Hearing impairment among workers and satisfaction with the use of hearing aids

Abstract

BACKGROUND:

Hearing problems can have adverse effects on an individual’s job performance, as well as on unemployment or underemployment and increased risk of stress-related sick leave.

OBJECTIVE:

To investigate hearing impairment among workers and satisfaction with the use of hearing aids.

METHODS:

Cross-sectional study with workers who are hearing aid users. Subjects underwent pure tone audiometry and answered the Hearing Handicap Inventory for Adults and the Satisfaction with Amplification in Daily Life questionnaires.

RESULTS:

Participants were 36 workers between 36 and 75 years old, with an average age of 53.47 years, 52.7% male and 47.3% female. There was a mild to moderate hearing handicap perception, with worse results for women in the emotional domain. As hearing loss increased, workers’ frustration increased when talking to coworkers. Everyone was satisfied with the use of their hearing aids. Satisfaction increased with increasing age and decreased with increasing hearing loss. The greater the frustration when talking to co-workers, the lower the overall satisfaction with hearing aid use; the lower the satisfaction with the competence of the professional who assisted in adapting the hearing aid; the lower the satisfaction in environments with background noise and overall worse personal image. The worse the attitudes and emotional responses of workers regarding their hearing impairment, the lower the overall satisfaction with the hearing aid.

CONCLUSIONS:

Despite the use of hearing aids, workers perceive having a hearing impairment, especially women. As hearing loss and frustration in talking with co-workers increased, satisfaction decreased.

Keywords

Audiology occupational health surveys and questionnaires hearing loss

1 Introduction

Hearing loss is a chronic condition that affects about 432 million adults worldwide [1]. It is prevalent in the working age population. The prevalence in the United States of America [2] was estimated to 12.9% in 40–49-year-olds and 28.5% in the age group 50–59, and in the Swedish, 31% reported hearing loss [3].

Some studies report that adults with hearing impairment are less likely to have high education or income and are more likely to be considered unsuitable for work compared to normal hearing individuals [4, 5]. Hearing problems imply reduced access to oral communication, which may result in barriers that have adverse effects on job participation [6], higher incidence of unemployment or underemployment [5, 7] and increased risk of fatigue and stress-related sick leave [8]. Thus, hearing loss may be a risk factor for fatigue [3 , 9–12]. However, how hearing-impaired workers perceive barriers and how barriers contribute to fatigue is not yet well understood. Moreover, little is known about how these individuals perceive which factors facilitate their participation in work [6].

Some authors [6] report that participation in professional life involves three main contexts: personal context, work context, and service provider context. During the course of professional life, contexts interact and influence the individual’s professional resilience.

Adulthood hearing loss requires emotional and psychological adjustments. These adjustments dep-end on an individual’s ability to adapt to the limitations imposed by the impairment and to how closely an individual relates to the environment in which he or she lives and works. As such, the consequences of hearing loss cannot be predicted by audiometric data alone [13]. There is no direct association between hearing loss and the degree of impairment experienced by a given individual [14].

One way to minimize the negative effects of hearing loss is through the use of hearing aids (HA). However, up to 40% of hearing aid users fail to wear them or may not get optimal benefits [15].

Studies show that many audiologists are involved in the process of adult hearing intervention [16, 17]. A rehabilitative intervention involves not only hearing assessment and hearing aid fitting but also the application of self-assessment hearing questionnaires. These questionnaires target the psychosocial problems and hearing difficulties that may interfere with the adaptation of hearing aids and help the patients to reflect on their difficulties and better understand their needs. In addition, the self-assessment questionnaires help assess the performance of individuals using hearing aids and their perceived benefits, as the devices’ efficiency in daily communication situations cannot be assessed by clinical testing.

Hearing impairment can generate relationship problems that go beyond social communication en-vironments. It may directly interfere with job performance in the work environment. Thus, by analyzing the impact of hearing loss on the worker’s daily life activities, new audiology intervention may arise to minimize this impact and favor the workers’ performance in conversation activities. This may improve relationships, working conditions, and job performance. This study aims to investigate the perception of workers’ hearing impairment and satisfaction with the use of hearing aids.

