Instructions: The purpose of this scale is to identify the problems your
hearing loss may be causing you. Please select the appropriate number ranging
from 1 to 5 for the following questions. Select only one number for each
question. If you have a hearing aid, please fill out the form according to how
you communicate when the hearing aid is not
in use.
(1) Does a hearing problem cause you to feel
embarrassed when meeting new people?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(2) Does a hearing problem cause you to feel frustrated when
talking to members of your family?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(3) Do you have difficulty hearing when someone speaks in a
whisper?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(4) Do you feel handicapped by a hearing problem?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(5) Does a hearing problem cause you difficulty when visiting
friends, relatives, or neighbors?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(6) Does a hearing problem cause you to attend religious
services less often than you would like?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(7) Does a hearing problem cause you you to have arguments with
family members?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(8) Does a hearing problem cause you difficulty when listening
to a TV or radio?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(9) Do you feel that any difficulty with your hearing limits or
hampers your personal or social life?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
(10) Does a hearing problem cause you difficulty when in a
restaurant with relatives or friends?
1) almost never (or never)
2) occasionally (about 1/4 of the
time)
3) about half of the time
4) frequently (about 3/4 of the time)
5) practically always (or always)
Scoring:
Add up all the points and refer to the scale below:
0 to 9 Count again the minimum score
possible on this test is 10
11 to 15 Any hearing loss you may have is only minor consult with
a hearing professional if you or a loved one questions these results.
16 to 25 You may have a mild to moderate hearing loss consult with a
professional for a complete audiological evaluation and possible
treatment.
26 to 35 You may have a moderate to severe hearing loss consult with a
hearing professional for a complete audiological evaluation and proper treatment.
36 to 45 You most probably have a severe hearing loss it is highly
advised you consult with hearing professional for a complete audiological
evaluation and proper treatment.
46 to 50 You have a severe to profound hearing loss. Consult immediately
with a hearing professional.
Over 51 Add again the maximum score possible is 50.
