Working in Noise with a Hearing Loss: Perceptions
 

from Workers, Supervisors, and Hearing

Conservation Program Managers

Thais C. Morata, Christa L. Themann, Robert F. Randolph, Babette L. Verbsky,
 

David C. Byrne, and Efrem R. Reeves
 

National Institute for Occupational Safety and Health, Cincinnati, Ohio (T.C.M., C.L.T., B.L.V., D.C.B), and Pittsburgh, Pennsylvania (R.F.R., E.R.R.).

Objective: Workers with hearing loss face special

problems, especially when working in noise. However, conventional hearing conservation practices

do not distinguish between workers with normal

hearing versus impaired hearing. This study collected information from workers with self-reported

noise exposure and hearing loss, supervisors of

such workers, and hearing conservation program

managers through focus groups and in-depth interviews to evaluate their perspectives on the impact

of hearing loss on safety and job performance, the

use of hearing protection, and information needed

to appropriately manage hearing-impaired workers

who work in noisy environments.

Results: Concerns about working in noise with a

hearing loss could be grouped into the following 10

categories: impact on job performance, impact on

job safety, impaired ability to hear warning signals,

impaired ability to monitor equipment, interference with communication, stress and/or fatigue,

impaired communication caused by hearing protector use, reduced ability to monitor the environment

as the result of hearing protector use, concerns

about future quality of life, and concerns about

future employability. Mostly, there was an agreement between the perceptions of workers, supervisors, and hearing conservation program managers

regarding difficulties associated with hearing loss

and consequent needs. These findings suggest that

noise-exposed workers with hearing loss face many

of the same problems reported in the literature by

noise-exposed workers with normal hearing, with

additional concerns primarily about job safety as

the result of a reduced ability to hear environmental sounds, warning signals, and so forth.

Conclusions: The study outlines potential challenges regarding job safety and hearing conservation practices for noise-exposed, hearing-impaired

workers. Awareness of these issues is a necessary

first step toward providing appropriate protective

measures for noise-exposed, hearing-impaired

workers.

Of the 19 million adults in the United States with

some degree of hearing trouble, nearly half are

currently employed in the workforce (NCHS, 1994).

More than 30 million US workers are exposed to

hazardous noise levels, and noise-induced hearing

loss is the most common occupational disease in the

United States (NIOSH, 1996). Many workers incur

their hearing losses during the first 5 to 10 yrs of

employment (Rosler, 1994; Ward et al., 2000) and

subsequently work the rest of their careers in an

environment where noise and hearing loss interact

to impair their ability to hear communication and

other important signals.

Workers with hearing loss who are exposed to

hazardous noise levels present a dilemma to hearing

loss preventionists. On the one hand, it is of great

importance to ensure that their residual hearing is

protected from the damaging effects of the noise to

which they are exposed. On the other hand, however, traditional hearing protectors serve to further

“deafen” such workers, making communication more

difficult and impairing the detection of environmental sounds and warning signals. These workers have

special needs that must be addressed. However,

conventional hearing conservation practices do not

distinguish between workers with normal versus

impaired hearing; and, to date, no governmental or

professional organization has developed specific

guidelines or policies concerning the accommodation

of noise-exposed, hearing-impaired workers.

Some research regarding noise-exposed, hearingimpaired workers has been completed. These studies

have primarily focused on three areas: (a) speech

intelligibility in noise versus quiet, with and without

various types of hearing protection devices (Abel et al.,

1982; Abel et al., 1993; Abel & Spencer, 1997; Rink,

1979; Suter, 1989); (b) signal detection and localization

under similar conditions (Abel et al., 1993; Abel et al.,

1985; Abel & Hay, 1996); and (c) the use of hearing

aids as hearing protectors (Berger, 1986; Dolan &

Maurer, 1996; He ́tu et al., 1992; He ́tu et al., 1993).

Research in these three areas has provided an initial

framework for development of a management paradigm for these workers. However, each of these studies

addressed a very specific research question, examining
a single aspect of the problem. In addition, these prior

laboratory studies relied on the investigators to formulate research questions based on assumptions regarding the problems hearing-impaired workers might face

working in high noise environments. The studies then

evaluated these research questions by using standardized listening tasks with the hope that performance on

those tasks would generalize to real-world settings.

The science has not been translated into practical

guidance to employers and hearing health professionals so that they might make appropriate recommendations for individual hearing-impaired workers.

Other studies have used surveys or focus groups

of hard-of-hearing or deaf workers to identify obstacles to work integration. Laroche, Garcia, & Barrette (2000) drew attention to barriers including the

necessity of telephone use, background noise in the

workplace, and the use of auditory rather than

visual alerting signals. The most challenging workplace situations reported by deaf and hard-of-hearing people, however, involved group situations such

as departmental and staff meetings, training sessions, and work-related social functions—situations

recognized as important for career maintenance or

advancement (Laroche, Garcia, & Barrette, 2000;

Scherich, 1996; Scherich & Mowry, 1997). Detaille et

al. (2003) asked a group of hearing-impaired workers to complete the sentence, “What a person with

hearing loss needs to be able to keep on working is...”

Participants generated 59 statements that could be

clustered into nine categories, including awareness

of hearing aids and methods to finance them; support of occupational health physicians, management, and colleagues; and accessibility of assistive

listening devices. However, in all of these studies,

workers were not necessarily working in high noise

levels that might exacerbate or alter the difficulties

posed by the hearing loss; their needs may therefore

have been different from those of noise-exposed,

hearing-impaired workers.

The objective of the present study was to investigate, through focus groups, the perspective of workers with self-reported hearing impairment and occupational noise exposure, on hearing loss prevention

at work and the impact that hearing loss and noise

exposure have on safety, communication, and their

ability to perform their jobs. In addition, hearing

conservation program managers and supervisors of

noise-exposed, hearing-impaired workers were interviewed to obtain their insights on problems faced

by these workers and difficulties they may have

encountered or information they need to effectively

accommodate hearing-impaired employees who

work in noise. Participants were given an open

forum to express the challenges and problems that

exist in their own work settings. The intent was to

identify any previously overlooked issues that might

need to be addressed in the formulation of specific

recommendations for accommodating these workers.

METHODS

Focus Groups and Interviews

Four focus groups were conducted with a total of

31 workers who self-reported hearing trouble and

occupational noise exposure to examine the difficulties they encounter working in noise with a hearing

loss. Participants were recruited to represent different age categories in an attempt to sample workers

with various years of exposure and degrees of hearing impairment. Eight supervisors of noise-exposed,

hearing-impaired workers and five hearing conservation program (HCP) managers were interviewed

regarding the problems and questions they face in

managing these employees. Two supervisors were

dropped from the analysis— one because she indicated that she had no employees with hearing loss

under her supervision and the other because he

could not provide coherent answers to the questions—leaving six supervisor interviews for analysis.

Focus groups have been used previously to evaluate hearing conservation programs (Prince et al.,

2004). Based on research done using focus groups

with hearing-impaired participants (He ́tu et al.,

1994; Laroche, Garcia, & Barrette, 2000), it was

expected that focus groups would make the expression of negative perceptions and prejudices easier

for the participants. The interview format rather

than focus group format was chosen for supervisors

and hearing conservation program managers because the expression of negative perceptions was

less of a concern and because they comprise a

smaller population and were more difficult to recruit.

The focus groups and interviews took place in two

cities (Cincinnati and Pittsburgh) selected to provide a range of industries and occupational noise

environments.

Representative industries included manufacturing, mining, construction, and others. Participants

of one group did not have any relationship with the

other groups. The content of the focus groups and

interviews was identical regardless of location or

industry. Participants had no knowledge of the

number or location of other groups being conducted.

Focus group meetings took place for a period of up to

2 hrs; interviews lasted up to 30 minutes. Table 1

and Table 2 summarize the characteristics of the

study participants.

The focus groups and interviews were conducted
TABLE 1. Demographic and employment characteristics of the focus group participants

Group No./location Group size Work environments Age groups (yr) Gender Ethnicity

Group I 8 participants 5 manufacturing 2 persons (24–34) 7 male 7 white

Cincinnati 1 meatpacking 3 persons (35–44) 1 female 1 other

1 printing 3 persons (45–54)

1 construction

Group II 7 participants 5 manufacturing 4 persons (35–44) 6 male 5 white

Cincinnati 1 printing 2 persons (45–54) 1 female 2 black

1 unknown 1 person 55–64

Group I 8 participants 1 manufacturing 1 person (24–34) 8 male 8 white

Pittsburgh 3 construction 3 persons (35–44)

3 heavy equipment 4 persons (45–54)

1 mechanic

Group II 8 participants 8 mining 5 persons (45–54) 8 males 8 white

Pittsburgh 3 persons (55–64)

by a trained moderator from a market research

company with extensive experience contracted by

the National Institute for Occupational Safety and

Health (NIOSH). Study participants were recruited

by the contractor through newspaper ads and were

reimbursed for their participation. Focus group participants were required to meet three eligibility

criteria: currently working in “loud” noise, having

earplugs or earmuffs provided where they worked,

and reporting that their hearing was “not as good as

it used to be.” The moderator verified that each

participant met these criteria at the beginning of

each session by a series of questions (see discussion

guide in the Appendix). Supervisors and managers

of hearing conservation programs were eligible if

they reported that they managed noise-exposed,

hearing-impaired workers. No information was

gathered to confirm if the places of employment of

focus groups participants were required to have

hearing conservation programs. Information on the

availability of hearing protection at work was used

as a surrogate indicator for the need for these

programs.

The supervisors and hearing conservation program managers did not work for the same companies as the recruited employees, and participants of

one group did not have any relationships with the

other groups. As a consequence, it was not possible

to compare the groups’ responses for accuracy. This

design, however, allowed a wider range of perceptions and more honest, candid testimonials to be

obtained than if data collection had been restricted

to one company. The study design was approved by

the NIOSH Human Subjects Review Board, and all

participants gave informed consent.

NIOSH collaborated with the contractor in developing the discussion guide for the focus groups and

interviews. The focus group discussions were employee-centered and attempted to describe the difficulties in job performance caused by a hearing

impairment from the workers’ perspective. Issues

covered included (a) current/future impact of hearing loss; (b) hearing protection devices and other

protective equipment; (c) important environmental

sounds; and (d) management practices regarding

safety issues. Interviews with supervisors and hearing conservation program managers were face-toface and covered similar content areas, with the

addition of the following topics to gain insights into

the difficulties encountered by hearing-impaired

TABLE 2. Demographic and employment characteristics of supervisors and hearing conservation program (HCP) managers

interviewed for the study

Location Job title Work environment Gender Ethnicity

Cincinnati Supervisor Manufacturing plant Male Black

Cincinnati Supervisor Manufacturing plant Female Black

Cincinnati Supervisor Manufacturing plant Male Black

Cincinnati Supervisor Manufacturing plant Female White

Pittsburgh Supervisor Coal mine Male White

Pittsburgh Supervisor Limestone mine Male White

Pittsburgh HCP manager Manufacturing plant Male White

Pittsburgh HCP manager Manufacturing plant Male White

Pittsburgh HCP manager Coal mine Male White

Pittsburgh HCP manager Coal mine Male White

Pittsburgh HCP manager Mine/gravel processing Male White
workers from the managerial perspective: (a) methods used (if any) to recommend appropriate hearing

protection for a hearing-impaired worker; (b) problems that hearing-impaired workers report in the

use of hearing protection devices; (c) knowledge of

special hearing protectors and/or other accommodations that may be helpful to hearing-impaired,

noise-exposed workers; and (d) information required

to manage the unique needs of hearing-impaired

workers. The discussion guides used to conduct the

focus groups and interviews are provided as an

appendix.

The meetings were audiotaped and transcribed

verbatim. A NIOSH researcher observed each focus

group and interview. NIOSH received reports of the

focus groups and interviews, which were stripped of

the participants’ identifying information.

Data Analysis

The analysis of data was based on steps described

by Dahlgren & Fallsberg (1991). Initially, the transcripts were read and the most significant statements made by each subject were identified as

determined by their extensiveness, intensity, specificity, and frequency (Kruger, 1998). These statements were then compared across participants for

agreement or variation. Similar statements were

grouped together, the essence of their similarity was

described, and each category was given an appropriate label. Finally, the categories obtained were compared and contrasted. The transcripts were analyzed in this manner by the contractors and by the

NIOSH investigators separately to provide a measure of validity. Differences were resolved by continued review of the transcripts until consensus was

reached.

RESULTS

Results are summarized below by category. A

brief description of the statements and their range is

given, followed by verbatim quotes on that theme.

The quotes were selected to illustrate insights that

were typical of participants’ responses.

Focus Groups: The Workers’ Perspective

Focus group participants in all four sessions engaged in frank, candid conversation throughout the

discussion. One group included four participants

who worked at the same location and had been

friends for years; this made the group dynamic

somewhat unusual but did not prevent the other

members of the group from participating meaningfully in the dialogue. Demographically, the participants from Pittsburgh differed somewhat from participants in Cincinnati in that the Pittsburgh

participants were all white men.

All of the focus group participants reported hearing trouble of various degrees, all described their

workplace as noisy, and all indicated that hearing

protection was at least offered where they work. In

addition to hearing loss, more than half of the

participants reported tinnitus, at least periodically

and often at the end of the work day. Audiological or

medical care received for these conditions varied

between the participants from none to some limited

diagnostic or periodic testing. None of the focus

groups participants had hearing aids.

Analysis of the transcripts revealed experiences

and concerns about working in noise with a hearing

loss that could be grouped into the following 10

categories: impact on job performance, impact on job

safety, impaired ability to hear warning signals,

impaired ability to monitor equipment, interference

with communication, stress and/or fatigue, impaired

communication due to hearing protector use, reduced ability to monitor the environment due to

hearing protector use, concerns about future quality

of life, and concerns about future employability.

Figure 1 displays the frequency of expression by

focus group participants for each of these categories.

Specific points in each category are discussed in

detail below.

