Tinnitus and hyperacusis therapy specialist unit

Hyperacusis 1

In the following questionnaire, choose the answer which best applies to you:

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

Questionnaire	No	Yes, a little	Yes, quite a lot	Yes a lot
Do you ever use earplugs or earmuffs to reduce your noise perception? (Do not consider the use of hearing protection during abnormally high noise exposure situations)	0	1	2	3
Do you find it harder to ignore sounds around you in everyday situations?	0	1	2	3
Do you have trouble reading in a noisy or loud environment?	0	1	2	3
Do you have trouble concentrating in noisy surroundings?	0	1	2	3
Do you have difficulty listening to conservations in noisy places?	0	1	2	3
Has anyone you know ever told you that you tolerate noise or certain kinds of sound badly?	0	1	2	3
Are you particularly sensitive to or bothered by street noise?	0	1	2	3
Do you find the noise unpleasant in certain social situations? (e.g., Nightclubs, pubs or bars, concerts, firework displays, cocktail receptions)	0	1	2	3
When someone suggests doing something (going out, to the cinema, to a concert etc) do you immediately think about the noise you are going to have to put up with?	0	1	2	3
Do you ever turn down an initiation or not go out because of the noise you would have to face?	0	1	2	3
Do noises or particular sounds bother you more in a quiet place than in a slightly noisy room?	0	1	2	3
Do stress and tiredness reduce your ability to concentrate in noise?	0	1	2	3
Are you less able to concentrate in noise towards the end of the day?	0	1	2	3
Do noise and certain sounds cause you stress and irritation?	0	1	2	3