Do you think this individual has a hearing loss?

I avoid social activities because I cannot hear well and fear that I'll reply improperly

4 - 5

I have trouble following a conversation when two or more people are

speaking at the same time


People get annoyed because I misunderstand what they have said

I misunderstand some words in a sentence and need to ask

people to repeat themselves

Yes               No

By answering "Almost always" or "Often" to six or more questions, we strongly recommend that you call our office to have your hearing evaluated.

Five-minute Hearing Test

Concerned about your hearing?

One out of every 10 Americans, or 28 million people, have some degree of hearing loss that can affect their work, their relationships, or be a barrier to enjoying social occasions.

You can determine whether you need a more comprehensive hearing evaluation by

completing our simple five-minute hearing test.

The following quiz was developed by the American Academy of
Otolaryngology-Head and Neck Surgery.

Almost always     Often     Sometimes     Never

I have trouble hearing conversations in noisy backgrounds, such

as at a party or restaurant


Total Score: ______________

6 +

0 - 3

I have worked in noisy environments, such as assembly lines, with jackhammers or jet engines

I have difficulty hearing over the telephone

I hear fine---if people would just stop mumbling

I miss hearing certain common sounds, like the phone or doorbell

People complain that I turn the television volume up too loud

I misunderstand what others are saying and make inappropriate responses

If you answer "Almost always" or "Often" to four or five questions, we suggest that you have your hearing tested so you will have a baseline understanding of your current condition, and for future reference.

Phone: 949.675.3833

If you answer "Almost always" or "Often" to three or fewer questions, your hearing is basically fine and no real action is required.

​​In the Pursuit of Excellence in Hearing Health Care

To be answered by a family member or friend

Have their listening and communication skills become less effective?

I have to strain to understand conversations

I get confused as to where sounds are coming from

I especially have trouble understanding the speech of women and children