Patients with hearing impairment are more likely to encounter health problems and difficulties at work than their colleagues with normal hearing. This is often not realised by either patients or professionals. In this article we describe three cases that illustrate how working conditions can influence the health of workers with hearing loss. We have implemented a vocational enablement protocol that follows a multidisciplinary approach in order to meet these patients' needs. Due to a mismatch between the demands of a job and an individual's auditory capacities, even a mild hearing impairment can cause serious problems if a patient works in adverse conditions. In addition, in many workplaces the ability to hear well is a safety issue. Professionals have to be aware of both possibilities. Specialized centres offer good facilities and ensure the optimal transfer of insight into the working environment by involving an occupational physician in their team.