‘Vocational Rehabilitation for employees with hearing impairment: A cost-effectiveness study’.

A randomized controlled trial will be performed with 80 participants in the control (care as usual) and 80 participants in the treatment group (VEP). KLM, Corus and VU university have confirmed their participation in this study. Also patients of the ENT doctors and occupational physician will recruited in the study. All participants give their informed consent. Outcomes will be measured at baseline and after 3, 6, 9 and 12 months en consist of questionnaires. The participants in the intervention group have to visit the Audiological center of the VUmc.



Country of recruitment: The Netherlands.

The hypothesis is that the Vocational Enablement Protocol (VEP) is effective and cost-effective compared with usual care from a societal perspective.

Baseline measurement and after 3, 6, 9 and 12 months after randomization.

People in the intervention group get the VEP. The VEP comprise a half-day assessment of complex problems at the Audiological Center conducted by a team of professionals from different disciplines: E.N.T. physician, audiologist, occupational physician, social worker, psychologist, speech therapist. The patient's hearing status is assessed using an extensive battery of audiotry tests, including pure-tone and speech audiometry, various Speech-Reception-Treshold (SRT) tests (in quiet, in steady state noise and in fluctuating noise) and -if indicated- a test for localization. To examine aided hearing, a free-field version of the SRT in noise test is also performed.
Furthermore, a semi-structured interview is conducted by the psychologist evaluating the psychosocial history of the person, their specific needs, attitude and expectations and an evaluation of the problems at work from the patient's perspective. Refferal information is taken into account. The interview is attended by the occupational physician of the team to specifically evaluate the work-related problems and to discuss the patient's view on possible solutions and legal issues.

If indicated, the workplace itself is visited and is accoustically examined by conducting a Speech-Transmission-Index (STI) measurement. The STI provides an assessment of the intelligibility of speech in the workplace and verifies whether speech is intelligible for the employee, given the hearing impairment and the acousical conditions. The STI measures the combined effects of background noise and reverberation.

At the end of the session, all test results are examined and considered by the psychologist, specialized occupational physician, and the audiologist and explained to the patient. Here, we identify the (mis)match between the audiotry capacities of the employee and the audiotory demands at the workplace. Possibilities of technical, speech-therapeutic and/or psychosocial interventions are then discussed. We argue that a patient-centered approach (i.e. involving the patient in the problem solving process) is crucial.



People in the control group get the usual care of the general practitioner, Ear-, Nose and Throat doctor or the occupational physician.