Questions | Never 0 Points |
Occasionally 1 Point |
Always 2 Points |
|
1. | Have you noticed that you don't hear as well as you used to? | |||
2. | Can you hear when someone approaches you from behind? | |||
3. | Can you hear the sound of a coin dropping on the floor? | |||
4. | Can you hear the telephone ring in the same room without the use of a hearing aid? | |||
5. | Do your family and friends have to repeat what they say--on a regular basis? | |||
6. | Has someone said that you speak too loudly in conversation? | |||
7. | Do you have greater difficulty hearing children's voices? | |||
8. | Do you miss some words in a telephone conversation? | |||
9. | Have you noticed difficulty with your hearing? | |||
10. | Do you have trouble hearing or understanding what was said when there is lots of background noise? (Car, Theater, Large Groups, Noisy Restaurant) | |||
11. | Do you find yourself reading lips to understand the conversation? | |||
12. | Do you have to turn the television up so high it disturbs the rest of your family? | |||
13. | Are your family members are constantly say that you are hard of hearing—and you should get your ears checked? | |||
14. | Do You go out of your way to avoid going to places where its noisy? | |||
15. | Has Anyone told you you don't hear well? | |||
16. | Do you get frustrated from not understanding what others are saying? | |||
17. | When you are talking to someone do you have to ask them to repeat what they are saying numerous times? | |||
Grand Total = |
Should You Purchase a Hearing Aid? | |
0 Points - Normal Hearing (0% 0-20dB) Few if any communication problems. You do not seem to be experiencing difficulty with your hearing--no hearing aid may be needed | |
1-12 Points - You may have Mild Hearing Loss (0-22% 20-40dB). Some communication difficulties, especially in noisy situatations. May require loder volume on television, stereo, etc. Yes, you should be using hearing aids. | |
12 - 20 Points - You may have Moderate Hearing Loss (22-52% 40-60dB) Commication difficulties in most areas including telephone, television, and in listening to speakers at public gatherings. Yes, you should be using hearing aids. | |
21 - 30 Points - You may have Severe Hearing Loss (52-82% 60-90dB) Significant difficulties in most types of communications. Yes, you should be using hearing aids. | |
More than 30 Points - You my have a Profound Hearing Loss. (82-100% 90db +) Major communication problems in all situations. May require visual assistance such as lip reading and sign language. You should see an Audiologist for further testing. |