2 Methods

2.1 Study design

This is a descriptive cross-sectional study with a quantitative approach. All procedures performed as part of this study were approved by the Ethics Research Committee of Universidade Tuiuti do Paraná - Brazil, n. 2.393.567. Informed consent was obtained from all individual participants included in the study.

This study was conducted at the audiology clinic of a university in southern Brazil, accredited to the Unified Health System as a highly complex service, and was carried out between March and November/2018.

2.2 Study procedure

Thirty-six adults participated in this study. Inclusion criteria for sample selection were: Be a worker of any gender and age, be employed at the time of data collection, in any hiring regime and work sector; have sensorineural or mixed hearing loss of any degree, whether or not due to occupational noise exposure; be a user of hearing aids (HA). Exclusion criteria were: Having a hearing loss in isolated frequency; having unilateral hearing loss; being a user of individual hearing aid for less than six months.

All workers received a visual inspection of the external auditory canal to verify that there were no obstructions that could compromise the audiological evaluation. Afterward, pure-tone audiometry was performed by air for frequencies from 250 Hz to 8000 Hz, and by bone conduction only when the air thresholds were with values greater than 25 dBHL, for frequencies from 500 Hz to 4,000 Hz, in a sound-proof booth. Evaluations were performed using the Madsen audiometer, model ITERA II, with TDH39P earphones. In the cases of workers exposed to noise, there was an occupational auditory rest of 14 hours for audiometry.

The hearing normality criterion was defined for aerial tone hearing thresholds in up to 25 dB HL for the frequency rate of 500 to 8,000 Hz.

The Hearing Handicap Inventory for Adults (HHIA) questionnaire was used to evaluate self-perceived hearing impairment. This questionnaire was developed in 1990 [18] and adapted to Brazilian Portuguese in 1998 [19]. It was used to evaluate the social (social domain) and emotional (emotional domain) effects of hearing loss in different communication situations. Workers were asked to answer the questions thinking about the use of hearing aids in the situations proposed by the questionnaire. The objective was to verify if, despite the use of hearing aids, there was a presence of hearing impairment. The higher the total score, the higher the perception of hearing impairment reported by the individual. In analyzing the answers, emphasis was given to questions E-7 (“Does your hearing difficulty make you frustrated when talking to work mates?”) And S-11 (“Does your hearing difficulty cause you problems to hear/understand work mates? ”), as they refer specifically to the work environment.

Among the 36 workers, 23 also answered the Satisfaction with Amplification in Daily Life (SADL) questionnaire, developed in 1999 [20] and culturally adapted to Brazilian Portuguese in 2011 [21], to assess worker satisfaction with the use of the devices in four assessment categories. The higher the score, the higher the individual’s satisfaction. In this study, question number 12 (“How competent was the person who provided you with your hearing aids?”) was analyzed separately and compared to the other results. The standards proposed by the authors of the questionnaire were used to analyze the degree of satisfaction. Scores below the 20th percentile indicated dissatisfaction among users, scores between the 20th and 80th percentile suggested that users were satisfied and scores above the 80th percentile indicated that subjects were very satisfied with the use of amplification. Both questionnaires were applied in an interview format, in a private room.

2.3 Data analysis

For analysis, the mean thresholds were divided by frequency range, being Mean 1 (500, 1000 Hz and 2000 Hz), Mean 2 (1000 Hz, 2000 Hz, 4000 Hz) and Mean 3 (3000 Hz, 4000 Hz, 6000 Hz).

The Mann-Whitney U test was used to compare the hearing handicap between genders, at a significance level of 0.05 (p < 0.05). The Spearman correlation coefficient was used to correlate the hearing handicap with hearing loss; the age with hearing handicap; age, hearing loss and satisfaction with the use of hearing aids, and hearing handicap with the satisfaction, at a significance level of 0.05 (p < 0.05).

3 Results

Thirty-six workers between 36 and 75 years of age participated in this study. Nineteen were male (52.7%), with a mean age of 53.47 years (median of 51 years and a standard deviation of 10.16 years) and seventeen were female (47.3%), with a mean age of 54.06 years (median 55 years and a standard deviation of 9.46 years).

