November 25, 2008 Features

Aural Rehabilitation for the Workplace

Listening in Our Offices Helps Clients Listen in Theirs

At one time, when a still-working adult visited an audiological clinic complaining of listening difficulties, the audiologist could guess that the patient worked in a factory, on a farm or construction site, or in the armed services. Working adults who sought services were often victims of unremitting noise exposure.

With the aging of the work force and the high noise levels in modern society, more audiologists now treat patients who work in quieter environments. These workers often have no health-related issues other than hearing loss. As members of the "baby boom" generation, they tend to be well-educated and healthy compared with their counterparts of yesteryear. They expect and deserve to retain the ability to conduct their daily work-related responsibilities and to advance within their companies.

We recently conducted a series of focus groups to learn who these workers are, how hearing loss has affected their job performance, and what they would like from their audiologists (Tye-Murray, Spry, & Mauzé, submitted). Our goal was to collect information that could guide counseling, aural rehabilitation intervention, and self-management of this population.

A total of 48 professionals with self-reported acquired hearing loss participated in one of seven focus groups. Their ages ranged from 29 to 79, with an average age of 61. To be eligible for the study, participants had to be working in or retired for less than two years from a salaried (as opposed to an hourly) position. All had earned at least a high school diploma; 27 had some college, a college degree, or an advanced degree. Most reported having five other people working in their office or department.

The pure-tone average in the worse ear of the participants was 61 dB HL. Thirty participants use either a hearing aid or a cochlear implant; all communicate with spoken language.

Participants discussed their opinions and emotions related to hearing loss in the workplace. Participants were asked questions about a hypothetical executive ("Mary") who had hearing loss and about their own work-related predicaments. The sessions were audio- and video-recorded and later transcribed. Responses were sorted into four areas: the effects of hearing loss on job performance, accommodations and acceptance in the workplace, psychological and emotional reactions, and patient-identified aural rehabilitation needs.

Hearing Loss and Job Performance

The majority of participants believe their job performance has been affected by their decline in hearing. Most noted that their communication with employers, co-workers, and/or clients was compromised and that they performed their duties less effectively. One participant said, "I am a trial lawyer and had to apply for disability retirement because in good conscience, I didn't feel like I was being fair to my clients because of all the nuances involved with examining a witness. Not only in hearing a witness, but in hearing the manner in which a witness is responding."

Many believe their hearing loss prevented them from participating fully in meetings or conferences. "I'm there," said a state employee, "but do I actually know what's going on? Not all the time." An executive expressed a similar opinion about group meetings, saying, "Those people don't know I have a hearing loss nor do I have the time to tell them. There is an agenda and the boss just goes right through it. If it's important, they are going to have to either e-mail or give me the minutes. I just sit there and wait until the meeting ends."

Some said that hearing loss had led to a loss of their "competitive edge" and may have resulted in restricted job opportunities. "In every job I've had," one participant commented, "I needed to talk on the telephone. I worked at a bank as a collection manager and an opening for a loan officer came up. I wanted to see about that position, but my boss thought that I would miss too much information." A director of horticulture said, "I've been passed over for promotions. I've been denied a lot of things because of my hearing loss." Some participants believe that they had become less visible. A document coordinator reflected, "I did not put myself forward. If I did not have a hearing loss, I would have gone a lot further." One participant suggested that people may be hesitant to admit having a hearing loss because it would "be seen as a weakness."

About 70% of the participants said they sometimes—if not always—divulge their hearing loss to co-workers, employers, and/or clients. Of these, some said they would tell only a trusted individual at work; others said they made a point of talking about their hearing loss whenever appropriate, such as before making a presentation or when meeting people for the first time. Good communication is integral to most of the participants' successful job performance; they may believe it is more acceptable to disclose a hearing loss and perform the job competently than to hide the hearing loss and deliver impaired performance.

Despite the challenges posed by hearing loss and the occasional reluctance to admit its presence, many participants demonstrated resiliency, a sense of "I'll do what I have to do to get the job done." Many indicated they do not want to be on the sidelines of the action and want to continue their productive work lives. Often "getting the job done" was a matter of procuring the appropriate listening device, structuring the communication environment, enlisting the help of co-workers, and/or telling people about the hearing loss.

The bank collection manager who was discouraged from seeking a better position noted, "That's what really woke me up. I got a hearing aid at age 29." Many participants mentioned managing the communication environment; one office worker said, "When giving presentations I say, 'I don't hear well in this kind of environment. If I'm walking up to you, getting in your space, [it's] because I just don't hear that well in this environment.'" An attorney said, "I used my secretary when I was interviewing clients. I would say, 'I want my assistant to be here taking notes if you don't mind, because I may not get everything.'" A financial service representative, like several of the participants, explained the hearing loss when he felt it was necessary: "As my hearing got worse, I wasn't shy about telling people that I had a loss and needed to sit where the speaker was going to be."

