Hearing Problems Screening
This questionnaire helps you detect hearing problems. For each question, circle the value that matches your answer (Yes or No).
| Questions | Yes | Sometimes | No | |
|---|---|---|---|---|
| 1. | Does a hearing problem cause you to feel embarrassed when meeting new people? | 4 | 2 | 0 |
| 2. | Does a hearing problem cause you to feel frustrated when talking to members of your family? | 4 | 2 | 0 |
| 3. | Does a hearing problem cause you difficulty hearing/understanding coworkers, clients, or customers? | 4 | 2 | 0 |
| 4. | Do you feel handicapped by a hearing problem? | 4 | 2 | 0 |
| 5. | Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbours? | 4 | 2 | 0 |
| 6. | Does a hearing problem cause you difficulty in the movies or theatre? | 4 | 2 | 0 |
| 7. | Does a hearing problem cause you to have arguments with family members? | 4 | 2 | 0 |
| 8. | Does a hearing problem cause you difficulty when listening to a TV or radio? | 4 | 2 | 0 |
| 9. | Do you feel that any difficulty with your hearing limits or hampers your personal or social life? | 4 | 2 | 0 |
| 10. | Does a hearing problem cause you difficulty when in a restaurant with relatives or friends? | 4 | 2 | 0 |
Compile your total score. If you have a score of 4 or less, you do not have hearing problems. A total between 5 to 12 indicates a mild to moderate hearing handicap. If your total score is 13 or more, you have a severe hearing handicap.
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The patient information leaflets are provided by Vigilance Santé Inc. This content is for information purposes only and does not in any manner whatsoever replace the opinion or advice of your health care professional. Always consult a health care professional before making a decision about your medication or treatment.