SSQ-12

Our hearing assessment are very comprehensive to look at your ability to hear: different sounds, discriminate speech and how well you hear in noise, looking how well your middle ear is working.

Testing Your Hearing

The following questions inquire about aspects of your ability and experience hearing and listening in different situations.

We expect that all the questions are relevant to your everyday experience, but if a question describes a situation that does not apply to you, please select 10 from the available options.

SSQ-12

First Name

Last Name

Today’s date

Please check one of these options:

I have no hearing aid/s

I use one hearing aid (left ear)

I use one hearing aid (right ear)

I use two hearing aids (both ears)

If you have been using hearing aid/s, for how long?

Left ear

Years

months

or weeks

Right ear

Years

months

or weeks

1. You are talking with one other person and there is a TV on in the same room. Without turning the TV down, can you follow what the person you’re talking to says?

0 – Not at all

10 – Perfectly

2. You are listening to someone talking to you, while at the same time trying to follow the news on TV. Can you follow what both people are saying?

0 – Not at all

10 – Perfectly

3. You are in conversation with one person in a room where there are many other people talking. Can you follow what the person you are talking to is saying?

0 – Not at all

10 – Perfectly

4. You are in a group of about five people in a busy restaurant. You can see everyone else in the group. Can you follow the conversation?

0 – Not at all

10 – Perfectly

5. You are with a group and the conversation switches from one person to another. Can you easily follow the conversation without missing the start of what each new speaker is saying?

0 – Not at all

10 – Perfectly

6. You are outside. A dog barks loudly. Can you tell immediately where it is, without having to look?

0 – Not at all

10 – Perfectly

7. Can you tell how far away a bus or a truck is, from the sound?

0 – Not at all

10 – Perfectly

8. Can you tell from the sound whether a bus or truck is coming towards you or going away?

0 – Not at all

10 – Perfectly

9. When you hear more than one sound at a time, do you have the impression that it seems like a single jumbled sound?

0 – Jumbled

10 – Not jumbled

10. When you listen to music, can you make out which instruments are playing?

0 – Not at all

10 – Perfectly

11. Do everyday sounds that you can hear easily seem clear to you (not blurred)?

0 – Not at all

10 – Perfectly

12. Do you have to concentrate very much when listening to someone or something?

0 – Concentrate hard

10 – No need to concentrate

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