Job Performance

Although the moderator specifically inquired,

none of the participants believed that hearing impairment decreased productivity or compromised job

performance. Most participants answered the moderator’s question by simply replying “No,” but a few

elaborated:

•	 “Not with mine... it’s all hands on, reading the

paper, moving toggle switches, you don’t have a lot

of conversation that you have to do.”

•	 “No, not me. I work by myself... inside a machine.”

•	 “I’ve been doing it for so long; I don’t even think

when I’m working. Pretty much just routine.”

It appeared from comments such as these that the

workers believed there was little impact on their

performance due to the nature of their occupations

(involving little interaction or communication with

others) and the repetitive nature of their tasks.

There was, however, one participant who stated “To

me, it doesn’t make a difference because my hearing

loss isn’t great enough,” implying that there might

be a level of hearing impairment that would affect

his work.
Fig. 1. Difficulties and concerns expressed by noise-exposed, hearing-impaired workers and frequency of their expression during

the focus group sessions.

Job Safety

Just as participants were unanimous that their

hearing impairment did not affect job performance,

they were equally unanimous that working in loud

noise with a hearing loss did pose a safety risk.

Remarks such as the following were common:

•	 “You need to be able to hear pretty well where I

work to be safe.”

•	 “Loss of hearing could put you or maybe your

buddy in jeopardy, if you don’t see something or

hear something.”

•	 “There’s a tremendous amount of hazards running

around where I work, so it [hearing loss] could

definitely affect it [safety].”

Workers expressed particular concern about new

employees who might not have enough on-the-job

experience to rely on senses other than hearing in

order to recognize and avoid dangerous situations.

•	 “It seems like new people, their first few months

on the job, typically, they’re the ones that might

get hurt. If they had a problem with their hearing,

that would make it a lot easier for them to get hurt

because they couldn’t hear somebody say ‘watch

out’ or something happened.”

Participants described three particular types of

scenarios in which hearing loss would pose a safety

risk: impaired ability to hear warning signals, impaired ability to monitor equipment or environmental sounds, and difficulty to communicate. These

situations are discussed in more detail in the following sections.

Impaired Audibility of Warning Signals

The inability to hear auditory warning signals

was the most frequently mentioned scenario described by participants as examples of the safety

risk posed by hearing loss on the job. They indicated

that most warning signals at their jobs are auditory,

and described a number of situations in which the

inability to hear these warnings would endanger the

worker with hearing loss. For example:

•	 “Or... another machine backing up, beeping with

the safety alarm or something, you might not

hear. It increases your odds, I’d say.”

•	 “You might have your back turned or something. A

piece of equipment is coming at you and you just

don’t hear it.”

Workers most often cited back-up alarms on forklifts as an example of a warning signal that could be

easily missed; other necessary warnings included

buzzers or other indicators on machinery, fire

alarms, CO monitors, and start-up horns. Most

workers thought that buzzer sounds were more

easily heard than other types of warning signals.

Some participants indicated that there were not

many warning signals at their workplace; one reported “Our warning system is ‘Look out!’” Participants found warning lights that supplemented audible alarms helpful, but several reported that the

lights were not appropriately placed, eliminating

any potential benefit.

Impaired Ability to Monitor Equipment

Participants also described a number of situations in which hearing loss and noise could interfere

with the ability to monitor essential equipment

sounds. For example:

•	 “A lot of times you’ll just be in the area by yourself

and if you can’t hear that little whistling noise,

something that’s a little bit out of the ordinary, it

could be very dangerous.”

•	 “They’ve got vacuum machines they use to lift

parts with. By hearing the sounds you can tell if

they’re working like they’re supposed to or not. If

there’s a vacuum loss and you go to lift something
up, it could break loose and drop. Somebody could

get hurt that way.”

Several workers indicated that they compensated

for this inability to monitor equipment by removing

their hearing protectors. This is discussed more

specifically later, as an issue related to hearing

protection.

Interference With On-the-Job

Communication

Some workers indicated that their hearing loss

did interfere with their ability to communicate in

the noisy environment at work. Statements included

the following:

•	 “It’s hard to communicate, that’s the only thing I

can think where our job would have a problem

with the hearing.”

•	 “Rather than trying to talk, you’d just whack him

and point with your leg or finger or something.

Rather than say “Hey, I see this.” And “Huh, what

did you say?” So we’d just smack each other.”

Again, many workers indicated that communication difficulties were exacerbated by the use of

hearing protection. This is discussed further in a

subsequent section.

Stress and Fatigue

There were several comments made indicating

that having to work in noise with a hearing loss was

stressful and/or tiring. For example:

•	 “As the shift goes on, it aggravates on... It gets me

angry and I can’t wait to get out of there. It just

gets frustrating after a while.”

•	 “It does put a lot of fatigue on you”

•	 “It’s almost like you’re mad at yourself because

why can he hear? He works in the same atmosphere; why can he hear and I can’t?... that makes

you frustrated.”

One participant commented that when he works

in a quiet area for a little while, he is not as tired.

And another voiced frustration at equipment that

was kept running even while it was not being used.

But some comments, such as the third example cited

above, clearly indicated that stress or fatigue was

exacerbated by the effect of their hearing loss.

Hearing Protection and Interference With

Communication

Approximately half of the focus group participants indicated that hearing protector use was mandatory where they worked, though very few reported

strict enforcement of this requirement. Most of the

focus group participants reported wearing hearing

protection a majority of the time. A few of the focus

group participants said they never wore hearing

protection. Lack of use was most frequent among

Pittsburgh participants who worked outside, driving

heavy equipment or working construction. Conventional ear muffs and various types of ear plugs were

identified as the only known hearing protection

devices; no one was aware of more sophisticated

options, such as flat-attenuation devices or communication headsets.

The most common problem associated with hearing protector use among the participants was interference with communication. For example, participants stated:

•	 “That’s why I never wore them [hearing protectors]. I had them, I put them in and yeah, it made

it quiet but then every time somebody wants to

talk to you I can’t hear. I’ve seen guys wear them,

they keep them on, they’re carrying on a conversation, I’m thinking, am I deaf? Because I can’t do

that, I never could, maybe I am deaf.”

•	 “I’ve got the ear plugs in, we’re standing by the

fan, and he has something to tell me. Well, I just

can’t hear him with the ear plugs in. I have a hard

enough time hearing him with them out because

of the fan. But if they’re in, I can’t comprehend

what he’s saying.”

•	 “I would wear them [hearing protectors] but it

comes back to the point like everybody was saying,

then I can’t hear anything. Like if somebody

would be calling me for help I couldn’t hear nothing and then I’d have to be taking them out every

five minutes.”

Manufacturing and construction workers generally indicated that they removed their hearing protectors when they needed to communicate with

someone. This constant “taking them in and out”

was a major deterrent to wearing hearing protectors; this was particularly the case in environments

where people would have to reinsert the plugs with

grit or grease on their hands. Miners said they

usually did not remove their ear plugs when communicating with coworkers because of the dusty,

dirty environment underground and their expertise

in communicating nonverbally.