For analysis, the mean thresholds were divided by frequency range, being Mean 1 (500, 1000 Hz and 2000 Hz), Mean 2 (1000 Hz, 2000 Hz, 4000 Hz) and Mean 3 (3000 Hz, 4000 Hz, 6000 Hz). As a result, for the right ear, Mean 1 was 57.92 dBHL, Mean 2 was 64.35 dBHL and Mean 3 was 70.14 dBHL. For the left ear, Mean 1 was 56.02 dBHL and Mean 2 and 3 were 68.80 dBHL.

Regarding the perception of hearing impairment, the average total score was 41.2 (mild to moderate perception), with 20.1 in the social domain and 21.2 in the emotional domain. Table 1 shows the scores of the HHIA questionnaire obtained by female and male workers, separated by domain, highlighting the questions E-7 and S-11, as they referred to the work environment.

Table 1
Comparison between hearing impairment perceived by workers, according to the domain evaluated, total score and questions E-7 and S-11, divided by gender (N = 36)

Domain Mean scores p

Female Male

(n = 17)/ (n = 19)

Social 25,5 15,2 0,0308

Emotional 28,2 14,9 0,0523

Total 53,8 30,0 0,0529

Question E-7 2,4 1,6 0,2067

Question S-11 2,6 2,1 0,3127

Domain	Mean scores	p
Social	25,5	15,2	0,0308
Emotional	28,2	14,9	0,0523
Total	53,8	30,0	0,0529
Question E-7	2,4	1,6	0,2067
Question S-11	2,6	2,1	0,3127

Mann-Whitney U test, at a significance level of 0.05. Score of questions E-7 and E-11 range from 0 to 4 points.

A significant difference was noted only for the social domain. Women had worse results than men, even though they were both hearing aid users. Regarding the emotional domain and the total score, the result was very close to being significant (p = 0.0523), showing that, in general, the hearing impairment is perceived more by women, albeit with no difference regarding the questions that referred to the work environment.

The correlations between hearing loss and workers’ hearing impairment are presented in Table 2. The table shows that there was no correlation between hearing loss and perception of hearing impairment in relation to the total score, but there was a correlation between the right ear hearing thresholds and question E-7. A positive correlation was found between hearing loss and the perception of hearing impairment. As hearing loss increased, so did the frustration of hearing aid users when talking to coworkers.

Table 2

Correlations between Mean 1, 2 and 3 of the hearing thresholds with the Social, Emotional, Total score, Question E-7 and S-11 domains of the HHIA Questionnaire (N = 36)

In between			R	p
Ear	Mean thresholds	Domain
RE	Mean 1	Social	0,2991	0,0764
		Emotional	0,1829	0,2857
		Total	0,1952	0,2539
	Mean 2	Social	0,2201	0,1971
		Emotional	0,1031	0,5497
		Total	0,1068	0,5352
	Mean 3	Social	0,2436	0,1523
		Emotional	0,1576	0,9309
		Total	0,1336	0,4373
LE	Mean 1	Social	– 0,0186	0,9143
		Emotional	0,0823	0,6331
		Total	0,0663	0,7010
	Mean 2	Social	– 0,0714	0,7689
		Emotional	0,0718	0,6775
		Total	0,0443	0,7975
	Mean 3	Social	– 0,0919	0,5940
		Emotional	0,0654	0,7046
		Total	0,0274	0,8739
RE	Mean 1	Question E-7	0,4152	0,0118
		Question S-11	0,0781	0,6568
	Mean 2	Question E-7	0,3781	0,0230
		Question S-11	0,0733	0,6755
	Mean 3	Question E-7	0,3786	0,0228
		Question S-11	0,1373	0,4317
LE	Mean 1	Question E-7	0,1601	0,3510
		Question S-11	–,01226	0,4841
	Mean 2	Question E-7	0,0720	0,6765
		Question S-11	– 0,0637	0,7162
	Mean 3	Question E-7	0,0229	0,8946
		Question S-11	– 0,0391	0,8234

R = Spearman’s correlation coefficient, at a significance level of 0.05 (p < 0.05); RE = right ear; LE = left ear.

