5 Minute Hearing Test

Do you wonder whether or not you have hearing loss?

This is a quick screening tool that can be completed prior to a full hearing evaluation by an Audiologist. It does not in any way replace the need for a full and complete audiology evaluation by an Audiologist.

Please complete and submit your responses to the clinic prior to your appointment.

Personal Information

* Your Name:

* Email:

Your Telephone Number:

Please mark the column which best describes the frequency with which you experience each situation or feeling listed below;

1. I have a problem hearing while on the telephone.

2. I have trouble following the conversation when two or more people are talking at the same time.

3. I have trouble understanding speech on TV.

4. I have to strain to understand conversations.

5. I worry about missing a telephone ring or doorbell.

6. I have trouble hearing conversations in a noisy background such as a crowded room or restaurant.

7. I get confused about where sounds come from.

8. I misunderstand some words in a sentence and need to ask people to repeat themselves.

9. I especially have trouble understanding the speech of women and children.

10. I have trouble understanding the speaker in a large room such as a meeting or a church.

11. Many people I talk to seem to mumble to don't speak clearly.

12. People get annoyed because I misunderstand what they say.

13. I misunderstand what others are saying and make inappropriate responses.

14. i avoid social activities because I cannot hear well and fear I will reply improperly.

15. Family members and friends have told me they think I may have a hearing loss.

Score

To calculate your score, give yourself 3 points for each time you checked 'Almost Always', 2 points for each 'half the time', 1 point for each 'Occasionally', and 0 points for 'Never'. Add 3 points if you have a blood relative with hearing loss. Total your score.

Results: If you scored 0 - 5 your hearing is likely fine, if you scored 6 - 9 it is sugested that you see an Audiologist and if you scored 10 + it is strongly recommended that you consult an Audiologist.

Koike, K.J., Hurst, M.J., & Wetmore, S.J. (1994). Correlations between the American Academy of Otolaryngology-Head and Neck Surgery five minute hearing test and standard audiologic data. Otolaryngology-Head Neck Surgery, 111. 5. Novermber, 1994 This test is published as a public service. It may be freely used as long as attribution is given to the American Academy of Otolaryngology-Head and Neck Surgery, Inc, 1101 Vermont Ave., NW, Suite 302, Washington, DC 20005.