NATIONAL CENTER Series 2

For HEALTH STATISTICS Number 12

VITAL and HEALTH STATISTICS

DATA EVALUATION AND METHODS RESEARCH

Methodological Aspects

of a Hearing Ability

Interview Survey

Development and use of a set of scale questions to measure

functional hearing ability in an interview survey.

DHEW Publication No. (HRA) 74-1272

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Health Resources Administration

National Center for Health Statistics

Rockville, Maryland
____ —-._—— ——— —

Vital and Health Statistics-Series 2, No. 12

Reprinted as DHEW Publication No. (HM) 74-1272

August 1973

First issued in the Public Health Service Publication Series No. 1000, October 1965

1

For sale by the Superintendent of Documents, U.S. Government Printing Office,

Washington, D. C., 20402-Price 25 cents i
Lihrary o/ Congress Catalog Card Number 65-62271
PREFACE

The Health Interview Survey, National Center for Health Statistics, collects information

by means of household interviews on illness, accidental injuries, hospitalization experience and

various measures of disability, and on social

and economic impact due to episodes of morbidity.

If viewed from the standpoint of clinicians

or epidemiologists, the precision of diagnostic

information that can be obtained from lay household respondents may leave much to be desired.

However, these same respondents are the best

source of information, at the present time, on

the amount of disability and other forms of impact due to illness and injury. Information on

the degree of severity of certain physical impairments (e.g., visual and hearing loss) present

in the population are of extreme importance to

persons engaged in rehabilitation and other programs of assistance to the physically handicapped.

If Iay respondents can describe the severity of

these impairments in meaningful, functional terms

and, particularly, if these functional terms can be

correlated to standard clinical measures or tests,

data from interview surveys can be of great value

in describing the extent of the problems of the population of the United States with impaired hearing

or vision.

This report

Health Interview

describes the experience of the

Survey in the development and

use of a series of items designed to serve as a

functional scale of hearing loss. Gallaudet

College, a federally sponsored institution and the

only institution in the world that provides higher

education exclusively for persons with severely

impaired hearing, was asked by the Division of

Health Interview Statistics of the National Center

for Health Statistics to participate in this project.

Under a contract with the division of Health

Interview Statistics, Mr. Stanley K. Bigman, who

was at tha~ time Director of the Office of Sociological Research at Gallaudet College, developed

a set of items to be used as a hearing ability

scale and conducted some pretests of the scale.

Dr. Jerome D. Schein succeeded Mr. Bigman at

Gallaudet and conducted additional methodological

studies of the scale items. Dr. Schein also provided technical assistance during all phases of

the nationwide hearing ability survey in which the

scale items were used, and he is a coauthor of

this report. Mr. Kenneth Haase, Statistician,

Survey Methods Branch, and Mr. Augustine

Gentile, Chief, Survey Methods Branch, represented the Division of Health Interview Statistics and collaborated in the analysis and

preparation of this report.
CONTENTS

Page

Preface ------------------------------------------------------------- -

htrduction --------------------------------------------------------- -

The Hearing Scale ----------------- ------- ------- ---------- --------- ---

Description of the HearingScale --------------------------------------

Evaluation oftheScale -----------------------------------------------

Evidence ofUnidimensionality ----------------------------------------

Factors Affecting Scalkg --------------------------------------------

Scale Responses and Other Measures of HearingAbility -----------------

Classificationof Hearing Scale Scores -----------------------------------

Conclusions -----------------------------------------------------------

Appendix I. Procedures Used in This Survey and Level and Qualityof

Response ------------------------------------------------------------

Methods Usedto Obtain Respondents ----------------------------------

The Hearing Ability Questionnaire ------------------------------------

Utilization of the Basic Health Interview Questionnaire as a

Screening Rvice -------------------------------------------------

Level of Response --------------------------------------------------

Quality of Response ------------------------------------------------

Appendix II. Hearing Ability Survey Questiomaire -------------------------

i

1

2

2

3

3

4

7

10

10

11

11

11

11

12

13

16
THIS ISA REPORT on the development and use of a sem”es of items

designed to serve as a scale to measuve the degree of hearitg loss, in

functional terms, in an interview suvvey of the geneyal population.

Results of the use of the scale in several samples of persons are given.

Evidence of the logic of the scale, factors affectiwg an individual’s ability

to respond to the scale logz”cally, and the relationship of responses to

the scale to other measures of hearing loss, includi~ audiometric examinations, are discussed.

Methods used in the survey and factors affecti~ the general levels and

quality of responses obtained in the Sumey are. discussed in Appendix I.

It is concluded that for general statistical puvposes the hearing scale is

a satisfactory instrument for measuving the degree of heaving loss of

the #o@dation by means of an interview survey. Recommendations for

improvements to the scale and for obtaini~ a higher level and better

quality of vesponse fov jivtwe studies are also @“venin the report.

SYMBOLS

Data not available ------------------------ ---

Category not applicable ------------------ . . .