The correlation between workers’ age and hearing impairment is presented in Table 3. The table shows that, in relation to females, there was only a correlation between age and question S-11. Since the correlation was negative, as women’s age increased, the perception of hearing impairment decreased in relation to difficulties in understanding colleagues in the workplace. In relation to the social domain and question E-7, age resulted in a p-value very close to significance for females, with a negative correlation as well. Regarding males, the correlation was positive. Therefore, as age increased, men perceived greater hearing impairment. However, this correlation was not statistically significant.

Table 3

Correlation between age and scores obtained in the Social and Emotional domains, Total score, questions E-7 and S-11 of the HHIA Questionnaire, by gender (N = 36)

Age with	Female		Male
	R	p	R	p
Social domain	– 0,4729	0,0552	0,1927	0,4292
Emotional domain	– 0,3936	0,1181	0,0222	0,9281
Total score	– 0,4297	0,0852	0,1513	0,5365
Question E-7	– 0,4757	0,0536	– 0,0350	0,8868
Question S-11	– 0,6656	0,0049	0,3026	0,2080

R = Spearman’s correlation coefficient at a significance level of 0.05 (p < 0.05).

Regarding workers’ satisfaction with the use of hearing aids, the mean score obtained in the SADL questionnaire (general and by category), for both men and women, was between the 20th and 80th percentile, which means that all workers were pleased with the use of their hearing aids.

Table 4 shows the correlation between workers’ age and satisfaction with the use of hearing aids, as well as the correlation between hearing loss and satisfaction. The table shows that as age increased, workers were more satisfied since the correlation was positive in relation to the total score. In the other significant cases, the correlation was negative, indicating an inverse relationship, ie, the higher the Mean 1 and 2 (right ear), the lower the satisfaction with the use of hearing aids. In general, most of the other results were negatively correlated (i.e., inverse correlation), albeit not statistically significant. Therefore, as satisfaction with the use of hearing aids decreased, hearing loss increased.

Table 4

Correlation between age, mean frequency thresholds (Mean 1, Mean 2 and Mean 3) and satisfaction with hearing aids (n = 23)

Relationship between		R	p
Variables	SADL – categories
Age	Positive effects	0,2587	0,2332
	Negative factors	0,5481	0,0068
	Personal image	0,3778	0,0755
	Total score	0,6072	0,0021
Mean 1 (RE)	Positive effects	– 0,4955	0,0162
	Negative factors	– 0,5630	0,0052
	Personal image	– 0,3148	0,1434
	Total score	– 0,5927	0,0029
Mean 2 (LE)	Positive effects	– 0,3925	0,0640
	Negative factors	– 0,3580	0,0935
	Personal image	– 0,1913	0,3820
	Total score	– 0,4373	0,0369
Mean 3 (RE)	Positive effects	– 0,2623	0,2265
	Negative factors	– 0,1088	0,6211
	Personal image	– 0,1396	0,5252
	Total score	– 0,2841	0,1890
Mean 1 (LE)	Positive effects	– 0,0862	0,6956
	Negative factors	– 0,3839	0,0705
	Personal image	– 0,0490	0,8244
	Total score	– 0,2421	0,2658
Mean 2 (LE)	Positive effects	– 0,2785	0,1982
	Negative factors	0,0533	0,8092
	Personal image	– 0,1299	0,5547
	Total score	– 0,0804	0,7221
Mean 3 (LE)	Positive effects	– 0,0990	0,6531
	Negative factors	0,0719	0,7445
	Personal image	– 0,0190	0,9313
	Total score	– 0,2573	0,2477

R = Spearman’s correlation coefficient at a significance level of 0.05 (p < 0.05). RE = right ear; LE = left ear.

Table 5 shows the correlation between workers’ perception of hearing impairment and satisfaction with the use of hearing aids, separately analyzing question number 12: “How competent was the person who provided you with your hearing aids?”

