1. I have a problem hearing over the telephone. _____
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 miss hearing some common sounds
like the phone
_____
or the doorbell
ringing.
6. I have trouble hearing conversations
in a noisy
_____
background
such as a party.
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
(assembly lines, _____
jackhammers, jet engines, etc.).
11. I hear fine - if people just speak clearly. _____
12. People get annoyed because I misunderstand
what
_____
they say.
13. I misunderstand what others are
saying and make
_____
inappropriate responses.
14. I avoid social activities because
I cannot hear well and _____
fear
I'll reply improperly.
15. Do you think this person has a hearing loss? _____
16. If you have a blood relative who
has a hearing loss,
_____
add
three points.
0 - 5
Your hearing is probably fine and no action is required.
6
- 9 We suggest
that you have your hearing evaluated
by an Audiologist.
10+
We
strongly recommend that you have your
hearing evaluated by an Audiologist.
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