Quantity zero ---------------------------- -

Quantity more than O but less than 0.05----- 0.0

Figure does not meet standards of

reliability or precision-- ----------------

*
METHODOLOGICAL ASPECTS OF A HEARING

ABILITY INTERVIEW SURVEY

IX. Jerome D. Schein, Directov, Office of Psychological Resea~ch, Gallaudet College

Augustine Gentile, Chief, and Kenneth Haase, Statistician, Smwey Methods BYanch,

Division of Health Interview Statistics

INTRODUCTION

Although a sizable proportion of the population suffers impairment of hearing, there has

been little current, descriptive data avaiIable

about this health problem. The National Center

for Health Statistics has responded to requests

for more information about this problem by conducting a special hearing ability survey. This

report describes some of the methodological

aspects of this speciaI nationwide survey which

took place July 1962-June 1963, and it serves as

a background to the substantive results of the

study.

National estimates of hearing loss for earlier

years have been obtained from three principal

sources. From 1830 to 1930 the U.S. Bureau of

the Census enumerated the number of persons

with severe hearing losses of early onset (referred

to as “deaf mutes’’ l). At the conclusion of the 1930

census, the Bureau announced that it would

no longer attempt to collect data on persons with

hearing impairments. As shown by the following

quotation, this decision reflected discontent with

lAlthough the Bureau used the term “deaf mutes, ” it is

likely thatmany of these people did have usable speech since

in some years the Bureau used the term to describe persons

for whomthe age of onsetof deafness was as late as 16 years.

Persons who lose their hearing after speech has been developed can retain their ability to speak and usually do, and even

those who are not able to hear at birth can usually develop

some speech when properly taught.

the results of the 11 enumerations already done.

“No high degree of accuracy is to be expected

in a census of the blind and of deaf-mutes

carried out by the methods which it has been

necessary to use thus far in the United States.

The reasons for this are that even with careful definitions of the groups to be included

a large element of personal judgment enters

into the decision of an enumerator as to

whether a given individual should be reported as blind or as a deaf-mute; and inconsistencies follow from the varying degrees

of intelligence and persistence of enumerators. Added to this, there is a tendency on

the part of relatives to conceal the presence

of blind persons or deaf-mutes in their

families, especially in the case of children.

Because of these conditions, and of changes

made from time to time in definitions, as

well as in the administrative methods used

in taking the census, the enumeration of the

blind and of deaf-mutes has doubtless always

been mzore or less inaccurate and incomrdete.”

The next attempt to collect national data on

hearing impairments was made by the National

Institute of Health in the National Health Survey

2U.S. Bureau of the Census: The Blind and Deaf-Mutee in

the United States, 1930. Washington. lJ. S. Government Printing Office, 1931. p. 2.

1
of 1935-1936. ‘This Survey avoided the narrow

confines of definition used by the Bureau of the

Census in the earlier decennial enumerations;

and instead of concentrating exclusively on deafness of early onset, it concerned itself with

the full range of hearing impairment. In addition

to broadening the scope of its investigation, the

Survey combined the sample survey with a clinical

investigation. Samples of persons with and without hearing impairment were given audiometric

tests, the results of which were compared with the

survey findings. This ad hoc effort provided the

only nationwide data on hearing impairment until

the current National Health Survey was established

in 1956.

In 1959 the Health Interview Survey issued a

publication containing estjmates for the N:tion on

various types of physical impairments; these

estimates were based on data collected in household interviews during the period July 1957-June

1958. Included in this publication were estimates

that there were in the United States 109,000

totally deaf persons and 5.7 million persons with

lesser degrees of hearing loss. Similar estimates

of the prevalence of hearing loss have been made

for succeeding years. These estimates were based

on affirmative responses to the question, “Does

anyone in the family have deafness or serious

trouble with hearing?” No effort was made to assess the degree of hearing impairment. However,

when a respondent volunteered information about

the degree of hearing loss, the information was

recorded and taken into consideration during the

coding process. This dependence upon volunteered

information to describe the hearing ability of these

persons probably resulted in an underestimate of

the totally deaf and provided very little information

about the degree of loss for other hearing impaired persons. The principal objective of this

Survey therefore was to develop a method of

3National Institute of Health: Signi~icance, Scope and

Method of a Clinical Investigation of Hearing in the General

Population. The National Health Survey, 1935 -1936, prelimin ary report. Hearing Study Series Bulletin No. 1. Public

Health Service. Washington, D. C., 1938.

4u.s. National Health Survey: Impairments by tYPe> ‘ex,

and age. Health Statistics. PHS Pub. No. 584-B9. Public

Health Service. Washington, D. C., April 1959.

classifying persons with hearing problems

according to the extent of hearing loss in terms

that would serve a useful purpose.

Because members of the Health Interview

Survey staff had a limited knowledge of ‘thesubject

matter in this field, Gallaudet College 5was asked

to develop a plan for conducting a survey of persons with impaired hearing. After consultation

with Gallaudet and several other interested groups

and after consideration of various alternatives, it

was determined that the only practical method of

measuring hearing loss in an interview survey was

to devise a series of items that would serve as a

scale and make it possible to describe the amount

of hearing loss in functional terms. Such a scale

was developed and compared with audiometric

examinations in three test groups. The results of

these tests of the hearing ability scale and the efficacy of the scale as determined by the Hearing

Ability Survey are presented in this report. A

description of the methods and procedures used

in the Survey and information about the quality and

level of response obtained are given in Appendix I.

THE HEARING SCALE

Description of the Hearing Scale

It has been indicated that previous estimates

published by the Health Interview Survey of the

number of persons with impaired hearing assigned

such persons to one of two categories —deaf or

lesser degree of impairment. It was recognized

that Imth the means of assessing hearing loss and

the two-category limit on the degree of impairment

were inadequate. To determine the degree of

hearing impariment in better-defined, functional

terms, the items in figure 1 were developed for

this survey.