Many participants took responsibility for managing their communication difficulties, indicating that one must overcome listening challenges. One executive, in talking about the hypothetical Mary, said, "She has to learn to live with hearing aids [and hearing loss] and develop techniques or skills or work-arounds so that she can function in a variety of environments." A businessman pointed out that hearing loss should not serve as an excuse for failure. "If you are using [hearing loss] to cop out, you are using it as a crutch," he asserted.

Participants offered strategies for coping: carefully choosing lunch sites to avoid loud environments, being over-prepared for meetings so that they could follow the discussion, bringing along appropriate assistive devices to alleviate difficult communication environments, using confirmation strategies to ensure that they had understood messages correctly, and instructing communication partners about how to best convey their messages (see Tye-Murray, 2009, for a review).

Some participants reported using hearing loss to their advantage. A teaching associate tells his medical residents, "I want you to speak up, speak clearly and distinctly, and look at me when you're talking to me." He uses his hearing loss "as a teaching aid to teach them how to [interact with patients] properly." A senior executive who experienced sudden hearing loss said that his success in overcoming a disability had served to motivate his employees.

Most participants identified talking on the telephone as their greatest work-related challenge. Some participants use amplified handsets; others use e-mail in lieu of telephone contact. Other frequently cited sources of difficulty included women's voices, soft-spoken voices (often encountered in an office-cubicle environment), foreign accents, group meetings, and teleconferences. Most said that one-on-one communication was relatively nonproblematic, except in the presence of background noise such as piped-in music.

Acceptance and Accommodations

Many participants said their employers and co-workers were supportive and accepting of their hearing loss. A worker in a nonprofit organization noted, "If most of your communications are in-house, you may be able to get along fine. Your co-workers will help you." An accounting manager noted that her boss said she admired her and knew she was "trying my best."

However, some participants described unsupportive colleagues, such as a boss characterized as uncomfortable with a participant's hearing loss. One participant seemed to justify his co-workers' perceptions by saying, "All things being equal, it's a pain to talk to someone with a hearing loss...I think there is a natural tendency to exclude someone with a hearing loss."

The Americans With Disabilities Act (ADA) ensures that people with hearing loss have the same employment opportunities as people with normal hearing. The majority of participants, however, know very little or nothing about the ADA or were misinformed. One thought that the ADA requires the state to provide hearing devices to low-income adults; two others believed it provided funding for services or a government subsidy. Only 10 participants who responded to the question correctly cited at least one implication of the ADA for persons with hearing loss.

Psychological and Emotional Reactions

Many researchers have documented the stigmatization and emotional impact associated with living with hearing loss (e.g., Hétu, 1996; Jones, Kyle, & Wood, 1987). To assess participants' psychological and emotional reactions, we reviewed the focus group transcripts and found more than 100 utterances that carried an emotional overtone. We identified categories to describe the emotional content, using previous literature as a guide. For instance, previous investigators have found that the psychological and emotional consequences of hearing loss include feelings of insecurity, depression, rejection, embarrassment, loneliness, lack of confidence, stress, and/or anxiety.

Two audiologists and a research assistant trained in psychology rated each utterance from a menu of labels. The most common emotional connotations were compatible with previous findings. About 25% of the remarks conveyed feelings categorized as "anxiety/fear/self-doubt." About 20% fell under the label of "embarrassment/self-consciousness/shame." A receptionist admitted, "If somebody says, 'I want you to look for something,' and you haven't a clue what he's saying, you feel so dumb." Others said that there was no need for embarrassment. "The reality is," said one, "that hearing loss is becoming pretty common with the baby boomers."

About 15% of the remarks were coded with the label "anxiety" and about 15% with "frustration/sense of being misunderstood." A few participants spoke of how their co-workers didn't understand the limitations of hearing aids or cochlear implants.

More positive feelings than have been reported previously surfaced during our focus groups, and there was less evidence of anger, resentment, or feelings of stigmatization. More than 20% of the emotion-laden remarks were classified as conveying a sense of "equanimity/acceptance," such as a teacher who said, "I don't mind if people know I'm hard of hearing, because it doesn't matter."

Only about 10% of the utterances were labeled "resentment/anger." Often these remarks described a co-worker's failure to accommodate a participant's hearing loss by forgetting, for example, to speak slowly and clearly. These results suggest that although this group of workers does feel some of the negative emotions experienced by workers in other work environments and eras, the consequences of hearing loss may not be as negative in today's world, given the ADA, the aging of the baby boom generation, the ubiquity of ear-mounted technology (e.g., Blue Tooth), and technological changes that have provided more communication options—such as e-mail—in the contemporary office environment.

