First, print off this page.
Then, to enter your score, choose the number next to the words that best answer the question for you.
1. Think about how much you used your present hearing aids in the past two weeks. On an average day how many hours did you use the hearing aids?
Score
(1) None
(2) Less than 1 hour/day
(3) 1-4 hours/day
(4) 4-8 hours/day
(5) Over 8 hours/day
( ) My score
2. Think about the situation where you most wanted to hear better, before you got your present hearing aids. Over the past two weeks, how much has the hearing aid helped in that situation?
Score
(1) Helped not at all
(2) Helped slightly
(3) Helped moderately
(4) Helped quite a lot
(5) Helped very much
( ) My score
3. Think again about the situation where you most wanted to hear better. When you use your present hearing aids how much difficulty do you still have in that situation?
Score
(1) Very much difficulty
(2) Quite a lot of difficulty
(3) Moderate difficulty
(4) Slight difficulty
(5) No difficulty
( ) My score
4. Considering everything, do you think your present hearing aid(s) are worth the trouble?
Score
(1) Not at all worth it
(2) Slightly worth it
(3) Moderately worth it
(4) Quite a lot worth it
(5) Very much worth it
( ) My score
5. Over the past two weeks, with your present hearing aids, how much have your hearing difficulties affected the things you do?
Score
(1) Affected very much
(2) Affected quite a lot
(3) Affected moderately
(4) Affected slightly
(5) Affected not at all
( ) My score
6. Over the past two weeks, with your present aids, how much do you think other people were bothered by your hearing difficulties?
Score
(1) Bothered very much
(2) Bothered quite a lot
(3) Bothered moderately
(4) Bothered slightly
(5) Bothered not at all
( ) My score
7. Considering everything, how much has your hearing aid(s) changed your enjoyment of life?
Score
(1) Worse
(2) No change
(3) Slightly better
(4) Quite a lot better
(5) Very much better
( ) My score
Add up your scores and insert the total in My total score.
( ) My total schore
The maximum score is 35.
If your total score is less than 21, this indicates that use of your present hearing aids is less than satisfactory. It is suggested you refer to your audiologist.
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