Preliminary research indicated that statements a, b, c, e, and g approximate a unidimensional scale; i.e., once a person responds

negatively to any one of these items his response to succeeding items will also be negative.

5Gallaudet College, located in Washington, D. C., is a federally sponsored institution

worId dedicated exclusively

severely impaired hearing.

and is the &dy” colle”ge in the

to tbe education of persons with

2
SECTION A

Yes No

. WITHOUT using o heoring aid, whet can you

hear?

(P2ease check the “Yes” or “No” box after

each statement.)

a. I can hear loud noises.

b. Most of the time I can tell one kind of

noise from another.

c. If I hear a sound, most of the time I can

tell if it is a person’s voice or not.

d. I can hear and understand a few words a

person says if I can see his face and lips.

e. I can hear and understand a few words a

person says without seeing his face and

lips.

f. I can hear and understand most of the

things aperson says if I can see his face

and lips.

g. I can hear and understand most of the

things a person says without seeing his

face and lips.

h. Mostof the time I can hear and understand

a discussion between several people without seeing their faces and lips.

i. I can hear and understand a telephone conversation on an ordinary telephone (that

is a telephone without an amplifier).

Figure 1, The hearing scale as it appeared in the

Hearing Ability Survey Questionnaire.

In other words, the items are in order by

anticipated difficulty in hearing—ranging ”from

merely hearing loud noises to hearing andunderstanding most speech.

Evaluation of the Scale

Several things have tobeconsidered inevaluating the merits of thehearingscale. First, do the

items represent a unidimensional hierarchy of

hearing ability? Second, what factors other than

the degree of hearing loss have aneffectonresponses to the scale statements; and, finally,

what is the relationship between positions on the

scaIe and other measures of hearing ability?

Evidence of Unidimensionality

With regard to the first question, a series

of studies was conducted to determine whether the

hearing scale (fig. 1) had the properties associated

with a psychological scale. Logically, the ordering of the statements makes good sense (face

validity) in that a person who answered “No”

to statement a—” I can hear loud noises’’—would

be expected to answer “No” to all other statements

about his hearing. Similarly, a ‘No” response to

any of the statements b, c, e, or g would be

expected to preclude a ~sitive answer to the statements following it.

In the paragraphs that follow, respondents or

questionnaires providing answers to the scale

items which followed this logicaI pattern are referred to as “persons who scaled” and “scaled

responses, ” respectively. Conversely, the terms

“persons who failed to scale” or “nonscaled responses” are used to describe persons or questionnaires that did not follow this logical pattern.

Empirical tests confirm the logic of the scale.

Table A summarizes the results of the use of the

scale in five samples of persons with impaired

hearing. Sample I consists of 214 Gallaudet

College students to whom the scale question was

mailed; sample II consists of 171 Gallaudet

College students who were given the scale question

in a group session; sample HI consists of 534

Gallaudet College students who were asked the

scale question in individual interviews; sample IV

consists of 1,132 deaf adults from the Metropolitan

Washington, D.C., area who were administered the

scale question in individual interviews; and sample

V consists of 4,431 persons who were given the

scale question as part of the questionnaire used

in the Health Interview Hearing Ability Survey.

Respondents in sample V who did not complete

statements a, b, c, e, and g of the scale are not

included in this analysis because their responses

could not contribute pertinent data on scalability.

3
Table A. Results of the use of the hearing scale in five samples of persons with impaired hearing

Percent of

Number of persons

Type of administration persons in giving

sample scaled

responses

Sample I, Gallaudet students, mail interview-------------- 214 91,6

Sample 11, Gallaudet students, group interview------------- 171 91,8

Sample III, Gallaudet students, individual interview--------

Sample IV,

534 90,3

Deaf adults from D.C. area, individual

interview-------------------------------------- 1,132 92.6

Sample V, Health Interview Hearing Ability Survey

respondents----.----------.-------------------- 14,431 88.9 .

!tncludesonly respondents who completed statements a, b, c, e, and g of the scale.

The measure of scalinggivenin tableAis

thepercentscaled;i.e.,thenumber ofpersons

who gave scaledresponsesdividedby thetotal

number of persons who completed the scale.

Regardlessof the mode of administrationand

sample characteristics, thepercentageof persons givingscaledresponses(about90 percent)

is essentiallythe same for the fivegroups,

ranging from 88.9 percent to 92.6 percent.

An inspectionof the 10 percentof nonscaledresponses showed no consistentpattern

which would suggestthatthesepersonsmight

have some specialtype of hearingproblem.

Considerationwas then given to otherfactors

thatmight affectthe person’sabilitytoanswer

thescaleitemsintheexpectedpatterns.

