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

15.

Do you think this person has a hearing loss?

yes no

16.

Do you have a blood relative with hearing loss?

yes no

Hearing Test

5 Minute Hearing Survey