Answer the following questions, circling Y for yes and N for no.

Y         N          Do I have a problem hearing on the telephone?

Y         N          Do I have trouble hearing when there is noise in the background?

Y         N          Is it hard for me to follow a conversation when two or more people talk at once?

Y         N          Do I have to strain to understand a conversation?

Y         N          Do many people I talk to seem to mumble (or not speak clearly)?

Y         N          Do I misunderstand what others are saying and respond inappropriately?

Y         N          Do I often ask people to repeat themselves?

Y         N          Do I have trouble understanding the speech of women and children?

Y         N          Do people complain that I turn the TV volume up too high?

Y         N          Do I hear a ringing, roaring, or hissing sound a lot?

Y         N          Do some sounds seem too loud?

If you answer"Yes" to 3 or more of these questions, you may have significant hearing loss. Ask your primary care doctor whether you should see aspecialist.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

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