Factors Affecting Scaling

Use ofheaving aid.-Three ofthefivesamples

ofpersonsmentionedalmve-samples 111,IV,and

V—were usedtoobtaininformationonthe”useof

hearingaids.Responseswere obtainedfromeach

individualin the samples,and theproportionof

scaledresponsesby use ofhearingaiclisshown

in tableB. Those personswho were atthetime

of the ,Surveyusers of hearingaidstendedto

givescaledresponseslessfrequentlythanthose

who hadnever usedahearingaidand,generally,

lessfrequentlythanthosewho had usedahearing

aid butwho were notusingone atthetimeofthe

survey.Thisfindingwouldsuggestthateither(a)

usersofhearingaidswere lessabletodetermine

Table B. Percent of respondents giving scaled responses to the hearing scale, by use

of hearing aid

Respondents

Gallaudet College students

(Sample III)-----------------------

Deaf adults in D.C. area

(Sample IV)------------------------

Health Interview Survey respondents

(SampleV)-------------------------

Number

of

persons

in

sample

534

1,132

14,045

Use of hearing aid

All

persons

in Uses Used

sample Never

now p::t used

90,3 87.0 87.3 95.5

92,6 85,1 93.6 94.6

88.8 I 80.6 I 85.3 / 90.7

lExcludes 386 persons for whom information about use of hearing aids is ‘nkn’o~-
Table C. Number and percent distribution of persons with impaired hearing in Sample V

who scaled and who failed to scale, according to age

Age

Failed Failed

Total Scaled to Total Scaled to

scale scale

Under

17-24

25-34

35-44

45-54

55-64

65-74

Number of personsl

All ages ---------------------

l===

4,431

17 years --------------------- 317

years ------------------------ 128

years ------------------------ 293

years ------------------------ 511

years ------------------------ 594

years ------------------------ 763

~ears------------------------ 927

3,939

282

115

273

459

540

683

826

492

Percent distribution

=4-4===

100.0 89.0

100.0 89.8

100.0 93.2

100.0 89.8

100.0 90.9

100.0 89.5

100.0 89.1

11.0

10.2

6=8

10.2

1::;

10.9

75+ yekrs ------------------------ -- I 898 ]] 761 ] 137] Ioo*o\] 84.7] 15.3

lBased on total that responded to all of the items in the hearing scale.

the true condition of their hearing ability, (b)

instructions for answeringthehearingscalequestion did not make sufficiently clear thatthe statements were to be responded to as one hears

without the use of a hearing aid, or (c) the use

of a hearing aidsignificantly altered thepattem

ofhearing for some, thoughnotall,usersof hearing aids. It is also possible that this significant

result (chi-square for each of the samples exceeds that which corres~nds to a probability of

0.001)arises from a combination ofall three of

these factors.

Age.-The age of the person with impaired

hearing is another factorthatmight affectscaling.

Age, number, and percent of persons who scaled

and of those who failed to scale are givenin

table C. Only two of the age groups show any

marked difference in the proportion that failed to

scale. Persons aged 25-34 years scaled significantly more often and persons aged 75years and

Table D. Number and percent di.stributionof persons in Sample V who returned questionnaires but who failed to answer one or more of the scale questions, according to age

I

All persons who returned Persons who failed to answer

questionnaires one or more scale questions

Age I

I

Number I

Percent

I

Number I

Percent

distribution distribution

I I

All ages ----------- 5,404 I 100.0 I 9731 100.0

I I I

Under 17 years ----------- 370 6.8

17-24 years --------------

5.4

151 ;: 2.4

25-34 years -------------- 313 ;::

35-44 years -------------- 566 10.5 R ;:;

45-54 years -------------- 683 12.6 89 9.1

55-64 years -------------- 940 17.4 177 18.2

65-74 years -------------- 1,220 22.6 293 30.1

75+ years ---------------- 1,161 21.5 263 27.0

5
over scaled less often than those in other age

groups.

An indication that older persons might have

had some difficulty in understanding the scale

or estimating their hearing ability in terms of

the scale items is obtained from data in table D.

Of the 5,404 persons who returned questionnaires,

2,381 (or 44.1 percent) were 65 years and over;

and of the 973 who failed to answer one or more

of the scale items, 556 (or 57.1 percent) were in

this age group.

Unassisted and assisted wspondents.-one of

the items on the Hearing Ability Questionnaire is

for the signature of the person who actually completed the questionnaire. In the case of children, a

parent or guardian was expected to complete and

sign the form. Upon examination, however, it was

found that of the total persons 17 years of age

and over who returned a form with a signature,

28 percent were signed by someone other than the

person with impaired hearing (table E). In tables

E and F persons with impaired hearing who returned questionnaires with their own name signed

are called “unassisted respondents. ” Those who

returned questionnaires with another name signed

are called “assisted respondents ,“ even though

the person who assisted probably consulted the

intended respondent to obtain the required answers. The term “assisted respondent” is used

when any form of assistance in compl@ing the

questionnaire could be detected on the returned

questionnaire. It is not known how many questionnaires signed with the name of the person with

impaired hearing were in fact completed by

another person. However, the number of questionnaires with the names of persons other than those

of the persons to whom they were addressed is

known, and the magnitude is somewhat surprising.

The data in table E again reflects the difficulty

persons in the older age groups may have had in

answering the questionnaire.

