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Online Hearing Questionnaire
Please answer ALL questions as they pertain to you.
Do you often think ''my hearing is not as good as it used to be?''
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do women and children seem to ''mumble?''
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you get in arguments, or in difficult situations with your spouse (or friends or family) because you thought they said one thing, and they say they said another?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have difficulty understanding some voices and words on the phone?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have difficulty hearing the words from your grandchildren (or other children)?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have ringing in one or both ears?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have a history of industrial, work related, or recreational noise exposure, like working in a factory, as a firefighter, as a musician, at an airport, firing weapons, target practice or other noisy sources?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you sometimes say ''people don’t speak clearly any more, they don't pronounce the words as clearly as they used to.''
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you sometimes feel embarrassed about asking for repeats?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you get frustrated easily with unfamiliar and soft voices?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you find that you sometimes ''fake it'' by trying to nod in agreement, even though you weren’t sure what was said?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you think you can hear ''loud enough'' but cannot understand the words?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have a hard time hearing normal conversation in noisy backgrounds, such as a restaurant or a cocktail party?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have a hard time understanding whispers?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you listen to the TV louder than most people?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have difficulty hearing the words during religious services or at large meetings?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have difficulty determining where the sounds are coming from?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do your ears hurt or drain, or does one ear hear better than the other?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you have difficulty understanding when there are more than two people talking at the same time?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
Do you turn the volume up on the public telephone systems to hear better?
Yes, most of the time
Yes, sometimes
Maybe
No, almost never
No, this never happens
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