| Do you avoid crowded places because of difficulty hearing conversations? |
Yes |
No |
| Do you have ringing or other noises in your ears? |
Yes |
No |
| Do you have difficulty understanding women or young children? |
Yes |
No |
| Have others told you that you don’t seem to hear? |
Yes |
No |
| Do others complain that you watch TV with the volume too high? |
Yes |
No |
| Do you frequently have to ask others to repeat themselves? |
Yes |
No |
| In everyday conversations, does it seem like people are mumbling? |
Yes |
No |
| Do you have trouble knowing where sound comes from? |
Yes |
No |
