Screening Form

Hearing Handicap Inventory For Adults — Screening


Please answer "yes". "no", or "sometimes" to each of the following items. Do not skip a question if you avoid a situation because of a hearing problem. if you wear a hearing aid, please answer the way you hear without the hearing aid
ITEM YES SOMETIMES NO
Does a hearing problem cause you to feel embarrassed when you meet new people?
Does a hearing problem cause you to feel frustrated when talking to members of your family?
Do you have difficulty hearing when someone speaks in a whisper?
Do you feel handicapped by a hearing problem?
Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?
Does a hearing problem cause you to attend religious services less often than you would like?
Does a hearing problem cause you to have arguments with family members?
Does a hearing problem cause you difficulty when listening to TV or radio?
Do you feel that any difficulty with your hearing limits or hampers your personal or social life?
Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?
Source: From Newman, C.W., Weinstein, B.E., Jacobson, G.P., & Hug, G.A. (1991). Test-retest reliability of the Hearing Handicap Inventory for Adults. Ear and Hearing, 12. 355-357.

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