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The hearing losses of workers exposed to occupational noise have been extensively documented, but no information exists on the level of hearing loss which results in job loss.To define levels of hearing loss associated with ill-health retirement (IHR), comparing them with existing standards and assessing the extent to which poor hearing contributes to accidents and near misses to assist the development of rational standards for retention.All UK local authority fire brigades were approached for information on IHRs due to audiological problems, accident/near-miss totals and the numbers thought to be due to poor hearing in a 60-month period beginning in 1997.Only 15/59 (25%) of brigades provided all information requested, although 50 (85%) and 32 (52%) supplied medical and safety information, respectively, which was used for analysis. Of 3366 IHRs, 135 (4%) were due to audiological problems. When compared to a control group of firefighters of similar age, those taking IHR had worse mean and median hearing losses in all grouped frequencies in both ears than the controls, and this difference always reached statistical significance (P < 0.001), but there was considerable overlap in terms of range of hearing loss in each group. Only 41/31 274 (0.13%) of accidents/near misses reported were believed to result from hearing problems, and seven of these were related to device failure.Retention criteria based on audiometric grounds alone may result in unnecessary IHRs. Poor hearing is only responsible for a small proportion of accidents and near misses.