1. I ________ feel discomfort or embarrassment when meeting new people because of my hearing

NeverSometimesOften

2. I _______ find that following conversations in a noisy environment, such as a busy restaurant, can be very difficult

NeverSometimesOften

3. I _______ have to ask people to repeat themselves, particularly when they are not directly facing me.

NeverSometimesOften

4. People _______ seem to mumble when they talk.

NeverSometimesOften

5. Others _______ comment that I have the radio or television turned up too loud for their liking

NeverSometimesOften

6. If I did not see the source of a sound, I _______ find it hard to know what direction it came from

NeverSometimesOften

7. Family members _______ comment that they think that I may have a hearing problem

NeverSometimesOften

8. Following conversations on the telephone is particularly difficult, particularly with children

NeverSometimesOften

9. I _______ mishear what people have said and respond inappropriately

NeverSometimesOften

10. I _______ experience a persistent or prolonged ‘ringing in my ears’ (known as tinnitus)

NeverSometimesOften

11. Do you agree with the following statement: “I used to be more active in group conversations.”

DisagreeNeither agree or disagreeAgree

Adding up your score

• Never/Disagree = 0
• Sometimes/ Neither agree or disagree = 1
• Often/Agree = 2

YOUR TOTAL -/22