II. Criteria: Questions
- Embarrassed when meeting new people due to Hearing problem
 - Frustrated when speaking to family due to Hearing problem
 - Difficulty Hearing whispered voice
 - Feel impaired by Hearing problem
 - Hearing interferes with visiting with family and friends
 - Attends religious services less often due to Hearing problems
 - Hearing problem result in arguments with family
 - Hearing problem interferes with listening to television and radio
 - Hearing problem interferes with social life
 - Hearing problem interferes with communication in a restaurant
 
III. Protocol
- Rate each question with either a Yes, Sometimes or No
 - Scoring: Total the score for each of the 10 questions
- Yes: 4 points
 - Sometimes: 2 points
 - No: 0 points