Hearing Protection and Reduced Ability to

Monitor Important Sounds

An inability to monitor important environmental

or equipment sounds was another major problem

caused by hearing protector use among the hearingimpaired workers. For example, workers related the

following difficulties:
•	 “We got a lot of fork lifts coming and if you have a

hearing loss plus your plugs are in your ear, they

could be coming up behind you and you wouldn’t

know it...”

•	 “You just have to be very careful, you will get run

over if you don’t really watch yourself. You have to

use some of the other senses because you don’t

have time to be putting them [hearing protectors]

in, taking them out, putting them in, taking them

out all the time.”

•	 “In retreat work [a mining job] I never wore any

kind of hearing protection because I wanted to be

able to really hear the ribs. I just wanted that

extra that I could hear it for sure.”

In addition to reduced audibility, some workers

reported that hearing protection made it impossible

to determine the directionality of a signal:

•	 “I can hear a train right here... But I can’t tell you

if that train is coming in that direction or from this

direction... and they’re loud.”

•	 [Re: back-up alarms] “You don’t know which direction it’s coming from.”

One person described working in a noisy, enclosed

area with hearing protection and not hearing the

bell or seeing the visual signals for a fire drill. This

person and three coworkers continued at their jobs,

even after the rest of the plant had been evacuated.

This event illustrates not only the difficulty hearingimpaired workers may have in perceiving audible

warning signals, but also the importance of ensuring

that supplemental signals such as lights are placed

in appropriate locations.

Quality of Life

Respondents consistently expressed concern that

their hearing will deteriorate further in the future.

They were fatalistic that, given their workplace

environments, they would continue to lose hearing

over time. Participants were unanimously more concerned about the impact continued hearing loss

would have on interactions with family and friends

than the potential impact on the jobs. For example,

participants said:

•	 “Our quality of life would definitely be affected by

it [continued hearing loss]; it wouldn’t be good...”

•	 “It could be a real handicap if you go to ball games

or go to sports bars and places like that and you

have friends sitting around the table like this and

like Gene’s trying to talk to me and I can’t hear

him because the noise is already loud.”

•	 “My dad worked at [Company] for thirty-something years and I hope I don’t end up like him. You

got to scream for him to hear you. It’s gone.”

Some workers talked about “turning up the TV”

and other indicators that their hearing loss already

impacts their personal lives. None of the focus group

participants had hearing aids. A few knew coworkers who wore hearing aids in the workplace. Some

respondents described hearing aids as a “last resort.” Others implied that simply purchasing a hearing aid would “magically” restore their hearing to

normal levels with little inconvenience.

Future Employability

Although the impact of further hearing loss on

their work was clearly less important than its impact on their personal life, some participants did

express concern that their jobs would be affected if

their hearing continued to decline. For example:

•	 “Yes, it would be a problem in mine... I have to

communicate with a lot of people when we’re

working out on the floor, so if I can’t hear we’ve got

to go to another conference room or something to

talk and get off the floor and that’s going to slow

us down.”

•	 “I’ve got to be able to talk to somebody about as far

away from me as Albert with orders... I’d say if

your hearing decreases over time... that would

affect my job.”

It is unclear from the discussion whether or not

these concerns about the impact of further hearing

loss on quality of life or future employability is

translated by the workers into preventive actions,

such as consistent use of hearing protection devices.

Other Comments

Consistently, manufacturing and construction

workers said management “couldn’t care less” if

workers lost their hearing. They described workplaces where even minimal safety standards were

not always followed. They did not identify any innovations or other types of support from management.

These reactions were somewhat more intense in

Cincinnati than in Pittsburgh. Conversely, miners

had considerably more respect for upper management than the members of the manufacturing and

construction sectors. They reported that while many

of the miners were “a dying breed,” management

was consistently interested in the health and safety

of their workers. Some said they were proud to have

worked for these types of employers. Miners who

said equipment was outdated or safety training was

inept quickly added that they worked for “mom and

pop operations” whose profit margins did not allow

them to do more.

Several manufacturing workers reported that annual hearing tests were offered or mandated at their
TABLE 3. Features of the ideal workplace for hearing-impaired

workers, as identified by focus group participants

●	 Bright, clean environment

●	 Some new equipment

●	 Baffles or enclosures on the noisiest machinery

●	 Custom-made ear plugs provided by employer

●	 Ear muffs offered “with no hassle”

●	 Upper management wearing hearing protection while in the

plant

●	 A “caring” work environment—management truly interested in

employees and the workplace issues that affect them

●	 High-quality public address system

●	 Lights to indicate start-up of noisy equipment

●	 Signs indicating all high-noise areas

●	 Quiet areas around the shop floor

●	 All equipment well-maintained, defective parts replaced immediately

work site. In many cases, however, the workers

never saw the results of the testing. None indicated

that they received information comparing recent

results with a baseline audiogram. Focus group

participants recommended that they receive a written report following each test and indicated that a

chart tracking hearing levels over time would get

their attention. On the other hand, few of the miners

had their hearing tested at work, and most were

unaware of the specific amount of hearing loss they

had sustained.

Participants from all groups said training about

hearing loss or hearing conservation was typically

non-existent. When it did exist, it was cursory and

ineffective. Some people recommended that training

programs be converted to CD-ROM, with questions

at the end of each section to make sure each learner

had absorbed the content.

Ideal Work Environment

Towards the end of each focus group, the moderator asked the participants to visualize their own

company and imagine that they had the power to

make it an ideal workplace for employees with

hearing impairment. Features identified by the participants are summarized in Table 3.

Throughout the discussions, workers mentioned a

number of ways in which they thought noise could

be reduced at their workplace. However, during this

exercise, one participant described a particularly

innovative way to ensure workers protected their

hearing in an ideal job site. He stated:

•	 “I saw a lot of equipment not being able to operate

unless you had hearing equipment on, similar to

the safety belt and your forklift— doesn’t start

unless you’ve got your seat belt latched.”

Single Most Important Change

As each session was drawing to a close, the moderator asked the participants to discuss among themselves and determine the single most important

change that ought to be made in their workplaces to

make it better for people with hearing loss. Despite

difficulties that had been reported with the use of

hearing protection, three of the four focus groups

determined that making hearing protector use mandatory for workers was the most important change

that would benefit those who have hearing loss. One of

the groups added as a corollary that it would be

equally necessary to implement good educational programs explaining why hearing protection is important.

In a similar vein, the remaining focus group recommended providing the workers with their audiometric

results as the most important change. They thought

this would be the strongest tool for educating workers

regarding the effects of noise on their hearing and the

necessity of taking preventive action.

Interviews: Management’s Perspective

All of the persons interviewed indicated that they

worked in environments where noise was a hazard.

Almost all of the supervisors indicated that they had

some level of hearing loss themselves. Demographically, participants in the Cincinnati interviews differed from the Pittsburgh participants in that a

number of the respondents were female and a majority of participants were black; in Pittsburgh, all

respondents were white men.