Table 5

Correlation between scores, question E-7 and question S-11 of the HHIA, and scores and question 12 of the SADL (n = 23)

Relationship between HHIA and SADL		R	p
HHIA	SADL
Social scale	Question 12	0,0444	0,8446
	Positive effects	– 0,1598	0,4664
	Negative factors	– 0,3433	0,1088
	Personal image	– 0,2505	0,2489
	Global score	– 0,3439	0,1081
Emotional scale	Question 12	– 0,0223	0,9216
	Positive effects	– 0,1298	0,5549
	Negative factors	– 0,4573	0,0282
	Personal image	– 0,3716	0,0808
	Global score	– 0,4913	0,0173
Question E-7	Question 12	– 0,4417	0,0396
	Positive effects	– 0,2736	0,2065
	Negative factors	– 0,4756	0,0218
	Personal image	– 0,4300	0,0406
	Global score	– 0,5535	0,0061
Question S-11	Question 12	0,1610	0,4856
	Positive effects	– 0,1986	0,3756
	Negative factors	– 0,3373	0,1248
	Personal image	– 0,2132	0,3407
	Global score	– 0,2900	0,1905
Total score	Question 12	0,0159	0,9441
	Positive effects	– 0,1385	0,5285
	Negative factors	– 0,4033	0,0564
	Personal image	– 0,2917	0,1769
	Global score	– 0,4059	0,0546

R = Spearman’s correlation coefficient at a significance level of 0.05 (p < 0.05).

Correlations were negative in the HHIA question E-7. Therefore, the greater the frustration when talking to coworkers, the lower the worker’s satisfaction with the competence of the professional who assisted with the hearing aids fitting (question 12 of the SADL questionnaire). Also, the lower the satisfaction with background noises, with HA feedback, and with telephone use (Negative Factors), the worse the Personal Image (PI) that the worker had of himself or herself and the lower the overall satisfaction with the use of hearing aids. The same was found with the Emotional Scale, Negative Factors, and Total Score (SADL). The worse the attitudes and emotional responses of workers regarding their hearing impairment, the lower the overall satisfaction with the use of hearing aids. In general, it was observed that most results, although not significant, had negative correlations. That is, the higher the perception of hearing impairment, the lower the workers’ satisfaction regarding the use of hearing aids.

4 Discussion

Thirty-six workers with ages ranging from 36 to 75 years participated in this research. Among the participants, eight elderly were included, with an average age of 66.9 years. According to a survey conducted in Brazil [22], the participation of the elderly in the labor market is considered high, because the average amount of benefit paid by social security to retirees is low. Therefore, elderly people with basic health conditions return to work, earning income from work and retirement, which allows them to contribute significantly to their family’s financial income.

Some studies suggest that work is a fundamental and determinant factor of an individual’s living conditions and earnings [23, 24]. However, the demand for the work market often excludes those with physical or cognitive disabilities. In addition, the workplace, as it is a space where oral communication predominates, can be a very difficult environment for those with hearing loss, as compromised communication can prevent or make it difficult for workers to show their full potential [25]. Such impairment can cause embarrassing situations. Although there are legislations that support the hearing impaired, recognition of their potential and ability to work depend on the resources available for their rehabilitation, such hearing aids or others electronics devices, and also on the public education of a society that is mostly made up of normal-hearing individuals [26].

Studies have shown that adult hearing impairment, which, at first, constitutes the economically active portion of the population [27 –30]. Other studies have specifically referred to the auditory impairment perceived by workers from different sectors [31, 32]. Resources for rehabilitation include hearing aids, which aim to reduce the impact of hearing loss and improve a person’s ability to participate in everyday life. However, it is not clear how beneficial they are, although they are widely used and the most common technology for adults with hearing loss [33]. In addition, hearing loss denial and the will of wanting to use these devices remain a barrier for many people [26].

For most individuals, hearing aids are effective tools for overcoming the loss of sensitivity, especially when incorporating recent technological developments. However, they are not always able to help the individual compensate for speech comprehension difficulties, particularly in noisy environments. Even the most sophisticated hearing aids are unable to improve the listening skills or understanding required for efficient communication [34, 35]. According to a systematic review conducted in 2016, up to 40% of hearing aid users fail to wear them or may not get the optimal benefit [15].

In the present study, when analyzing the workers’ hearing impairment, even when using hearing aids, the total mean score was 41.2, being 20.1 in the social domain and 21.2 in the emotional domain. These results were worse than those reported in previous studies: Mean score of 33.7, 16.5 in the emotional domain and 17.2 in the social domain [36]; mean score of 30 points, with a mean of 16 points in the emotional domain and 14 points in the social domain [27] and a mean score of 26.94 [30]. Only one study showed no perception of hearing impairment after hearing aid fitting, as the mean score was below 16 [28].

