Introduction:
The following hearing loss test is based on the Revised American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) five-minute hearing check. It is a means of quickly assessing if you possibly have a hearing loss requiring referral for an objective hearing test and possible hearing solution. This test is related to objective measures of hearing loss using audiological equipment. In step #1 you are asked to respond to 15 items related to your hearing. Upon completing the survey, you will be given a score and correlating assessment of your hearing.

Instructions:
With respect to your hearing please think about your experiences with each of the following WITHOUT the use of hearing aids or other devices designed to help you hear better. For each item, indicate the degree to which you agree or disagree.


I have a problem hearing over the telephone.
I have trouble following the conversation when two or more people are talking at the same time.
I have trouble understanding things on TV.
I have to strain to understand conversations.
I have to worry about missing a telephone ring or doorbell.
I have trouble hearing conversations in a noisy background such as a crowded room or restaurant.
I get confused about where sounds come from.
I misunderstand some words in a sentence and need to ask people to repeat themselves.
I especially have trouble understanding the speech of women and children.
I have trouble understanding the speaker in a large room such as at a meeting or place of worship.
Many people I talk to seem to mumble (or don't speak clearly).
People get annoyed because I misunderstand what they say.
I misunderstand what others are saying and make inappropriate responses.
I avoid social activites because I cannot hear well and fear I will reply improperly.
Family members and friends have told me they think I may have a hearing loss.