Implications for Aural Rehabilitation

The final question posed to our focus groups concerned what they want from an aural rehabilitation program. Participants listed three common priorities: instruction about communication strategies, speechreading classes, and information and services on the care and use of hearing aids. Three focus groups discussed whether participants would be interested in having their supervisor and co-workers attend a workshop about hearing loss in the workplace. In one focus group the response was a resounding "no." In a second focus group, there was lukewarm enthusiasm; in the third group, the response was positive.

Moving Forward

We reached several conclusions about patients' attitudes toward listening in the work environment and aural rehabilitation intervention. First, many of our participants are willing to use hearing aids and to disclose hearing loss when appropriate. These findings suggest that many working adults may be receptive to undergoing a hearing-aid evaluation.

Second, participants expressed an almost-unanimous concern: that hearing loss has diminished their ability to perform their jobs competently and/or has diminished their competitive edge. Participants' comments about use of listening devices, co-workers' reactions to their hearing losses, coping strategies, and communication difficulties were almost always expressed in the context of being able to perform their jobs to the best of their abilities or of being able to advance in their careers.

This overriding concern leads our participants to one of at least two mindsets: they are determined to perform and compete in the workplace and develop the resolve to do so, or they are resigned to the limitations imposed by hearing loss. With this latter mindset, retirement or changing jobs become very real possibilities. An aural rehabilitation plan might begin with the question of how to maximize the patient's communication effectiveness in the work place.

Although many patients may be resourceful in using communication strategies, some may desire explicit training in communication strategies. Instruction in general principles of speechreading and ways to optimize the speechreading environment may also lead to enhanced job performance. Patients might also receive information and counseling about assistive devices, particularly those related to telephone use, and about other telephone services (such as relay services) that are available for persons who have hearing loss.

Third—and this is a positive finding, indeed—many patients may have developed a sense of acceptance and equanimity and may be experiencing no stigmatization in their workplaces. Those who still may occasionally experience resentment, embarrassment, and shame may benefit from counseling and psychosocial support.

Finally, and perhaps surprisingly, few of our participants were familiar with the ADA. Many patients might benefit from receiving an overview of its provisions and how they may help in obtaining workplace accommodations.

Our focus groups presented just a sampling of what can be learned by listening to patients talk about their everyday communication difficulties. Listen in your workplace—it just might allow you to help them listen in theirs. 

Nancy Tye-Murray, PhD, CCC-A, is a research professor at Washington University School of Medicine's Department of Otolaryngology and the Program in Audiology and Communication Sciences. Her research interests include childhood deafness and adult aural rehabilitation. Contact her at murrayn@ent.wustl.

Jacqueline L. Spry, is a fourth-year AuD student at WU who participated in this research as part of her Capstone project. Contact her at

Elizabeth Mauzé, MS, CCC-A, is an audiologist at Washington University. Her research focuses on adult aural rehabilition. Contact her at

cite as: Tye-Murray, N. , Spry, J. L.  & Mauzé, E. (2008, November 25). Aural Rehabilitation for the Workplace : Listening in Our Offices Helps Clients Listen in Theirs. The ASHA Leader.

Aural Rehabilitation Resources

Audiologic Rehabiliation

The ASHA Web site offers free information and materials, including:

  • Patient education materials that can be downloaded at no charge and reproduced
  • Information on AR reimbursement codes
  • Strategies for approaching employers and health plans about coverage of AR services

The ASHA store offers:

  • Patient counseling materials (search "Assessment, Amplification, and Audiologic Rehabilitation")
  • Professional development seminar: Needs Assessment for Assistive Technologies (search "hearing assistive technologies")
  • New audiology brochures (search "audiology brochures"), including How Do I Know if I Have a Hearing Loss?, My Audiologist Recommends Hearing Aids, Now What,and Making the Most of Your New Hearing Aids

Assistive Technology

The following Web sites offer information about assistive technology for individuals with hearing impairments:

Americans with Disabilities Act

The U.S. Equal Employment Opportunity Commission provides information about the ADA and how it relates to deafness and hearing impairments in the workplace. 


Hétu, R. (1996). The stigma attached to hearing impairment. Scandinavian Audiology, 43, 12–24.

Jones, L., Kyle, J., & Wood, P. (1987). Words apart: Losing your hearing as an adult. New York, NY: Tavistock.

Tye-Murray, N. (2009). Foundations of aural rehabilitation: Children, adults, and their family members. Clifton Park, NY: Delmar-Cengage Learning.

Tye-Murray, N., Spry, J., & Mauzé, E. (Submitted for publication). Professionals with hearing loss: Maintaining that competitive edge.


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