Supervisors consistently reported that at least a

third of the workers in their plants had some type of

hearing loss. Supervisors felt confident that they had

identified the workers with hearing loss. “Having to

repeat yourself” was the indicator mentioned most

often. Other ways that supervisors used to identify

hearing-impaired workers included noticing that hearing-impaired workers were “cocking their heads” to

maximize use of “the good ear,” being told by coworkers about a person’s hearing loss, and being aware that

there was greater interference with communication in

the presence of background noise. None of the supervisors said that they identified hearing-impaired

workers on the basis of audiometric tests. More significantly, only three of the HCP managers reported that

they identified workers with hearing loss through

review of audiometric test results; the remaining two

stated that they identified such workers by noticing

communication difficulties.

Analysis of the transcripts revealed concerns and

difficulties associated with workers who have a

hearing loss and who are exposed to noise that could

be grouped into the following five categories: impact

on job performance, impact on job safety, problems
caused by hearing protection, need for special accommodations, and effect on future quality of life.

These are very similar to the categories gleaned

from the transcripts of the focus groups; some of the

earlier categories have been collapsed due to the

smaller number of interview participants. Figure 2

displays the frequency of expression by supervisors

and HCP managers for each category. Specific

points are discussed in detail below.

Job Performance

Just as among the workers who participated in

the focus groups, there was little indication that the

supervisors or HCP managers believed that hearing

loss impaired the ability of the workers to perform

their jobs efficiently and effectively. Any affirmative

remarks were qualified by saying that such an effect

was “possible” or might occur “ultimately” or that

the effect would be very small. For example:

•	 “The degree of hearing loss... ultimately can affect

productivity.” (supervisor)

•	 “I would say maybe it [hearing loss] affects their

job performance.” (supervisor)

•	 “You do have some glitches in that [productivity].

But they’re pretty miniscule, really...communicating in noisy areas.” (HCP manager)

Fig. 2. Frequency of expression of concerns regarding the effects that hearing loss has on employees who work in noise by

supervisors of noise-exposed, hearing-impaired workers (N � 6) and hearing conservation program (HCP) managers (N � 5).

One supervisor did suggest that hearing loss might

affect a worker’s chances of promotion, due to the fact

that workers with hearing loss tend to talk louder than

workers with normal hearing, which can cause annoyance among other workers. This supervisor observed

that some of her employees with hearing loss did not

seem to get the same job assignments as other employees with the same seniority.

Job Safety

Supervisors and HCP managers did indicate that

hearing loss increased a worker’s safety risks,

though the perception that hearing loss caused

safety problems was not as universal among this

group as it was among the workers themselves.

Similar to the risks noted by the workers, the safety

problems cited most often were inability to hear

approaching fork lifts or tow trucks and inability to

hear fire alarms or other audible warning systems.

Comments included these:

•	 “There’s been a few near misses, fork trucks...

Each part of the line has an audible alarm on it if

the oven shuts down or there’s a problem with the

line and all those buzzers are well above 105

decibels so they’re much louder than all the other

pieces of equipment and machinery and extrusion;

those are quite audible. I’d say the fork truck

would be the big thing.” (HCP manager)

•	 “I think it could be a problem when it comes to

safety because if they can’t hear when the loudspeaker... we’ve got an intercom speaker and if

they can’t hear well enough in order to get out of

the building for example or whatever, then yes,

that’s a definite problem.” (supervisor)

One HCP manager attributed the safety risk more

to an attitude that accompanies refusal to wear hearing protection than to the resulting hearing loss:

•	 “From the standpoint of the person who fights you

tooth and nail in wearing their ear plugs, they’re

probably the same person who cuts corners in

safety in other areas... I would say there is probably some connection there.”

Supervisors said their employers were genuinely

concerned about some safety issues—wearing safety

glasses and steel-toed shoes— but not very interested in hearing. When asked to speculate on the

discrepancy, some people suggested that eye injuries

or crushed feet were acute and obvious, whereas

hearing loss was subtle and not easily noticed.

Difficulties Associated With Hearing

Protection

Most supervisors indicated that wearing hearing

protection was mandatory at their workplace. Four
of the five HCP managers reported a mandatory

hearing protection requirement; the fifth indicated

that protector use was “strongly encouraged” and

reported a 95% compliance rate. None of the companies had different hearing protection requirements

for hearing-impaired workers. Most participants believed that wearing hearing protection should be

mandatory. Some stated that it was hard to get

workers (with or without hearing loss) to wear

hearing protection. Although many supervisors indicated that workers could be disciplined if they did

not wear hearing protection, some stated that it

would be “too much of a hassle” for employers to

enforce or that employers were concerned about

reduced productivity should hearing protection

rules be fully enforced. No one reported that workers

with known hearing loss were monitored more

closely than those without an obvious hearing deficit. Several supervisors and even two HCP managers indicated that they sometimes failed to wear

hearing protection. The most frequent reason given

was that “I was only going to be there for a minute.”

Respondents had inconsistent opinions about

whether hearing-impaired workers were more or

less likely to wear hearing protection. At least one

supervisor stated “It’s hard to get the people who do

have hearing loss to wear hearing protection.” When

asked why workers did not wear hearing protection,

supervisors were most likely to cite “inconvenience”

in having to remove and reinsert ear plugs, particularly when communicating. There was an impression among some respondents that use of hearing

protection can interfere with communication and

potentially pose a hazard for the worker:

•	 “I think there are situations where it [wearing

hearing protection] can be dangerous... when people wear hearing protection sometimes it’s difficult to communicate.” (supervisor)

One HCP manager explained workers removing

their hearing protection to communicate as more an

issue of politeness than necessity:

•	 “The plugs, they usually take them out; the muffs

they flip up because they’re attached to hard

hats... Kind of a more respectful thing to do... Like

when I’m wearing sunglasses and I’m talking to

somebody I’ll try to usually take them off so they

can see my eyes.” (HCP manager)

None of the people interviewed had any personal

experience with communication head sets or other

special types of hearing protection. One supervisor

speculated that it would “be nice” to have a microphone connected to a traditional ear muff, but said

she had never seen such a device.

Special Accommodations

Very few participants were able to identify any

special accommodations available for workers with

hearing loss. One supervisor reported:

•	 “There’s a lady that’s in my department and also a

gentleman who works downstairs, they ask for the

volume phones, the ones you can increase the

volume on.”

In addition, one HCP manager reported that a

flashing light was installed as a back-up warning on

a fork lift to accommodate a former employee who

had a severe hearing loss. No other accommodations

were mentioned by supervisors or HCP managers.

None of the participants had hearing aids, but

over half the participants were aware of workers

who wore hearing aids. Among these workers, it was

most common for the employee not to wear the

hearing aid at work. However, there were other

workers who wore their hearing aids under conventional earmuffs, workers who wore their hearing

aids turned off in lieu of standard hearing protection, and one worker who wore his hearing aid

turned on even in the noisy work environment.

Quality of Life

As with the focus group participants, supervisors

and HCP managers were concerned about the impact of further hearing loss among these workers in

the future. The concern was again primarily regarding the impact this would have on their quality of

life away from work.

