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Test Your Hearing Loss

Hearing Handicap Questionnaire

Instructions

Print off the chart below or follow along on a piece of paper. Answer Yes, No, or Sometimes for each question. Do not skip a question if you avoid a situation because of a hearing problem. If you use a hearing aid, please answer according to the way you hear with the aid.

Scoring

Give yourself points for each answer: No = 0, Sometimes = 2, Yes = 4.

Total Your Score

0 - 8 = no handicap; 10 - 24 = mild to moderate handicap; 26 - 40 = severe handicap

*Adapted from Ventry I, Weinstein B. Identification of elderly people with hearing problems. ASHA. 1983; 25:37-42.


Yes

No

Sometimes

1. Does a hearing problem cause you to feel embarrassed when you meet new people?

2. Does a hearing problem cause you to feel frustrated when talking to members of your family?

3. Do you have difficulty hearing when someone speaks in a whisper?
4. Do you feel handicapped by a hearing problem?
5. Does a hearing problem cause you difficulty when visiting friends, relatives or neighbors?
6. Does a hearing problem cause you to attend religious services less often than you would like?
7. Does a hearing problem cause you to have arguments with family members?
8. Does a hearing problem cause you difficulty when listening to TV or radio?
9. Does a hearing problem cause you difficulty when listening to TV or radio?
10. Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

Total from each column

TOTAL SCORE