Hearing Loss Impact Questionnaire

Please check "Yes," "No," or "Sometimes" to each of the following items. Do not skip a question if you avoid a situation because of a hearing problem. If you wear  hearing aids, please answer the way you hear without your hearing aids.

First answer the questions below and then click here to find your score.

Item

Yes

Sometimes

No

1.  Does a hearing problem cause you to feel embarrassed when meeting 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 a TV or radio?

      

9.  Do you feel that any difficulty with your hearing limits or hampers your personal or social life?

      

10. Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

      

Source: Ventry & Weinstien, Ear & Hearing, 3: 128-134.