Questionnaire for the screening of listening and hearing problems
 

Can You hear well?

Questionnaire for the screening of listening and hearing problems.

How to answer the test

Some people don't know they have a hearing problem. With this test, we invite you to find out if you are part of this category. On the other hand, it is important that significant people in your environment pay attention to signs that may reveal you could have hearing problems.

Signs of hearing loss

  • The person will ask you to repeat yourself when you address him/her (especially if he/she cannot see your facial expression).
  • The person does not answer or answers incorrectly or inapropriately when you ask a question.
  • The person will often appear to be absend-minded during group activities.
  • The person will tend to avoid group activities.
  • The person will stare at you when you address him/her.
  • The person does not answer when you address him/her unless he/she is facing you.
  • The person's families and friends will comment on the hearing problem: i.e. television is too loud, telephone conversations are difficult.

For each of the following questions, tick off :

  1. When you speak to one person, do you ask him to repeat?
    yes
    sometimes
    no

  2. Do you have any problems understanding when many people speak together?
    yes
    sometimes
    no

  3. Do you have any problems understanding when you don't see the face of the person who is speaking?
    yes
    sometimes
    no

  4. Do you have any problems understanding when there is noise around you?
    yes
    sometimes
    no

  5. Do you find that people mumble or do not speak loud enough (on T.V., friends, doctors)?
    yes
    sometimes
    no
  6. Do you find that people speak too fast (on T.V., friends, doctors)?
    yes
    sometimes
    no

  7. Do you have difficulty understanding on the phone?
    yes
    sometimes
    no

  8. Do you have any problems hearing the water running in the sink or bathtub when you are in another room?
    yes
    sometimes
    no

  9. Do you have any problems hearing the phone ringing when you are in another room or in the bathroom (at home or at other people's houses)?
    yes
    sometimes
    no

  10. Do you have any problems hearing the doorbell at home or at other people's houses?
    yes
    sometimes
    no

  11. Do you have difficulty hearing when someone knocks on the door?
    yes
    sometimes
    no

  12. Have your family, friends, or neighbours made any comments about the volume of your radio or television being too loud?
    yes
    sometimes
    no

  13. Do you have a tendency to avoid other people because you are afraid of not understanding them?
    yes
    sometimes
    no

  14. Do you prefer to avoid activities because of the noise around you (i.e., dining room, restaurant, family gathering, bingo)?
    yes
    sometimes
    no

  15. How do you consider your hearing?
    good
    slight hearing problem (occasional hearing problem)
    moderate hearing problem (frequent hearing problems)
    serious hearing problem (important hearing problems, nearly always)

Calculations of the questionnaire results

For questions 1 to 14 inclusively:
Every « yes » is worth 4 points,
each « sometimes » is worth 2 points and
each « no » is worth 0 point.

For question 15 :
Each « a » is worth 0 point,
« b » 2 points,
« c » 3 points and
« d » 4 points.

Your total :
If you total is greater than 14, please come an see us for a free screening hearing test.