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.
| Question | Yes | Sometimes | No |
| 1. Does a hearing problem cause you to feel embarrassed when meeting new people? | |||
| 2. Does a hearing prblem cause you to feel frustrated when talking ot 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 difficuty when visiting freinds, 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.