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4C Hyperacusis Management Questionnaire (Parent)

Hyperacusis is intolerance of certain everyday sounds. The sounds maybe perceived as uncomfortably loud, painful, frightening or annoying.


For each question please select one number based on how you are feeling now.

1. How certain is your child that she/he is able to carry out their day-to-day activities (e.g., learning in the classroom, having a conversation with friends or family members, eating lunch in the school canteen, travelling in the car, personal hygiene and care etc.) despite the noises that they may be hearing?

Not certain at all
(My child would not be able to cope at all)

Very certain
(My child would have no problems managing the situation and is confident being in these situations)

2. How certain is your child that she/he is able to relax and settle down despite the noises that they may be hearing?

Not certain at all
(My child would not be able to cope at all)

Very certain
(My child would have no problems managing the situation and is confident being in these situations)

3. How certain is your child that she/he can enjoy their leisure time despite the noises that they may be hearing (leisure time is hobbies such as playing, swimming, music and dance classes, computer games, sports, riding a bike, reading, family trips out, socialising with friends, going to events or parties, shopping with friends, going to the cinema, etc.)?

Not certain at all
(My child would not be able to cope at all)

Very certain
(My child would have no problems managing the situation and is confident being in these situations)

4. How certain is your child that she/he can carry on with their day to day activities, relax, and enjoy life, without using any distraction or avoidance strategies to help them? (examples of distraction or avoidance strategies are: using background noise or making sounds themselves to cover up the sound they find upsetting, getting away from the sound, refusing to go to or be in certain places, making excuses not to go, covering ears, asking parent to hug them and shield them from the sound, use earphones, noise cancelling headphones or ear protection, telling people to stop the noise, etc.)

Not certain at all
(My child would not be able to cope at all)

Very certain
(My child would have no problems managing the situation and is confident being in these situations)

For Hearing Healthcare Professionals