Hearing loss questionnaire from Hearing Aid Help

Hearing loss questionnaire

Questions		Yes	No
1.	Do people complain that you aren't listening?
2.	Do people complain that you turn the TV volume too high?
3.	Do you understand men's voices better than women's?
4.	Do you have trouble hearing birds or the wind in the trees?
5.	Do voices sound blurry — like people mumble?
6.	Do you have to ask people to repeat themselves frequently, even in quiet rooms?
7.	Do you need to turn toward the person speaking or cup your ear to understand what is being said?
8.	Do you find yourself confusing words or making silly mistakes?
9.	Do you miss hearing common sounds, like the ringing of the phone or doorbell?
10.	Do you have difficulty hearing in public gathering places — concert halls, theaters, houses of worship — where sound sources are far from the listener?
11.	Do you have difficulty hearing television and/or on the telephone?
12.	Do you have trouble understanding conversation within a group of people?
13.	Do you avoid group meetings, social occasions, or family gatherings where listening may be difficult or where one may feel embarrassed about misunderstanding what is being said?
14.	Has a friend or family member mentioned that you could have a hearing problem ?

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