Whether your hearing aids are brand new or several years old, it’s helpful to keep track of their performance and how well they help you hear and understand others. This questionnaire will help clarify your current hearing situation. You may want to save the results to your “My Saved Files” page or print them to take to your appointment with a hearing professional.
Instructions: Check Yes or No to reflect your everyday experience with hearing aids. If you have not experienced the situation described, skip the question.
You must have a My Saved Files account to save this questionnaire. Sign up or Log In.
1. I have difficulty hearing a conversation with one person at home. Yes No
2. When I am in a small office or conference room, interviewing or answering questions, I have difficulty following the conversation. Yes No
3. When I am having a quiet conversation with a friend, I have difficulty understanding. Yes No
4. When a speaker is addressing a small group, and everyone is listening quietly, I have to strain to understand. Yes No
5. When I’m in a quiet conversation with my doctor in an examination room, it is hard to follow the conversation. Yes No
6. I have to ask people to repeat themselves in one-on-one conversation in a quiet room. Yes No
1. When I am in a crowded grocery store, talking with the cashier, I can follow the conversation. Yes No
2. When I am listening to the news on the car radio, and family members are talking, I have trouble hearing the news. Yes No
3. When I am at the dinner table with several people, and trying to have a conversation with one person, understanding speech is difficult. Yes No
4. I can understand conversations even when several people are talking. Yes No
5. I can communicate with others when I am in a crowd. Yes No
6. I have trouble understanding others when an air conditioner or fan is on. Yes No
1. I miss a lot of information when I’m listening to a lecture. Yes No
2. I have trouble understanding dialogue in a movie or at the theater. Yes No
3. When I am talking with someone across a large empty room, I understand the words. Yes No
4. When I am in the theater watching a movie or a play, and the people around me are whispering and rustling paper wrappers, I can still make out the dialogue. Yes No
5. It’s hard for me to understand what is being said at lectures or church services. Yes No
6. I can follow the words of a sermon when listening to a religious service. Yes No
1. Unexpected sounds, like a smoke detector or alarm bell or tone are uncomfortable. Yes No
2. Traffic noises are too loud. Yes No
3. The sounds of running water, such as a toilet or shower, are uncomfortably loud. Yes No
4. The sounds of construction work are uncomfortably loud. Yes No
5. The sounds of a fire engine siren close by is so loud that I need to cover my ears. Yes No
6. The sound of screeching tires is uncomfortably loud. Yes No
Save »