Sophia E' Kramer,

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Hearing impairment, work and vocational
rehabilitation

• Sophia E. Kramer,
• Dept. of Audiology, E.N.T. / EMGO Institute
• Expertise Center Hearing and Work (NCvB, AMC,
  VUmc)
• VU University medical center
• Amsterdam

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1. Hearing Impairment Cognition2.
Occupational Performance3. Vocational
Rehabilitation
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1. Cognitive functioning as an additional
explanatory factor in intelligibility in noise
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Pure-tone Audiometry
Hz 500 1000
2000 4000 8000
Speech-Reception in Noise (SRT test)
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Hearing and speech perception in the presence of
background noise underlying components involved
Peripheral auditory Central auditory Cognitive
/ Linguistic Psychological
(Hinchcliffe,1992 Humes,1995,1996, 2007
Pichora-Fuller et al.,1995 Zhao and Stephens,
2000Gatehouse et al.,2003Hallgren,2005)
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disentangle modality-specific auditory
processes from more global cognitive
functioning
(McFarland and Cacace, 1995 Watson et al., 1996
Pichora-Fuller et al., 2005 Humes et al., 2007)
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Experiment 1 Relationship SRT and TRT
Speech-Reception-Threshold in noise

• List of short everyday Dutch sentences
• Two types of masks (stationary, 16 Hz
  modulated-block)
• Adaptive procedure
• SRT threshold at which 50 correctly reproduced

(Plomp Mimpen, 1979 b)
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is
Sweden
of
full
green
forests
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is
Sweden
of
full
green
forests
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is
Sweden
of
full
green
forests
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is
Sweden
of
full
green
forests
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is
Sweden
of
full
green
forests
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is
Sweden
of
full
green
forests
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Visual analogue
28 unmasked text 34 40 46 52 58 64 7
0
TRT score percentage unmasked text needed to
read 50 of the sentences correctly
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Two experiments

• 1. Normally hearing
• Correlation SRT en TRT
• 2. Hearing impaired (and normally hearing)
• Regression analysis with Speech-in-Noise as the
  dependent variable

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The relationship between the Speech-Reception-Tre
shold in noise (SRT) and the Text-Reception-Thres
hold (TRT a visual analogue)
Experiment 1 Relationship SRT and TRT
Experiment 1
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Experiment 1 Relationship SRT and TRT
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Participants, normally hearing (N34)
Experiment 1 Relationship SRT and TRT
Gender 24 females, 10 males Ages M34
yrs (sd 18.4), 19 78 years PTA at 0.25,
0,5,1,2kHz lt 15 dB HL PTA at 4 kHz lt 30
dB HL
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Procedure
Experiment 1 Relationship SRT and TRT

• Two Blocks

3 x TRT 1 x SRTstat 2 x SRTmod
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Result
Experiment 1 Relationship SRT and TRT
R 0.54 (p lt 0.01)
R 0.54 (p lt 0.01)
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Experiment 2 Predicting SRT
Experiment 2, hearing impaired and normally
hearing
Gehoorverlies
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Experiment 2 Predicting SRT
Test battery

• Pure-tone audiometry
• 3 x Text-Reception-Threshold test (TRT)
• 2 x Speech-Reception-Threshold, modulated noise
  (SRTmod) Temporal Acuity
• Spectral Acuity

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Experiment 2 Predicting SRT
Regression Analysis

• Dependent (to predict) variable
• Speech-Reception-in-Noise test (SRTmod)
• Independent variables (predictors)
• Pure-tone audiometry
• Temporal acuity
• Spectral acuity
• Text-Reception-Test (TRT)
• Age

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Experiment 2 Predicting SRT
Result Experiment 2 (Normally hearing, N13)
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Experiment 2 Predicting SRT
Result Experiment 2(Hearing impaired, N21)
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SRT as function of TRT
cognitive
? NHR normally hearing ? HI hearing
impaired
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Conclusions
About 30 of the interindividual variance in both
the TRT and SRT appears to be associated with
modality aspecific cognitive and linguistic
skills TRT may be clinically relevant to
determine part of the origin (auditory or
non-auditory) of deteriorated speech reception
among hearing impaired listeners
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More details

• Zekveld AA, George ELJ, Kramer SE, Goverts ST,
  Houtgast T (2007)
• The development of the text reception threshold
  test a visual analogue of the speech reception
  threshold. J Speech Lang. Hear. Research, 50
  576-84.
• George ELJ, Zekveld AA, Kramer SE, Goverts ST,
  Festen JM, Houtgast T (2007). Auditory and
  non-auditory factors affecting speech reception
  in noise by older listeners. J. Acoust. Soc. Am.,
  121(4) 2362-75.

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2. Occupational performance

• WHO, ICF
• Borg Ecological Conceptual Framework

( Borg, Scan Audiol, 1998, Acta Otolaryngol,
2000)
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Numbers

( Ruben, 2000 Parving Christensen, 1993,
Danermark Coniavitis Gellerstedt, 2004)
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Hearing impairment and Work

• Occupation Health

Health Occupation
(Hétu, 1991, 1994 Danermark, 2005)
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Occupational Noise Level
lt

• 80 dB

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(No Transcript)
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Study
Effect of hearing impairment on occupational
performance and well-being
Kramer SE, Kapteyn TS, Houtgast T. (2006)
Occupational Performance Comparing normally
hearing and hearing impaired employees using the
Amsterdam Checklist for Hearing and Work. Int J
Audiol 45 503-12.
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Participants (N211)
77 using hearing aid(s) 37 unilaterally
fitted 63 bilaterally fitted
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Amsterdam Checklist for Hearing and Work

• Type of Job
• Working conditions (demand, control, support)
• Type of contract (permanent vs temp., fulltime
  vs parttime)
• Sick-leave
• Working environment (noise, reverberation)
• Effort in hearing
• Hearing activities

 
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Activity (limitation)

• Intelligibility of speech in noise
• Intelligibility of speech in quiet
• Localization of sounds
• Detection of sounds
• Distinguish between, identify, recognize sounds
  

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Sick-leave
How many days were you absent during the last 12
months and what was the reason?