•	 “What are these guys going to be like when they’re

retired, late sixties or early seventies? Are they

going to have any hearing at all left?” (supervisor)

•	 “How would you like to have your grandkids come

up to you and you not be able to hear a word they

say?” (HCP manager)

No supervisor or HCP manager made any remark

expressing apprehension about the future employment prospects of workers with hearing impairment. In fact, at least one respondent indicated that

noise was a great equalizer—no one can hear well.

Other Comments

Although it was clear from some participants that

an audiometric monitoring program was well-established at their work site, there were others who

reported that their employer did not offer annual

hearing tests. The supervisors and HCP managers

corroborated the opinion expressed by the focus

group participants that these tests are valuable in

motivating workers to wear hearing protection.

A few participants reported that there was no hear­
TABLE 4. Features of the ideal workplace for hearing-impaired

workers, as identified by supervisors of such workers and

hearing conservation program managers

●	 Clean facility, bright lights, uncluttered work areas

●	 Noise abatement

●	 Improved public address system

●	 A “light thermometer” (vertical series of lights) that light up

and alert workers to the amount of noise expected when a

machine starts up

●	 Mandatory hearing protection

●	 Annual hearing examinations—results and comparison to

baseline reported to employees

●	 Trend analysis of audiograms to identify the loudest areas in

the plant

●	 Key person to assist the hearing-impaired worker

●	 Mentoring—new employees matched with experienced workers

●	 Job-switching every few hours to reduce individual noise exposures

●	 Support for hearing protection from company management—

personally encouraging use of hearing protection, modeling

behavior when management is in noisy areas

ing conservation training at all in their plant. Most

participants indicated that there was at least some

minimal level of training conducted as part of new

employee orientation; however, several people reported that the training was very cursory and ineffective and they doubted whether new workers truly

knew how to insert ear plugs properly. Some persons

interviewed stated that hearing conservation was covered at least annually and sometimes more frequently

as part of safety meetings. Training seldom lasted

more than a few minutes and sometimes involved

merely watching a video. A number of participants

stated that bringing in outside “experts” would result

in higher-quality programs.

Few participants realized the impact of shortterm exposure to noise. Even some HCP managers

admitted that they did not use hearing protection if

they would only be in a noisy area of the plant for a

few minutes. However, most of those interviewed

did recognize that noise abatement was the best way

to protect employee hearing. The universal difficulty

mentioned was the price of this investment. Although some believed the cost would be offset by

savings in workers’ compensation claims, few were

optimistic that upper management would invest in

noise control.

Ideal Work Environment

As for the focus groups, the moderator asked each

participant to visualize the ideal working environment for hearing-impaired workers. Participants

identified the features listed in Table 4. One HCP

manager had a particularly insightful comment: “I

saw a plant nurse who is also a key person to assist

the hearing-impaired person.”

Single Most Important Change

At the conclusion of each interview, the moderator

asked each individual what one recommendation he

would make to the CEO of his company regarding workers with hearing loss. Once again, mandatory hearing

protection was the most common response. Several also

indicated that management should make more types of

hearing protection available, including “more modern”

devices and the best available protectors, instead of being

“cheap on the supplies.” Other suggestions included better training programs, especially geared toward younger

workers to convince them early on that hearing conservation is important; investments in noise reduction and

quiet equipment; visible support from upper management; and audiometry both as a means to identify hearing-impaired workers and to monitor employee hearing.

One supervisor remarked, “We need to take hearing

protection as serious as we take eye protection and

clothing or body protection.”

DISCUSSION

Hearing-impaired workers face special problems,

especially when working in hazardous noise environments. These problems may include communication difficulty, diminished ability to monitor environmental sounds (e.g., warning signals), increased

risk of accidents resulting from impaired hearing

and communication, and possibly even reduced productivity and compromised opportunities for workplace advancement. Standard hearing conservation

practices do not accommodate these special problems. Although it is particularly important to protect the residual hearing of such workers, traditional hearing protectors can further reduce such

workers’ ability to communicate and monitor important background sounds.

The workers in this study verified the assumptions drawn from earlier studies that also used

qualitative methods to examine the problems hearing-impaired workers might face working in highnoise environments (He ́tu et al., 1994; Laroche,

Garcia, & Barrette, 2000; Scherich & Mowry, 1997;

Stika, 1997). Workers, supervisors, and hearing conservation program administrators all confirmed that

working in noise with a hearing loss does not have

much, if any, effect on worker productivity but does

present a concern for employee safety, particularly

as regards communication and the ability to hear

important environmental sounds. Workers expressed a greater level of concern about hearing

environmental sounds than verbal communication.

Many of them described elaborate nonverbal com­
munication techniques that rendered speech intelligibility less important. Because these techniques

must be learned, new workers may be at a disadvantage and possibly at increased risk for accidents.

Training them in the nonverbal communication

techniques in place at their work site should be a

high priority. Also, future laboratory research on

audibility for workers should include a significant

number of warning sounds, approaching equipment

noises, and other environmental sounds that workers have said they need to hear. These stimuli are at

least as important as speech sounds for maintaining

safe environmental awareness.

Previous focus group studies have indicated that

noise in the workplace and the consequent need for

hearing protection were the most evident barriers to

communication among workers who have a hearing

loss (He ́tu et al., 1994; Laroche, Garcia, & Barrette,

2000; Stika, 1997). In the present study, focus group

and interview participants verified that hearingimpaired workers have more difficulties hearing

communication and other important signals under

conventional hearing protection devices than workers with normal hearing. Because of the severe

audibility problems that result when persons with

hearing loss put on traditional hearing protectors,

workers in this study indicated that they remove their

protectors often, which can increase the risk of further

hearing loss (Franks, Stephenson, & Merry, 1996).

Results of this study indicated that supervisors of

noise-exposed, hearing-impaired workers were more

frequently concerned than hearing conservation program managers about the impact of hearing loss on

job safety and quality of life. Furthermore, no program manager indicated that noise-exposed, hearing impaired workers might need special accommodations. In most instances, supervisors are in closer

contact to the worker and might therefore be more

aware of the problems experienced by workers than

program managers. Moreover, sometimes supervisors have hearing loss themselves and thus have

first-hand knowledge of the unique difficulties faced

when working in high noise levels with impaired

hearing. This study indicates that remarkably,

hearing conservation program managers may need

more training than line supervisors regarding the

special needs of hearing-impaired workers.

The Americans with Disabilities Act of 1990

(ADA) requires employers to make reasonable

accommodation for disabled workers. Employers

are obligated to change the work environment or

process as necessary to provide an equal employment opportunity for workers with hearing loss, as

long as such accommodations do not place undue

hardship on business operations. Although the

ADA has specific guidance on communication issues for the deaf, the ADA provides no guidance

for occupational management of hearing-impaired

workers who continue to be exposed to an agent

responsible for loss of hearing.

The research conducted to date has not been

translated into practical recommendations to

guide employers and hearing health professionals

when trying to accommodate individual noiseexposed, hearing-impaired workers. The issue of

accommodating workers with hearing loss is

therefore very timely.