Table E. Number and percent distribution of unassisted and assisted respondents in

Sample v 17+ years who returned signed questionnaires, according to age

Age Totall Unassisted Assisted

respondent respondent

Number of respondents

All ages.17+ years --------------- 4, fj7fj 3,352 1,324

17-24 years ------- ------- -------------- 144 106 38

25-34 years -------- -------- ------------ 301 242

35-44 years ---------------------------- 537 437 1;:

45-54 years ---------------------------- 645 514 131

55-64 years ---------------- ------------ 880 669 211

65-74 years -------- -------------------- 1,111 816 295

75+ years -------- -------- -------- ------ 1,058 568 490

17-24

25-34

35-44

45-54

55-64

65-74 IT‘

Percent distribution

All ages 17+ years --------------- 100.0 71.7 28.3

years -------- ----.--- ------------ 100.0 73.6 26.4

years ----------------- -------- ---- 100.0 80.4 19.6

years ---------------------------- 100.0 81.4 18.6

years ---------------- -------- ---- 100.0 79.7 20.3

years ---------------------------- 100.0 76.0 24.0

years ---------------------------- 100.0 73.4 26.6

75+ ye&s ------- ------- ------- ------- -- I 100.O/l 53.7 ] 46.3

lExcludes 358 persons who returned questionnaires without signatures.
Because of the large number of “assisted”

persons, scale responses of the “assisted” and

“unassisted” groups were examined. The data in

table F show that generally “assisted” persons

failed to scale more frequently than the “unassisted” persons and that for persons in the

older age groups the failure to scale was markedly

higher for “assisted” persons. The causal relationships involved here are unknown, but one

might speculate that any or all of the following

factors are involved:

1. The person completing the form was

using his own judgment as to the afflicted person’s ability to hear.

2. The fact that the afflicted person required

assistance might indicate that

a.

b.

c.

He lacked an interest in the study and

therefore was not sufficiently motivated to provide precise answers to the

“assistant.”

He was unable to understand the questions even with assistance.

He was too old or too ill to provide

an accurate assessment of his hearing

ability.

Scale Responses and Other Measures

of Hearing Ability

Internal consistency of the hearing scale. —

After answering the hearing scale question, respondents in the Survey were requested to rate

their hearing ability separately for each ear.

The question asked is reproduced in figure 2.

Further understanding of the hearing scale

can be gained by comparing responses to the

scale with self-estimates of hearing ability for

each ear. This comparison yields a measure of

the consistency, rather than validity, between two

ways of inquiring alxmt hearing ability. Table

G compares the hearing scale responses with

groupings of the estimates for the individual ears.

The contingency coefficient calculated for

table G yields a value of 0.62, with the maximum

possible contingency coefficient being 0.89 and the

probability that the relationship does arise

from chance alone being less than 0.001. Even

though the contingency coefficient has limitations

as a measure of correlation, the obtained relationship suggests substantial consistency between the

two self-estimates of hearing ability.

Table F. Percent distribution of unassisted and assisted respondents in Sample V who

scaled and who failed to scale, according to age

I

Unassisted >espondent IAssisted respondent

Age Failed Failed

Totall Scaled to Total* Scaled to

scale scale

I

Percent distribution

All ages-17+ years -----------

l==

100.0

17-24 years ------------------------

25-34 years ------------------------

35-44 years ------------------------

45-54 years ------------------------

55-64 years ------------------------

65-74 years ------------------------

75+ years --------------------------

100.0

100.0

100.0

100.0

100.0

100.0

100.0

90.71 9.3

I

1

87.8 12.2

93.4

90.2 :::

91.2

90.8 :::

91.5 8.5

88.6 11.4

‘Excludes 358 persons who returned questionnaires without

E14!l

signatures.

7
Please describe how well you con heor, without using(

hearing aid, by checking oneofthe statements belowfol

eoch ear. For exomple, a person who is deaf in his Ief!

ear and hasgoodheoring in his right ear would checkthc

following: Inleftear- box(d) ;inright eor-box (e).

In Iefteor

(a) ❑ Myhearing is good

(b) ❑ Ihavealittle trouble bearing

(c) ❑ Ihavealot of trouble hearing

(d) ❑ Iam deaf

In right ear

(e) ❑ My bearing is good

(f) ❑ Ihavealittle trouble hearing

(g) ❑ Ihavealot of trouble hearing

(h) ❑ Iam deaf

Figure 2. Question 2of the Hearing Ability Survey Questionnaire.

The estimatesof hearing ability for eachear

have a further use in conjunction with thehearing

scale. Individualshavinganimpairment inonlyone

ear should respond to the scale astheyhear with

both ears, which would mean obtaining a scale

score of 5 since their hearing in general would

permit good reception and understanding of

speech. In fact, only 134 (9.2 percent) of the 1,462

persons who indicated a unilateral hearing loss

(one ear good, other ear worse) obtained scale

scores of less than 5 (table G). This finding lends

some support to the contention that most respondents answered the scale in terms of the

overall functioning of their hearing. For those

who apparently did not respond in this way, the

relation of their scale scores to their hearing

estimates derived from question 2 suggests that

they tended to refer the scale items to their

impaired ear. Thus, by the conjoint application

of questions 1 and 2, errors in estimating functional hearing impairment can be substantially

reduced—i.e., those with scale scores of less

than 5 who indicated on question 2 that they

could hear well with one ear can be assumed to

have near-normal hearing for most situations.

Table G. Comparison of hearing scale positions for those persons who scaled with combined self-estimates for each ear for the Health Interview Hearing Ability Survey

Sample

Hearing scale positiong

Combined estimates of hearing loss for

each ear

To tall

o 1 2-3 4 5

Number of persons

Totall ------------------------------ 3,728 100 99 278 441 2,810

Deaf in both ears ------------------------- 92 55 19 10 1 7

One ear severe loss, other ear same

or worse -------- -------- -------- -------- 508 35 60 140 139 134.