A possible explanation for the difference between study results may be the length of time hearing aids were worn. In the study, the hearing impairment [28] evaluation was performed one month after the hearing aid fitting. According to authors [37, 38] patients tended to report a large reduction in hearing impairment after a short time, influenced by high expectations or enthusiasm. As usage time increased, starting from three months, the patient was already able to correctly assess the benefit of adaptation, including device limitations, which remained somewhat unchanged over time. According to a study, the variation found in the results obtained through self-perception questionnaires, such as the HHIA, can also be explained by the user’s personality [39].

In general, hearing impairment was perceived more by women, albeit with no difference in relation to issues related to the work environment. A study with adults and the elderly showed that hearing impairment difficulties decreased after adaptation of hearing aids [28]. Female individuals showed greater impairment²⁸. Other studies found no significant differences between genders [27, 40].

A study revealed that women with hearing impairment have a lower chance of getting a job, greater fatigue at work and greater hearing impairment than men [10]. Hearing loss severity was statistically significant when associated with employment rate and part-time work. The authors concluded that hearing loss and its associated factors appeared to have a greater impact on women than on men.

Differences in work and working conditions have been used as an explanation for these gender differences. For employees with hearing loss, it may be particularly relevant that some of the female-dominated jobs, such as healthcare and social work, may require more communication skills and are more demanding than other jobs, making them more vulnerable [12]. In addition, social circumstances are also known to contribute negatively to women’s health and work participation.

No significant correlation was observed between increased hearing loss and hearing impairment in any of the domains. However, a significant correlation was observed between the right ear auditory thresholds mean and the frustration of hearing aid users when talking to coworkers. This made clear the negative impact caused by hearing loss on work relationships.

A study found that employees with hearing loss perceived higher background noise than their normal-hearing colleagues, with a relationship between hearing impairment and hearing effort [8]. Thus, the authors concluded that hearing is an essential skill in the work environment and often difficult for people with hearing loss. As such, hearing effort deserves more attention in rehabilitation and audiological research.

A study supporting the aforementioned findings showed that people with mild to moderate hearing loss find tasks in a noisy office significantly more labor intensive than their normal-hearing colleagues, although they are all equally disturbed by office noise [36]. Another study also found a negative association between the degree of hearing loss and work performance, especially for moderate hearing loss [10].

According to studies, workers may have difficulty understanding rules, routines and obligations when communicating with bosses and colleagues, and may fail in their commitments due to impaired understanding because of hearing loss [25, 41]. These challenges in the professional environment can generate negative emotions, such as anxiety, anger, sadness and frustration [42].

Arguing that communication skills are important in the work environment, it can be inferred that workers with hearing loss are more vulnerable than the ones with normal hearing [5–7 , 43]. One study found an association between fatigue and sick leave due to illness and a strong association between fatigue and degree of hearing loss, which led to the conclusion that hearing loss may be a contributing factor to average leave [10]. Thus, the reason for leaving work may be fatigue, but hearing loss may be the main contributing factor to the fatigue.

Another study conducted in Norway reported that workers with hearing loss with a support network, professionals and non-professionals, felt safe in their daily lives, knowing that assistance was at hand whenever problems occurred [6]. Participants without a support network were, on the other hand, much more vulnerable and at the mercy of their own initiative and resistance. Thus, there is a need for support from managers, colleagues and professionals in the workplace to prevent burnout and to facilitate the participation of employees with hearing impairment. This joint action can facilitate workers’ communication. The authors also reported that the contact between the hearing impaired workers with colleagues going through the same situation reduced the feeling of loneliness due to communion and sharing of experiences.

A study revealed that the overall health of workers with hearing loss was inferior to the health of their normal hearing colleagues [36]. There was no significant relationship between age and the domains assessed for hearing impairment. However, it was observed that in relation to women, as age increased, the perception of difficulties to understand colleagues in the workplace decreased (p = 0.0049).

