Online Hearing Test & Evaluation

Print this page, fill it out, and bring it to your audiologist!

Hearing Loss Questionnaire

Name ________________________________________

Of all our senses, hearing is one of the easiest to take for granted. Early recognition improves your chances for assisting the problem. (How we hear)

First and foremost, do any of these apply to you?

1. Do you hear sounds but have trouble understanding the words?
2. Do high-pitched sounds such as women's or children's voices, telephone dial tones "fade" or "disappear"?
3. Is it difficult to hear or understand others in public places such as restaurants, theaters, stores, at your house of worship, or any place where the background noise level is increased?
4. Does it seem to you that people mumble more than they used to?
5. Do you often need to ask others to repeat themselves?
6. Do people ask you to turn down the volume of the TV or radio?
7. Do you strain to listen?

If you answered "yes" to any of these questions, your hearing may be impaired.

There are two types of hearing loss: conductive and sensorineural.

A sensorineural loss is the result of damage to the nerve fibers in the inner ear. It is commonly caused by the natural aging process, but can also be caused by noise exposure, strong medications, diabetes, stroke, and other circulatory diseases. Hearing aids are usually the best solution to a sensorineural hearing loss.

A conductive hearing loss can be caused by an obstruction or infection in the ear canal. Other causes may include a perforation or scarring of the eardrum or middle ear, and Eustachian tube dysfunction. Otosclerosis, fixation of the middle ear bones, is another potential cause of conductive hearing loss. Most conductive hearing loss can be helped with medical treatment.

Remember, have your hearing checked annually by a certified clinical audiologist. Most insurance companies cover the hearing exam.