One ear some loss, other ear same or

worse ----------------------------------- 1,329 7 14 89 209 1,010

One ear good hearing, other ear worse ----- 1,462 3 6 34 91 1,328

Hearing good in both ears ----------------- 337 - - 5 1 331

‘Excludes the 211 persons who failed to provide estimates of hearing loss.

20 = Unable to hear loud noises.

1 = Able to hear loud noises, but unable to distinguish between different kinds

of noises.

2-3 = Able to distinguish between different kinds of sounds, including voice, but

unable to hear and understand speech.

4 = Able to hear and understand a few words, but unable to hear and understnad

most of what is spoken.

5 = Able to hear and understand most of the words spoken.

8
Audiometric equivalents of the lzeari?&

scale.—The evidence presented thus far suggests

that in terms of scalability the hearing scale

items might be adequate in distinguishing the

degree of hearing loss for general statistical

purposes. However, if it could be demonstrated

that responses to these items were highly correlated with audiometric measurements for the same

persons, the meaning and utility of the scale

would be greatly enhanced. It was not possible

to conduct audiometric examinations for the

persons h. the Health Interview Survey, but

tests were conducted for persons in the I, II,

and III samples previously described.

The mean pure-tone-average losses (betterear average loss for the frequencies 500, 1,000,

and 2,000 cycles per second) for each position on

the hearing scale are given in table H. Several

precautions should be taken in interpreting these

data. It should be noted first that this group consists only of persons with severe hearing losses

(Gallaudet College students), the smallest average

loss being 56 decibels. Second, since this group is

not a random sample of the total population with

hearing impairment, no attempt should be made

to apply these average losses to those in the

Health Interview Survey sample having similar

positions on the hearing scale. What the table

does illustrate is an orderly progression of degree

of hearing loss for each scale step, with a

minimum degree of overlap between each position

as illustrated by the small standard errors.

Table H. Number of persons

ard error for s te~s

, mean pure-tone-average loss (PTA)l in decibels, and standon the hearing scale. based on scores of three samples of

Gallaudet College s~udents

.

Scale position

Item

Combined samples (872 students)

Number ------- -------------- ------- ------- ------- --

pure-tone-average loss ----------------------------

Standard error ------- ------- ------- -.----- ------- -

Samrile 1. mail interview (194 students)

Number --------------------------------------------

Pure-tone-average loss ------------------------ ----

Standard error ------------------------------------

Sample 11, group interview (157 students)

Number ---------------- -------- -------- -------- ----

pure-tone-average loss -------- --------------------

Standard error ------- ------- ------- ----.-- ------- -

Sample 111, individual interview (521 students)

Number ..------- ----------------- -------- -------- ----

pure-tone-average loss ----..--- --------------------

Standard error ------------------------------------

o

128

98

0.7

%

1.3

1%

1.8

;:

1.0

1

348

91

0.8

;;

0.9

E

1.1

184

92

0.7

2

161

83

1.0

48

78

1.8

;:

2.3

%

1.3

3

102

75

1.4

10

69

4.8

12

80

4.2

;;

1.6

4

107

66

1.5

%

3.2

18

73

3.2

77

65

1.7

5

26

63

2.7

52

7.0

6;

5.8

15

64

3.3

lBetter-ear average for frequencies 500, 1,000, 2,000 cycles per second; 105 decibels assigned to nonresponse at limits of audiometer.

9
CLASSIFICATION OF HEARING

SCALE SCORES

While specific audiometric values should not

be assigned to the various scale scores for reasons

discussed above, the data gathered so far would

justify considering that all those who occupy the

same scale position have a similar degree of hearing that is distinct from that in the other five

categories. Furthermore, the scale score indicates the relative degree of impairment from

O (worst) to 5 (best). While the evidence (see,

especially, table H) might support the treating

of each of the six scale positions separately, a

more conservative attitude is recommended for

any publication of the substantive results of the

Survey. The following classification is suggested:

Category 1. Unable to heav andundevstand

speech (scores from O to 3 on the heayi~

scale) .— Persons in this group deny being

able to both hear and understand speech

without a hearing aid. They range in impairment from inability to even perceive loud

noises to just being alie to distinguish the

sound of speech from other sounds.

Category H. Limited speech perception

(scale of 4).– These persons can hear and

understand only a little of what is said to them.

Category III. Can hear and understand most

speech (scale stove of 5).—This group contains persons with only slight hearing impairment.

Category IV. Unilateral heaving loss. —

Persons in this group have one normally

functioning ear and should be able to hear

well, except under conditions in which the

hearing of the good ear is masked by noise.

Of course, spatial localization of sounds and

some other aspects of hearing will be affected by a unilateral loss. For communication,

however, one good-hearing ear can serve

adequately; hence this group is regarded as

lesser impaired.

A fifth category arises by implication—those

persons for whom information was insufficient

to permit classification. Persons in this group

did not respond to the Hearing Ability Questionnaire or did so to such a limited extent

that classification was precluded.

CONCLUSIONS

While it is believed that the evidence presented indicates that the hearing scale is a satisfactory instrument for use in morbidity surveys,

certain limitations must be pointed out. It is necessary m obtain more data from a sample of the

general population, including those withn?l~hearing

impairment. Such data should include hearing tests

which would permit a more precise determination

of the meaning of the scale positions in terms of

audiometric measures. Further consideration

should be given to the fact that little is known

about those who obtained the highest position on

the scale. As it now stands, the hearing scale

is like a measuring stick that is 72 inches long.

