805 N. Bethleham Pike  -  Spring House,  PA  19477

 

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10 Myths &
10 Facts
Personal Reactions to Hearing Loss
Hearing Evaluation for Adults
Hearing Evaluation for Seniors
Hearing Aid Types
Hearing Aid Care
Hearing Aid Repair
Ask Alicia

Two Ears are Better than One
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Starkey Labs

Hearing Handicap Inventory
for Adult
Screening I1HHIA-S]

INSTRUCTIONS: The purpose of this questionnaire is to identify the problems your hearing loss may be causing you. Answer YES, SOMETIMES, or NO for each question. To obtain a total score, add up the "yes" (4 points), "sometimes" (2 points), and "no" (0 points) responses. If your score is greater than 10, a hearing test is recommended.

Yes

Sometimes

No

4

2

0

  • El - Does a hearing problem cause you to feel embarrassed when you meet new people?

  • E2 - Does a hearing problem cause you to feel frustrated when talking to members of your family?

  • S1 - Do you have difficulty hearing/understanding co-workers, clients, or customers?

  • E3 - Do you feel handicapped by a hearing problem?

  • S2 - Does a hearing problem cause you difficulty when visiting friends, relatives or neighbors?

  • S3 - Does a hearing problem cause you difficulty in the movies or in the theater?

  • E4 - Does a hearing problem cause you to have arguments with family members?

  • S4 - Does a hearing problem cause you difficulty when listening to TV or radio?

  • E5 - Do you feel that any difficulty with your hearing limits or hampers your personal or social life?

  • S5 - Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

Blue Bell Hearing Aid Center, Inc.

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805 N. Bethleham Pike   Spring House, PA  19477   (215) 641-1317
alicia@heargal.com