loss suffer from higher Need For Recovery (NFR) after work. The aims of this study are to assess the NFR of employees with hearing loss before and after aural rehabilitation and to examine to what extent change in the NFR can be explained by changes in subjective listening effort, personal adjustments, communication strategies, auditory work demands, and self-reported hearing ability.

METHODS

We included patients who received aural rehabilitation in two audiological centers in the Netherlands because of hearing complaints in their work situation. Outcomes were measured by questionnaires at baseline and 3 month follow-up. The NFR before and after the rehabilitation was compared with a t test. Hierarchical multiple analyses were performed.

RESULTS

In total, 60 patients (aged 22-63, working hours ≥8 per week) participated in the study, of which 50 completed the follow-up questionnaires. The NFR was significantly lower after the aural rehabilitation (M = 45.03) compared to before the aural rehabilitation (M = 51.89), t = -3.43, p < 0.01). Change in NFR could best be explained by the change in personal adjustments (R² = 0.45, B = -1.23, p < 0.01).

CONCLUSION

The NFR of employees with hearing loss can be improved by aural rehabilitation, but this study shows that current practices reduce the NFR only in part of the employees. Therefore, improving current practices should be considered and evaluated, for example by applying a different combination of rehabilitation components. Especially, interventions that affect personal adjustments may be promising to further reduce the NFR in employees with hearing loss.

The Longitudinal Relationship Between Speech Recognition in Noise, Need for Recovery After Work, Job Demand, and Job Control Over a Period of 5 Years

OBJECTIVE

Hearing impairment may lead to an increased need to recover from fatigue and distress after a day of work. Also, hearing impairment may negatively affect the balance between workload and control over it (job demand and job control). The uptake of hearing solutions may have a positive effect on these outcomes. We aimed to assess the longitudinal relationship between change in speech recognition in noise and changes in need for recovery after work and job demand and job control, and the influence of hearing solutions on these relationships over a period of 5 years. Research questions (RQs) were as follows: (1) Is a 5-year change in speech recognition in noise associated with a change in need for recovery after work over that same 5-year period?; (2) Is a 5-year change in speech recognition in noise associated with a change in job demand and job control over that same 5-year period?; (3) What is the effect of hearing solution uptake in the 5-year period on the change in these outcomes in that same 5-year period?

METHOD

Data of the Netherlands Longitudinal Study on Hearing, collected between 2006 and January 2019, were divided into two 5-year follow-up intervals: T0 (baseline) to T1 (5-year follow-up) and T1 (5-year follow-up) to T2 (10-year follow-up). An online digit-triplet in noise test was used to assess speech recognition in noise. Online questionnaires on demographic, socioeconomic, and work-related characteristics were administered. For RQ1-RQ2, the study sample included adults working ≥12 hours per week, with at least two consecutive measurements (n = 783). For RQ3, employees who had not yet obtained hearing solutions at baseline, but who would be eligible based on a speech reception threshold in noise ≥ -5.5 dB signal-to-noise ratio (SNR), were included (n = 147). Longitudinal linear regression analyses using mixed models were performed to assess RQ1-RQ3.

RESULTS

After adjusting for baseline values, 5-year change in speech recognition in noise showed a statistically significant association with 5-year change in need for recovery. A worsening of 1 dB SNR in speech recognition in noise in an individual was associated with an increase of 0.72 units in need for recovery (scale range 0 to 100). A 5-year change in speech recognition in noise was not significantly associated with a 5-year change in job demand or job control. The uptake of hearing solutions in the 5-year period did not have a significant effect on change in need for recovery in that same 5-year period.

CONCLUSION

The significant longitudinal association between 5-year worsening in speech recognition in noise and increase in need for recovery over the same time period strengthens the evidence for the importance of early detection of a worsening in speech recognition in noise to identify employees with an increase in need for recovery. The absence of an effect of the uptake of a hearing solution on need for recovery indicates that additional alternative interventions may be needed to foster beneficial use of hearing solutions as well as to mitigate the increased need for recovery in case of worsening speech recognition in noise.