Research reported that women acted and reacted more openly emotionally and used more nonverbal communication strategies than men [12]. Another study stated that women included active and constructive efforts to better control or dominate the interactive scene [44]. Hearing impairment was often made official. Men, however, did not seem to disclose their hearing loss. They adopted more often strategies of withdrawal, avoidance of demanding hearing situations, guessing and pretending to listen in order to compensate for hearing loss in situations of hearing demand.

The present study showed that all participating workers were satisfied with the use of their individual sound amplification devices. These findings agreed with other studies [27 , 45].

Individual’s satisfaction with sound amplification was affected not only by the benefit it provided, but also by the user’s expectations, the monetary costs, the psychological aspects, the problems encountered during the rehabilitation process and the communication difficulties. All of these aspects continued even with the use of amplification [20]. Hence, analyzing users’ satisfaction with the use of hearing aids was considered important to evaluate clinical procedures and ensure the quality of service. Identifying factors contributing to satisfaction can achieve a more effective results in the use of health services devices [46]. It was observed that as age increased, so did workers’ satisfaction. However, satisfaction decreased as hearing loss increased, experiencing an overall greater frustration when talking to coworkers.

In addition, the greater the frustration when talking to coworkers, the lower the workers’ satisfaction regarding the competence of the professional who assisted to adapt the hearing aids, the lower the satisfaction in environments with background noise, the worse the personal image the workers had of themselves, and the lower the overall satisfaction with the use of hearing aids. Moreover, the worse the workers’ attitudes and emotional responses to their hearing impairment, the lower their overall satisfaction with the use of hearing aids.

A study conducted in Brazil’s countryside with 27 workers, discussed issues related to health professionals that respondents experienced. Issues, such as inadequate guidance, unpreparedness in the workplace, lack of a referral and readaptation in the workplace system added to the workers’ frustration [26].

Another study showed that individuals with hearing impairment experienced a strenuous work situation, which increased the risk and likelihood of leaving work [6]. Strenuous situations may occur due to lack of information and education about the impact of hearing loss, which prevented individuals from developing adequate and sufficient coping strategies, resulting in negative attitudes towards their own disability. Therefore, services that covered only technical assistance, such as hearing aids, limited the possibility of developing both workers’ knowledge and the strategies they can use. According to the authors, the lower the level of information over time, the greater the risk of workplace fatigue. On the contrary, workers’ knowledge about their hearing situation seemed to be a safe platform to deal with work-related situations. In addition, the lack of information and education also from managers and coworkers about the impact of hearing loss required workers to constantly repeat their needs. Therefore, a wide range of professionals can facilitate this process and serve as a safety net for future challenges.

Authors suggested that workers may require a more intense hearing rehabilitation, including clinical audiological rehabilitation and workplace rehabilitation [6 , 47–49]. It is of great importance to carry out extensive evaluation of tasks, of both the workplace and working conditions, because the degree of hearing loss and job position or function do not provide sufficient information about the difficulties faced by the individual. Therefore, a more integrated approach is required in vocational rehabilitation, involving managers and other stakeholders. A multidisciplinary approach to the workplace can benefit hearing impaired employees in reducing work strain.

A limitation of the present study is related to the impossibility of association of communication difficulties with the workers specific activities, in what it refers to the necessities of the job itself, because these data were not collected in the present study. In future research it would be interesting to investigate not only those difficulties, but also the strategies that are used by workers, co-workers and managers for an effective communication in the work environment.

5 Conclusions

Workers perceived hearing impairment despite the use of individual sound amplification devices. Hearing impairment was higher among women, especially in relation to the difficulty in talking to coworkers. The greater the hearing loss, the greater the frustration when talking to coworkers. For women, this frustration decreased as age increased. All workers were satisfied with their hearing aids. However, as hearing loss increased, satisfaction decreased. The greater the frustration when talking to coworkers, the lower the workers’ satisfaction regarding the competence of the professional who assisted him/her to adapt the hearing aids, the lower the satisfaction in environments with background noise, the worse the personal image the workers had of themselves, and the lower the overall satisfaction with the use of hearing aids. The worse the workers’ attitudes and emotional responses to their hearing impairment, the lower their overall satisfaction with the use of hearing aids.

Conflict of interest

The authors state that they have no conflict of interest.

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