Earlier studies have indicated that one important reason for lack of accommodations is the lack

of information regarding what the ADA requires

and what technical resources exist (Geyer & Schroedel, 1999; NRC, 2005; Scherich, 1996). Neither

the supervisors nor the HCP managers interviewed in this study evidenced much knowledge of

the special accommodations and hearing protection options already available that could be of

assistance to noise-exposed, hearing-impaired

workers. Devices such as flat-attenuation or electronic earmuffs might address some of the needs of

hearing-impaired workers, yet they were largely

unknown to participants. Employees who have

hearing aids are handled in a number of different

ways, which may or may not be appropriate. It is

clear that guidance and education regarding these

nonstandard hearing conservation approaches is

needed.

The lack of initiative to ask for special accommodation has also been linked with apprehension

and anxiety about the potential consequences of

having one’s hearing difficulties known to others

(He ́ tu et al., 1994; Stika, 1997). Missing out on

promotions was another concern that was raised

in both previous studies and the present investigation. Moreover, the present study confirmed

that stress and fatigue are associated with a

hearing loss, and that social norms play an important role. It was suggested that workers may be

encouraged to wear hearing protection by learning

about the experiences of other workers whose

hearing is impaired. Incorporating hearing-impaired workers as role models into the training

program can be a powerful endorsement for the

use of hearing protection. People respond most

strongly to personal anecdotes about hearing loss.

When discussing the effects of hearing impairment during the focus groups and interviews, participants regularly told stories about other workers and

their own family members. Promoting the concept that

using hearing protection improves later quality of life

may be powerful, especially when associated with a

message such as “be able to hear your grandchildren.”

Although it is important to include problems experi­
enced by the hearing-impaired workers on-the-job,

emphasizing communication problems outside of work

was overwhelmingly considered to be the more compelling argument by those who participated in this

study.

It was evident from this study that front-line

supervisors are much more likely than administrators of hearing conservation programs to admit that

workers do not always wear hearing protection and

that they remove their hearing protection from time

to time. In contrast, administrators of hearing conservation programs know much more about federal

regulations and are less likely to say that employees

at their plants do not follow workplace rules. In

future studies, it will be important to gather data

from both perspectives.

The findings of this study verify that accommodations for noise-exposed, hearing-impaired workers are needed, and especially concerning hearing

protection and warning signals, so that they can

perform their jobs safely and be protected from

further hearing loss. It made evident that multiple

factors play a role in determining the best management strategy for individual hearing-impaired

workers. These factors include the type, degree,

and configuration of the hearing loss; the worker’s

need for and/or use of hearing aids; the noise to

which the worker is exposed; the auditory requirements and communication needs of the employee’s

job; and the worker’s own perceived needs and

difficulties (Geyer & Schroedel, 1999; He ́ tu et al.,

1994; Laroche, Garcia, & Barrette, 2000; Scherich,

1996).

Although some important information can be

taken from this study, readers should be aware

that the findings have limitations. Focus group

participants’ noise exposure and hearing status

were both self-reported, so it is possible that some

of the participants had normal hearing or worked

at places where noise exposure was not excessive.

Previous studies have indicated that questions

about hearing and noise exposure appear to be

sufficiently sensitive and specific indicators of

hearing status and noise levels (Noble, 1998; NRC,

2005; Svensson et al., 2004), but in this case there

was an inherent conflict of interest—that is, interest in being eligible to participate in the study.

However, this possibility was accounted for in the

study. Questions before and during the focus

groups helped get some understanding of participants’ hearing status. Those who may not have

had much difficulty with hearing still contributed

valuable information regarding their peers with

hearing loss.

Hearing status has an impact on the availability of various accommodations. The more serious

the hearing loss, the more likely that accommodations are in place. The studies of Scherich &

Mowry (1997) and Geyer & Schroedel (1999) found

that employers recognized the needs of hard-ofhearing workers less than those of deaf workers,

and that hard-of-hearing workers may have been

reluctant to ask for necessary accommodations.

The main interest in the present study was to

better understand the difficulties of workers with

mild to moderate hearing losses, which are more

prevalent in the workforce and more likely to be

overlooked than more severe conditions.

Previous research has indicated that requests for

reasonable accommodations are most likely to be

approved when employers and workers collaborate

to determine how to best accommodate a worker’s

needs (Anderson & Watson, 1995; Scherich, 1996).

Our results indicate that supervisors and hearing

conservation program managers should also be involved in decision-making and need to be better

informed regarding potential accommodations.

Professional hearing healthcare providers, particularly audiologists, occupational physicians, and

otolaryngologists, could be instrumental in the resolution of communication issues, safety issues, and

prevention of noise-induced hearing loss. They offer

professional supervision of the audiometric testing

component of hearing conservation programs and

sometimes do or could expand their contribution.

The information obtained in this study will

serve as a basis for the development of a standard

evaluation and intervention technique that will

provide hearing conservationists and others with

the necessary tools to manage hearing-impaired,

noise-exposed workers so that they can continue to

perform their jobs safely while still preventing

additional hearing loss (NIOSH project number

39277451). This evaluation and intervention technique will be designed to be incorporated into

existing hearing conservations programs. A

framework for determining the accommodations

best suited for a particular worker will include at

least:

1. a questionnaire to gather information from the

individual worker regarding the unique difficulties caused by working in a noisy environment with a hearing loss;

2. an evaluation of the worker’s particular noise

exposure;

3. audiometric testing, with an emphasis on evaluating the worker’s ability to hear speech and

other important signals in noise; and

4. audibility using different hearing protection

options.

The qualitative data obtained in study have

implications not only to hearing-impaired workers
but also to normal-hearing workers. Unfortunately, the scenarios described by the participants

of the focus groups and interviews paint a rather

bleak picture of current hearing conservation efforts in the United States, suggesting that not

even the current regulatory standards are being

implemented. Successful hearing loss prevention

initiatives benefit both the company and employees. Employees benefit with the prevention of

disabling hearing impairments and a less stressful work environment. Companies benefit from

reduced medical expenses, fewer worker compensation claims, and improved employee morale.

The existence of a hearing loss prevention program (even one that complies with government

standards) does not guarantee the prevention of

occupational hearing loss. Experiences with successful hearing loss prevention programs show

that management needs to develop and adhere to

certain policies from the start. NIOSH has published Preventing Occupational Hearing Loss—A

Practical Guide (Franks, Stephenson, & Merry,

1996) to summarize some of the important attributes of successful hearing loss prevention programs (http://www.cdc.gov/niosh/96-110.html).

The fourth edition of the Council for Accreditation

in Occupational Hearing Conservation (CAOHC)

Hearing Conservation Manual (Suter, 2003) also

covers all facets of developing a successful hearing

loss prevention program. Both NIOSH and

CAOHC discuss program evaluation alternatives

and indicate that to achieve success in a hearing

loss prevention program one should not be limited

by legislative requirements. Similarly, mere adherence to existing regulations may not provide

appropriate accommodation for noise-exposed,

hearing-impaired workers.

APPENDIX

Discussion Guide for the Focus Groups

Purpose: To understand the problems experienced by hearing-impaired workers and to identify

ways to minimize or eliminate those problems.