For measurements of those over 6 feet, such a

measuring stick permits no further differentiation beyond stating that the individual is “more

than 6 feet tall. ” In the same sense, ‘those who

obtain scores of 5 on the hearing scale are inferred to have the best hearing, but this could

now include those who have no hearing loss at

all. It is apparent, then, that in future development of this scale attention must be given to

providing increased differentiation at the betterhearing end of the scale. And, finally, some

effort should be directed toward obtaining a

higher rate and a better quality of response from

persons in the older age groups.

000

10
PROCEDURES

APPENDIX I

USED IN THIS SURVEY AND LEVEL AND QUALITY OF RESPONSE

The basic Health Interview Survey Questionnaire

seeks to obtain information on a variety of healthrelated topics. In order to avoid extending the length

of the interview unreasonably, the number of questions

that can be devoted to a given topic must be limited.

One method of probing a specific topic or condition that

avoids the problem of extending the length of the original

interview is to have the basic interviewer screen

respondents for followup interviews. By this procedure

persons who are reported in the original interview as

having experienced the event or as having had the condition which is to be the subject of more intensive study

are selected for additional interviewing at a later time.

The Hearing Ability Survey, which was conducted for a

12-~onth period ending June 1963, was the first attempt

by the Health Interview Survey to utilize this type of

procedure. A description of the procedures used, some

comments on these procedures, and some data on the

level and quality of response obtained in the survey are

given in this appendix.

Methods Used to Obtain Respondents

During the basic interview respondents were asked

to report the existence of hearing problems in one or

both ears. Most of the reported cases of hearing impairment were elicited from responses to the question:

Does anyone in the family have serious trouble hearing

with one or both ears? A relatively few cases were

picked up from responses to some of the other illnessprobe questions used in the basic interview questionnaire.

Persons reported as having hearing problems were

mailed a copy of the Hearing Ability Survey Questionnaire. Adults were asked to fill out the questionnaire

for themselves, and a parent or guardian was asked

to complete the questionnaire for children.

In order to obtain the maximum level of response

to the survey, persons who failed to respond to the

initial inquiry were sent a reminder letter followed by

a second reminder letter and finally by a personal

visit when necessary. As a result of these procedures,

responses were obtained from 93 percent of the persons who were sent questionnaires. Further details

about response rates follow in the section entitled

Level of Response.

The Hearing Ability Questionnaire

A facsimile of the Hearing Ability Questionnaire is

shown in Appendix II. In addition to the hearing ability

scale (question 1) and to the estimate of hearing ability

in each ear (question 2) which have been discussed

previously, the questionnaire was designed to provide

the following information: (a) age at onset and progression of hearing difficulty, (b) cause of hearing loss,

(c) associated orological condition, (d) mode of communication to and by the person with the hearing loss,

(e) special training, (f) hearing aid ownership and use,

and (g) hearing tests.

Utilization of the Basic Heaith interview

Questionnaire as a Screening Device

An important feature of the Hearing Ability Survey

was the utilization of the basic health interview questionnaire as a screening device to elicit reports of hearing

problems that later were followed up to obtain more detailed information. Since followup questiomaires were

sent only to persons for whom some loss of hearing had

been reported in the original interview, the completeness of the followup data is limited by the accuracy of

reporting in tie original interview. Ageneral discussion

of the response problems in interview surveys is not

feasible here.6 However, some comments on res~nse

problems that were encountered in this survey may be

pertinent.

The first type of response problem is an implicit

one. It involves the failure to repxt in the original irlterview the existence of hearing loss for an unknown

number of persons. Because of the need to limit the

scope and objectives of this study, no effort was made

to obtain additional information about persons for whom

no hearing loss was reported. Such an effort might have

yielded some information on the extent of underreporting

of hearing impairments.

Some data on a second type of respmse problem,

the reporting of hearing impairments in the original interview which later were not reported in the followup

6For ~e~ul~ of studies related to the problems of resPOnse e~rs,

see U.S. National Health Survey, Health Statistics, PHSPub. Nos.

584-I?4, -D5, and -D6, Public Health Service, U.S. (iove~ment Printing Office, 1961.

11
interview, is available from the survey. Of the 4,978

persons who were reported to have a hearing impairment on the basic questionnaire and who responded to

question 2 on the supplement, 482 (almost 10 percent)

reported that their hearing was good in both ears. Therefore, either the reporting in the original interview was

incorrect for these persons or the supplementary

questiomaire yielded false negatives. No procedures

were used in this study to resolve these apparent inconsistencies in reporting. One source of these inconsistencies may be the use of a proxy respondent

in the original interview, while the supplement was completed by the person for whom the hearing loss was

reported. It is probable that many individuals relate their

hearing ability to their age. Therefore, a 70-year-old

person with hearing loss may consider his hearing

“good” in comparison with other persons his age,

whereas a younger proxy respondent who reported for

him might recognize and report the hearing loss.

Another s,ource of these inconsistencies is probably the

use of different terms and the interpretation of these

terms by different people. ln the original interview,

respondents were asked to report persons who had

“serious trouble” hearing; in the supplement respondents were asked to describe their hearing in the following terms:

1 am deaf

1 have a lot of trouble hearing

I have a little trouble hearing

My hearing is good

Aside from the type of response problems indicated

above, the Hearing Ability Survey results indicate that

the basic interview can be successfully used to screen

conditions or events for subsequent detailed interviews.

