Check YES or NO to each item for yourself or for an adult loved one:
YES
NO
1. Do you experience ringing or noises in your ears?
YES
NO
2. Do you hear better with one ear than the other?
YES
NO
3. Have any of your relatives had a hearing loss?
YES
NO
4. Have you had significant noise exposure at work, recreation or in military service?
YES
NO
5. Do you find it difficult to follow a conversation in a noisy restaurant or crowded room?
YES
NO
6. Do you sometimes feel people are mumbling or not speaking clearly?
YES
NO
7. Do you experience difficulty following dialog in theatre?
YES
NO
8. Do you sometimes find it difficult to understand a speaker at a public meeting ior religious service?
YES
NO
9. Do you sometimes find yourself asking people to speak up or to repeat themselves?
YES
NO
10. Do you find men’s voices easier to understand than women’s?
YES
NO
11. Do you experience difficulty understanding soft or whispered speech?
YES
NO
12. Do you sometimes have difficulty understanding speech or words on the telephone?
YES
NO
13. Does a hearing problem cause you to feel embarrassed when meeting new people?
YES
NO
14. Does a hearing problem cause you to be nervous?
YES
NO
15. Does a hearing problem cause you to visit friends, relatives or neighbors less often then you like?
YES
NO
16. Does a hearing problem cause you to talk to family members less often then you would like?
YES
NO
17. Does a hearing problem cause you to feel depressed?
YES answers to any of these questions may mean that you have a hearing problem.
If you have five or more YES answers, a hearing check-up is strongly recommended.