Version June 2024
| Item | Yes (4 pts) | Sometimes (2 pts) | No (0 pts) |
| Does a hearing problem cause you to feel embarrassed when you meet new people? | |||
| Does a hearing problem cause you to feel frustrated when talking to members of your family? | |||
| Do you have difficulty hearing when someone speaks in a whisper? | |||
| Do you feel handicapped by a hearing problem? | |||
| Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors? | |||
| Does a hearing problem cause you to attend religious services less often than you would like? | |||
| Does a hearing problem cause you to have arguments with family members? | |||
| Does a hearing problem cause you difficulty when listening to TV or radio? | |||
| Do you feel that any difficulty with your hearing limits or hampers your personal or social life? | |||
| Does a hearing problem cause you difficulty when in a restaurant with relatives or friends? | |||
RAW SCORE (sum of the points assigned each of the items): ____________ | |||
| Interpreting the raw score | |||
| 0 to 8 = 13 percent probability of hearing impairment (no handicap/no referral) | |||
| 10 to 24 = 50 percent probability of hearing impairment (mild-moderate handicap/refer) | |||
| 26 to 40 = 84 percent probability of hearing impairment (severe handicap/refer) | |||
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