• Number of days
• Reason 1 mental distress
• 0 other reason (fever, cold, broken leg)

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Incidence and reason of sick-leave
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Logistic Regression Analysis (N112)

• Dependent (to predict) variable
• Sick-leave for reason of mental distress
• Independent variables (predictors)
• Generic working conditions (job demand, control,
  support)
• Type of contract (permanent vs temporary)
• Demographic variables (age, gender, education)
• Hearing activities (speech, detection,
  localization, identification)

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Result
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Correlation / Essential Factors

• Communication in Noise
• Effort in Hearing
• Lack of control
• Recognition/Distinguishing between sounds

Feelings of insecurity, unsafe
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Comparable findings

• Eriksson Erlandsson (1984) importance of
  nonverbal sounds
• Morata et al. (2005) environmental sounds
• Gatehouse Noble (2005) SSQ
• Danermark Gellerstedt (2004) job control
• Detaille et al. (2003) lack of knowledge

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Limitations

• Relatively small number
• Moderate Severe losses
• Generalization

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INTERNET
National Longitudinal Study on Hearing

• National Hearing Screening test on Internet
  (Smits et al., 2004)
• Both normally hearing and hearing impaired
• Age 18-65 years

• N 1649
• Response 1451 (88,0) (av. age 46 y)

www.hooronderzoek.nl
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Outcomes
National Longitudinal Study on Hearing

• Psychosocial health
• Distress, depression, anxiety somatisation
  (4DSQ)
• Loneliness
• Self-efficacy
• Work Performance
• Health Performance Questionnaire
• Job control / demand
• Need of recovery
• Use of health care

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National Longitudinal Study on Hearing
N 680 NH, 771 HI

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3. Vocational Rehabilitation
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Vocational rehabilitation relevant?

• Coping with hearing loss at work one of the most
  frequently reported care needs (De Graaf Bijl,
  2002).
• 2. Previous study 147 of the 151 participants
  (97)
• reported to need counselling in coping with loss
  at work (Kramer et al., 2006).

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Expertise center for Hearing and Work

• Diagnostics, care, research, education

• Netherlands Center for Occupational Diseases
• Dr. B. Sorgdrager
• Audiological Center AMC
• Prof. Dr. Ir. W.A. Dreschler
• Audiological Center LUMC
• Dr. Ir. J. de Laat
• Audiological Center VUmc
• Prof. Dr. Ir. J.M. Festen, Dr. S.T. Goverts, Dr.
  D.J. Bruinvels, dr. S.E. Kramer

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Protocol

• Evaluation of the problem from various
  perspectives
• Diagnostic examination of hearing status
• Recommendations for rehabilitation
• Written report

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Consultation hour
Questionnaires
Interview written report
PTA Speech audiometry
Speech in Quiet (monaurally per ear)
Localization
Speech in Noise (SRT) (monaurally per ear)
Speech in Noise (free field)
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Interventions to facilitate occupational
performance multidisciplinairy approach

• Hearing aids
• Assistive listening devices
• Acoustics
• Speech reading
• Communication strategies
• Person with loss (coping)
• Significant other (colleagues)
• Providing control
• Environmental changes

Audiological Technical
Audiologist Speech Therapist Social
worker Occupational Physician
Speech-Therapeutical
Psychosocial At work
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Acoustical environment

• Speech Transmission Index (STI) measurement

(Steeneken Houtgast, 1980)
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Experiences (86 patients)
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Hearing Status
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Occupations
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Interventions

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• Psychosocial counselling

• Social worker / psychologist

• Communication course for employees
• Video-trainingprogramme Speechreading
• Video-trainingprogramme Hearing strategies
• CD-rom information package Hearing and Work

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Hearing impairment at work how do we deal with
that?
GENERAL
EMPLOYEES
COLLEAGUES
EMPLOYERS
PROFESSIONALS
Background info About CD-rom
Introduction HI at work Function /
tasks Working conditions Environment Summary
Introduction Put yourself in anothers place
Introduction Role employer Legal
issues Analysis workplace Websites
Introduction
Health Care Inst.
Hearing impairment The hearing organ Types,
causes
Example 1 (demo)
Diagnostics Standard Additional
Example 1 (demo)
Tips
Interpretation scores
Signal-to-noise
Example 1 (demo)
NIHL Hazardous effects Act Noise at work
Example 2 (demo)
Example 2 (demo)
Demo Without hearing aid With hearing aid
Example 2 (demo)
At work Problems How do they develop?
Interventions Technical Speech
Therapeutical Accomodations work Psychosocial
More information Literature Websites
Colofon
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Thanks for your attention!
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The International Classification of Functioning,
Disability and Health (ICF WHO, 2001)
Domestic life Social life Education Work
Health Condition
disability
impairment
handicap
Activity
Participation
Functions and Structure
Speech quiet/noise Localization Detection Identifi
cation
Environmental Factors
Personal Factors
Acoustical environment Hearing aids ALD Significa
nt other
Age Gender Coping styles