 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check YES or NO to each item for yourself or for an adult loved one:
1. Do you experience ringing or noises in your ears?
YES
NO
2. Do you hear better with one ear than the other?
YES
NO
3. Have any of your relatives had a hearing loss?
YES
NO
4. Have you had significant noise exposure at work, recreation or in military
service?
YES
NO
5. Do you find it difficult to follow a conversation in a noisy restaurant
or crowded room?
YES
NO
6. Do you sometimes feel people are mumbling or not speaking clearly?
YES
NO
7. Do you experience difficulty following dialog in the theatre?
YES
NO
8. Do you sometimes find it difficult to understand a speaker at a public
meeting or religious service?
YES
NO
9. Do you sometimes find yourself asking people to speak up or to repeat themselves?
YES
NO
10. Do you find men's voices easier to understand than women's?
YES
NO
11. Do you experience difficulty understanding soft or whispered speech?
YES
NO
12. Do you sometimes have difficulty understanding speech or words on the
telephone?
YES
NO
13. Does a hearing problem cause you to feel embarrassed when meeting new
people?
YES
NO
14. Do you feel handicapped by a hearing problem?
YES
NO
15. Does a hearing problem cause you to be nervous?
YES
NO
16. Does a hearing problem cause you to visit friends, relatives, or neighbors
less often than you like?
YES
NO
17. Does a hearing problem cause you to talk to family members less often
than you would like?
YES
NO
18. Does a hearing problem cause you to feel depressed?
YES
NO
YES answers to any of these questions may mean that you have a hearing problem. Several YES answers strongly suggest that a hearing test is needed.
For more information, or to schedule your hearing test, contact a Hearing Instrument Practitioner in your area.