Form 2 Hearing Handicap Inventory (HHI)

Attachment 2
Hearing Handicap Inventory

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX

Name of test: Hearing Handicap Inventory
Estimated time burden: 3 minutes1
Materials:
Laptop
Monitor
Mouse
Description:
This set of questions allows the participant to self-report any difficulties with hearing or hearingrelated activities. Each participant will answer 12 questions.
Administration Instructions:
The following instructions are on the screen for the participant to read along with the examiner.
Say:
“The purpose of this questionnaire is to identify any problems your hearing may cause you.
Select ‘No’, ‘Sometimes’, or ‘Yes’ to answer each question. Do not skip a question if you
avoid a situation because of a hearing problem. If you currently use hearing aids, please
answer as if you were WITHOUT your hearing aids.”
“After you make your choice, the computer will automatically go on to the next question.
If you want to change your answer, select the GO BACK button to return to the question,
then choose a different answer.”
“Select the CONTINUE button when you are ready to begin.”
If a participant has difficulty using the mouse, he/she may point and the examiner may operate
the mouse. The examiner should say something like the following to the participant:
“You can point to your choice and then I will use the mouse to select it for you.”

HHIA-S E-1 Does a hearing problem cause you to feel embarrassed when meeting new people?
Yes Sometimes
No

Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD
20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address.

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX
HHIA-S E-2 Does a hearing problem cause you to feel frustrated when talking to members of
your family?
Yes Sometimes
No

HHIA-S S-3 Does a hearing problem cause you difficulty hearing/understanding co-workers,
clients, or customers?
Yes Sometimes
No

HHIA-S E-4 Do you feel handicapped by a hearing problem?
Yes

Sometimes

No

HHIA-S S-5 Does a hearing problem cause you difficulty when visiting friends, relatives, or
neighbors?
Yes Sometimes
No

HHIA-S S-6 Does a hearing problem cause you difficulty in the movies or theater?
Yes Sometimes
No

HHIA-S S-7 Does a hearing problem cause you to have arguments with family members?
Yes Sometimes
No

HHIA-S S-8 Does a hearing problem cause you difficulty when listening to TV or radio?
Yes Sometimes
No

HHIA-S E-9 Do you feel that any difficulty with your hearing limits or hampers your personal
or social life?
Yes Sometimes
No

HHIA-S S-10 Does a hearing problem cause you difficulty when in a restaurant with relatives or
friends?
Yes Sometimes
No

HHIE-S S-6

Does a hearing problem cause you to attend religious services less often than you
would like?
Yes Sometimes
No

HHIE-S S-3

Do you have difficulty hearing when someone speaks in a whisper?
Yes Sometimes
No