1. Do you find it difficult to follow a conversation in a noisy restaurant or crowded room?
2. Do you sometimes feel that people are mumbling or not speaking clearly?
3. Do you experience difficulty following dialog in the theater?
4. Do you sometimes find it difficult to understand a speaker at a public meeting or religious service
5. Do you find yourself asking people to speak up or repeat themselves?
6. Do you find men's voices easier to understand than women's?
7. Do you experience difficult understanding soft or whispered speech?
8. Do you have difficulty understanding speech on the telephone?
9. Does a hearing problem cause you to feel embarrassed when meeting new people?
10. Do you feel handicapped by a hearing problem?
11. Does a hearing problem cause you to visit friends, relatives, or neighbors less often than you would like?
12. Do you experience ringing or noises in your ears?
13. Do you hear better with one ear than the other?
14. Have you had any significant noise exposure during work, recreation, or military service?
15. Have any of your relatives (by birth) had any hearing loss?
How many times did you answer "Yes"?