Almost Always
Half the time
Occasionally
Never
1.
I have a problem hearing over the phone.
2.
I have trouble following the conversation when two or more people are talking at the same time.
3.
People complain that I turn the TV volume too high.
4.
I have to strain to understand conversations.
5.
I have trouble hearing conversations in a noisy background such as a party.
6.
I miss hearing some common sounds like the phone or doorbell ring.
7.
I get confused about where sounds come from.
8.
I misunderstand some words in a sentence and need to ask people to repeat themselves.
9.
I especially have trouble understanding the speech of women and children.
10.
I have worked in noisy environments.
11.
Many people mumble when they talk.
12.
People get annoyed because I misunderstand what is being said.
13.
I misunderstand what others are saying and make inappropriate responses.
14.
I avoid social activities because I cannot hear well and fear that I’ll reply improperly.
To be answered by a family member
YES
NO
15.
Do you think this person has a hearing loss?
16.
Do you have a blood relative with hearing loss?
