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Abbreviated Profile of Hearing Aid Benefit

Please indicate the answers that come closest to your everyday experience. Notice that each choice includes a percentage. You can use this to help you decide on your answer. If you have not experienced the situation we describe, try to think of a similar situation that you have been in and respond for that situation. If you have no idea, leave that item blank.

* Mandatory fields

* First name:

* Last name:

* Gender: Female
Male

* Email:

* Hearing aid experience:

* Daily hearing aid use:

* Degree of hearing difficulty without hearing aid:

1. When I am in a crowded grocery store, talking with the cashier, I can follow the conversation.

Without a hearing aid:

With a hearing aid:

2. I miss a lot of information when I'm listening to a lecture.

Without a hearing aid:

With a hearing aid:

3. Unexpected sounds, like a smoke detector or alarm bell are uncomfortable.

Without a hearing aid:

With a hearing aid:

4. I have difficulty hearing a conversation when I'm with one of my family at home.

Without a hearing aid:

With a hearing aid:

5. I have trouble understanding the dialogue in a movie or the theatre.

Without a hearing aid:

With a hearing aid:

6. When I am listening to the news on the car radio, and family members are talking, I have trouble hearing the news.

Without a hearing aid:

With a hearing aid:

7. When I'm at the dinner table with several people and am trying to have a conversation with one person, understanding speech is difficult.

Without a hearing aid:

With a hearing aid:

8. Traffic noises are too loud.

Without a hearing aid:

With a hearing aid:

9. When I am talking with someone across a large empty room, I understand the words.

Without a hearing aid:

With a hearing aid:

10. When I am in a small office interviewing or answering questions, I have difficulty following the conversation.

Without a hearing aid:

With a hearing aid:

11. When I am in a theatre watching a movie or play and the people around me are whispering and rustling paper wrappers, I can still make out the dialogue.

Without a hearing aid:

With a hearing aid:

12. When I am having a quiet conversation with a friend, I have a difficulty understanding.

Without a hearing aid:

With a hearing aid:

13. The sounds of running water, such as a toilet or shower, are uncomfortably loud.

Without a hearing aid:

With a hearing aid:

14. When a speaker is addressing a small group and everyone is listening quietly, I have to strain to understand.

Without a hearing aid:

With a hearing aid:

15. When I'm in a quiet conversation with my doctor in an examination room, it is hard to follow the conversation.

Without a hearing aid:

With a hearing aid:

16. I can understand conversations even when several people are talking.

Without a hearing aid:

With a hearing aid:

17. The sounds of construction work are uncomfortably loud.

Without a hearing aid:

With a hearing aid:

18. It's hard for me to understand what is being said at lectures or church services.

Without a hearing aid:

With a hearing aid:

19. I can communicate with others when we are in a crowd.

Without a hearing aid:

With a hearing aid:

20. The sound of a fire engine siren close by is so loud that I need to cover my ears.

Without a hearing aid:

With a hearing aid:

21. I can follow the words of a sermon when listening to a religious service.

Without a hearing aid:

With a hearing aid:

22. The sound screeching tires is an uncomfortable sound.

Without a hearing aid:

With a hearing aid:

23. I have to ask people to repeat themselves in one-on-one conversation in a quiet room.

Without a hearing aid:

With a hearing aid:

24. I have trouble understanding others when an air conditioner or fan is on.

Without a hearing aid:

With a hearing aid: