Self assessment hearing questionnaire

A self assessment hearing questionnaire can be a very useful tool to determine if further hearing assessment is necessary. It is recommended that a patient answering “yes” to any of the following questions be evaluated more thoroughly for possible hearing deficit.

1. Does a hearing problem cause you to feel embarrassed when meeting new people?

2. Does a hearing problem cause you to feel frustrated when talking to members of your family?

3. Do you have difficulty hearing when someone speaks in a soft voice?

4. Do you feel handicapped by a hearing problem?

5. Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?

6. Does a hearing problem cause you difficulties at movies, the theatre, or religious services?

7. Does a hearing problem cause you to have arguments with family members?

8. Does a hearing problem cause you difficulty when listening to TV or radio?

9. Do you feel that any difficulty with your hearing limits or hampers your personal or social life?

10. Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?