Hearing Loss Questionnaire

~ For Children and Adults

Does my child have a hearing loss that needs to be evaluated by an audiologist?

If you observe any of the following behaviors or symptoms of hearing loss, you should consider having your child’s hearing evaluated by Dr. Brooke Casey:

  • Your child does not respond to sound consistently (i.e., does not startle to loud sounds, does not seem to notice other sounds around him/her)
  • Your child’s speech and language development is delayed
  • Your child’s speech is unclear and others cannot understand him/her
  • Your child does not follow directions
  • Your child does not respond to his/her name when called
  • Your child often says: "Huh?"
  • Volume is turned up on electronic equipment (TV, phones, etc.).

Do I have a hearing loss that needs to be evaluated by an audiologist?

If you answer yes to more than two of the following questions, you should have your hearing evaluated by Dr. Brooke Casey:

  • Do you have a problem hearing over the telephone or cell phone?
  • Do you hear better through one ear than the other when you are on the telephone?
  • Do you have trouble following the conversation in a small group setting, such as with two or more people talking at the same time?
  • Do others complain the TV volume is too loud?
  • Do you have to strain to understand conversation?
  • Do you have to ask people to repeat themselves?
  • Do you often feel you miss what others have said?
  • Do you have trouble hearing in a noisy background, such as restaurants, meetings, church, or sporting events?
  • Do you have dizziness, pain, or ringing in your ears?
  • Do many people seem to mumble (or not speak clearly)?
  • Do you misunderstand what others are saying and respond inappropriately?
  • Do you have trouble understanding the speech of women and children?
  • Do people get annoyed because you misunderstand what they say?

Reference: ASHA. (1997-2014). Self Test for Hearing Loss. Retrieved from http://www.asha.org/public/hearing/self-test-for-hearing-loss/