0:00

I. Warm-Up

•	 Purpose of the study

•	 Participants introduce themselves

•	 Describe current type of work

•	 Rate current ability to hear— good hearing, a little

trouble hearing, a lot of trouble hearing

•	 Have ringing/buzzing/roaring? If so—not bothersome, slightly distracting (gets my attention),

moderately distracting (affects ability to concentrate), severe (problems falling asleep, problems

doing daily tasks)

0:15

II. Current/Future Impact of Hearing Loss

•	 Does your current hearing loss prevent you from

doing your job as well as you could if you had

normal hearing?

•	 Do you think you are more likely to have an

accident or injury on the job because of your

hearing loss?

•	 Are there any job tasks you feel uncomfortable

about performing because of your hearing loss?

•	 When do you have the most trouble hearing or

communicating with other workers on the job?

•	 Do you worry that you will lose more of your

ability to hear in the future?

•	 If you had additional hearing loss, how would that

affect you on the job?

0:35

III. Hearing Protection Devices/Protective Equipment

•	 Are you asked to wear some type of hearing

protector at work? If so, do you usually wear

hearing protection?

•	 What type of hearing protection do you use most

often?

•	 Have you ever used anything other than the

standard ear plugs or earmuffs for hearing protection? [probe for use of electronic hearing protection or communication headsets]

•	 If you have used other types of hearing protection,

how did you like them? Why did you like or dislike

them?

•	 Is there anything about your job or work environment that makes it hard to wear hearing protection?

•	 Have you had any problems that were caused by

your hearing protection?

•	 Do you use any other type of protective equipment

on the job? If so, do any of these pieces of equipment affect your ability to hear?

•	 Have you ever worn a hearing aid? Do you wear

it/them at work? If not, what keeps you from

wearing it/them at work? Do hearing aids interfere with your work in any way?

1:00

IV. Environmental Sounds

•	 What types of warning signals (bells, buzzers,

alarms) do you need to be able to hear at work?
Which ones are easy to hear? Which ones are hard

to hear?

•	 Have you ever been unable to hear a warning

signal?

•	 Can you think of any ways to change the warning

signals where you work to make them easier to

hear?

•	 Do you need to talk to other people while you are

working? If so, what do you do if you can’t hear

what someone is saying?

•	 Are there sounds where you work that make it

even more difficult for you to hear a warning

signal or talk to someone nearby?

1:20

V. Management Practices

•	 Do the bosses or supervisors where you work do

anything to make it easier for you to hear and

communicate? If so, what do they do?

•	 Have you had any training about hearing loss or

hearing health? If so, describe the training.

1:30

VI. Visualization Exercise

Close your eyes and imagine that you now run the

company where you work. You have the power to

make this workplace the ideal situation for a hearing-impaired worker.

•	 What do you do to make things easier for hearingimpaired workers?

•	 What kinds of training do you give them? [probe

for lecture versus one-on-one versus video]

•	 What type of hearing protection do you provide?

•	 What assistance or support do supervisors offer to

hearing-impaired workers?

•	 How does this ideal company make the work

environment as safe as possible?

1:50

VII. Wrap-Up/Conclusion

Interview Guide for Supervisors and Hearing

Conservation Program Managers

In this project, we are interviewing people who

supervise hearing-impaired workers and hearing conservation program managers. We want to learn about

the types of noise you have in your workplace, the

problems experienced by hearing-impaired workers in

your organization, and what you are doing now to

protect your workers’ hearing. We do not intend to ask

you any questions that would pry into confidential or

proprietary information about your company.

Background Information

1. Specifically what does your company do?

2. How many employees do you have?

3. What percentage of your employees are hearing-impaired?

4. At your job site, what aspects of the work

environment are most likely to cause hearing

loss?

Current Practices: Protecting Workers’ Hearing

5. Do you require your workers who do not have

current hearing loss to wear hearing protectors? If so, what type?

6. Is it hard to get your workers who do not have

current hearing loss to wear hearing protectors? What do you do to maximize compliance?

7. Is it hard	 to get your workers who have

current hearing loss to wear hearing protectors? What do you do to maximize compliance?

8. Do you use	 any kind of hearing protectors

other than the “standard” ear plugs or ear

muffs?

9. Have your workers	 ever tried any type of

electronic hearing protector or communication headset? If so, what was their opinion of

this type of hearing protection? [probe for

ease of use, effectiveness versus “standard”

hearing protection]

10. Do	 workers seem to prefer nontraditional

hearing protectors to the typical ear plugs or

ear muffs?

11. Does your company offer any type of training

about hearing loss or hearing health? If so,

describe this training briefly. Is the program

effective? How do you know?

12. Do	 you wear hearing protectors yourself?

Why or why not? If yes, what type?

Hearing-Impaired Workers

13. Do you know specifically which of your employees have hearing loss? How do you identify workers with hearing problems?

14. What difficulties do you have when communicating with workers who have hearing loss?

15. How does the hearing loss of these workers

impair their on-the-job performance?

16. What problems, if any, do your hearing-impaired workers report, when they wear hearing protectors?

17. Do you think hearing-impaired workers are

more accident-prone or injury-prone when

they are wearing hearing protection?

18. Do hearing-impaired workers ask for or need

any special accommodations on your job site?

19. Do	 any of your hearing-impaired workers

wear hearing aids? If so, do they wear them

on the job site? Do they turn them on and off

while working? Do they still wear them under

hearing protectors?
Ideal Situation: Visualization Exercise

Close your eyes and imagine a company that does

an amazingly good job of helping noise-exposed,

hearing-impaired workers.

20. How does this work site look different from

other companies?

21. What types of hearing protection is available

through this ideal company?

22. What does this ideal company do to make

sure hearing-impaired workers use this protection in situations where they are exposed

to noise?

23. What does this ideal company do to make it

as easy as possible for hearing- impaired

workers to hear and to communicate with

other people?

24.	 What types of training does this ideal company offer for hearing-impaired workers

and those who do not have hearing impairment?

25. What	 special services or accommodations

does this ideal company offer for hearingimpaired workers?

Summary Comments

26. Based on your experience, what is the most

important thing for company presidents/

CEOs to know about noise-exposed, hearingimpaired workers?

27. Are there any other issues we need to discuss?

Thank you for your time today/this evening!

ACKNOWLEDGMENTS

We dedicate this article to the memory of our dear colleague,

mentor, and friend, Dr. Derek E. Dunn. Drs. Rick Davis, Larry

Reed, Carol Merry Stephenson, (NIOSH), and Richard

Kretschmer, (University of Cinncinnati) provided helpful critiques of the manuscript. The authors thank all of those who

participated in the focus groups and interviews for their time,

interest, and cooperation.

The findings and conclusions in this report are those of the

author(s) and do not necessarily represent the views of the

National Institute for Occupational Safety and Health.

Address for correspondence: Thais C. Morata, 4676 Columbia

Parkway, Mail Stop C-27, Cincinnati, OH 45226-1998. E-mail:

tmorata@cdc.gov.

Received November 17, 2004; accepted August 10, 2005.

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