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Hearing Handicap Inventory for Elderly - Screening*

Instructions:

The purpose of this scale is to identify the problems your hearing loss may be causing you. Answer "Yes","Sometimes", or "No" for each question.

Do not skip a question if you avoid a situation because of your hearing loss. It is important that you answer all questions. If you use a hearing aid, please answer the way you hear without the hearing aid.

Please answer the following questions
before filling out the hearing handicap scale:

Age in years Sex

Do you feel like you have a hearing loss and if you do, how often does it cause problems in educational, social, or occupational activities?

Have you had a hearing test within the last two years, and if so what was the result of this test?

Please enter your email address.

Would you like your results emailed to you?

(1) Does a hearing problem cause you to feel embarrassed when meeting new people?	Yes Sometimes No
(2) Does a hearing problem cause you to feel frustrated when talking to members of your family?	Yes Sometimes No
(3) Do you have difficulty hearing when someone speaks in a whisper?	Yes Sometimes No
(4) Do you feel handicapped by a hearing problem?	Yes Sometimes No
(5) Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?	Yes Sometimes No
(6) Does a hearing problem cause you to attend religious services less often than you would like?	Yes Sometimes No
(7) Does a hearing problem cause you you to have arguments with family members?	Yes Sometimes No
(8) Does a hearing problem cause you difficulty when listening to a TV or radio?	Yes Sometimes No
(9) Do you feel that any difficulty with your hearing limits or hampers your personal or social life?	Yes Sometimes No
(10) Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?	Yes Sometimes No

Remember to answer all of the questions and if you wear a hearing aid answer the way you hear without the hearing aid.

* Reprinted with permission from Ventry, I. & Weinstein, B. The Hearing Handicap Inventory for the Elderly: A new tool. Ear Hear., 3, 128-134 (1982)