Level of Response

One of the major problems inherent in using a mail

interview instead of a direct interview is the inability to

Tab le 1. Number and percent distribution of

persons who responded and who did not respond

to the hearing ability supplement

L

Number Percent

Item of dispersions tribut ion

Total persons to

whom a supplement waa sent-- 5,830 100.0

Responded ------------- 5,404 92.7

Did not respond ------- 426 7.3

No supplement

returned ----------- 302 5.2

B~~:$plement

----------- 124 2.1

get all of the sample persons to respond. As shown

in table I, 7.3 percent of the 5,830 persons who were

sent a hearing ability supplement didnotrespon~ 5.2

percent never returned the supplement; and2.lpercent

returned a blank questionnaire.

Table H presents the percent responding and not

respmtding according to age. These figures fail to reflect

any relationship of age to response rates. Thehighest

response rate is evident for the persons under 17

years of age and those between the ages of 65and 74.

The lowest response rates were reported for those

persons aged 17-44 and 75 yeara and over.

In addition to the 5,830 persons who were sent a

supplementary questionnaire, there were 17;! persons

reported as having a hearing loss inthebasic interview

with no supplement available for final analysis. This

was primarily caused by a clerical failure to send a

supplement to the person with the hearing loss. (These

errors were essentially randomly distributed, and

therefore these losses should have no effect on the

data.) When the number of nonrespondents is added to the

Table II. Number of persons who were sent a hearing ability supplement and percent distribution

of those who responded and who did not respond, according to age

Number

Age of Total Responded Did not

persons respond~

Percent distribution

All ages ---------------------------- ------ 5,830 100.0 92.7 7.3

Under 17 years ------------------------ ---------- 390 100.0 94.9

17-44 years -------------------------------------

5.1

1,127 100.0 91.4

45-64 years -------------------------------------

8.6

1,749 100.0 92.8

65-74 years -------------------------------------

7.2

1,293

75+ years ---------------------------------------

100.0 94.4 5.6

1,271 100.0 91.3 8.7

lIncludes those persons who failed to return the supplement and those who returned the supplement but did not answer any of the questions.

12
Table 111. Number and percent distribution of responses to the hearing ability supplement, according to quality of response

Quality of response

Total responding --------------------------------------------

No omissions or inconsistencies -----------------------------------

A few on_Assi.ons or inconsistencies --------------------------------

Many omissions or inconsistencies --------------------------------- —

Number Percent

of responses distribution

number of persons for which no supplement was sent,

supplementary information ismissing for approximately

10percent of the tota16,002 persons whowere reported

as having hearing impairments in the household interview.

Quality of Response

Since these data were obtainedby aself-enumerationformandthe q~estionnaire wasmoderately complex,

coding procedures were adopted to reflect the quality

of the responses. These procedures were devisedto

recapture most of the data as itwasoriginally re~rted

and also to record the various types of errors that

therespondents made infilling outthe form. Coding

procedures of this type have several advantages: (1)

in analyzing the results of the study, knowledge of the

quality of response to a particular question can be

valuable in determining the inferences that can be

drawn from the data obtained from that question;

(2) evaluation ofthequali~ ofresponses will bebeneficial in designing future questionnaires and in deciding

the procedures to be used, e.g., direct interview or mail

questionnaire.

A detailed analysis of the quality of response to

the individual question is beyond the scope ofthisreport. However, the range of acceptable responsestothe

individual questions varied from 70 to 98 percent.

In addition to coding the errors for each individual

questior., an attempt was made toevaluate the overall

accuracy of responses to the entirequestionnaire. Even

though some basic criteria were established for rating

the quality of response of each questionnaire, it should

be emphasized that a substantial amount of subjective

judgment entered into these decisions. Consequently, in

interpreting the results of this rating procedure, which

are shown in the tables that follow, much more importance should be attached totherelationships between

quality of response ’and characteristicsof therespondents than totheabsohtte levels ofquality indicatedin

the tables. Even though about20percentofthe questionnaires were categorized as having many omissions or

inconsistencies, theycontainedclearandusableanswers

to many questions. Furthermore many of the errors of

omission or commission occurred in sections of the

questionnaire that hadno effecton theprimaryobjective

of this study, i.e., to classify persons with impaired

hearing according to degree ofloss.

The results of this evaluation are shown in table HI.

Perhaps the only inference that should be drawn from

these figures is that some of the questions and “skip

patterns’’ were too complex for use in a mail questionTable IV. Number of persons responding to the hearing ability supplement and percent distribution

of the quality of response, according to age

Quality of response

Number

Age of

persons No or few Many

responding Total omissions omissions

responding or or

inconsistencies inconsistencies

Percent distribution

All ages ------------- 5,404 100.0 80.5 19.5

Under 17 years ------------- 370 100.0 92.2

17-44 years --------------- 1,030 100.0 91.4 w

45-64 years----=----------- 1,623 100.0

65-74 years----------------

82.9 17.1

1,220 100.0 72.6 27.4

75+ years ------------------ 1,161 100.0 72.0 28.0

13
Table V. Number of persons responding to the hearing ability questionnaire and percent distribution of the quality of response, according to type of respondent

Type of respondent

Total-----------------------------------

Unassisted respondent -------------------------

Assisted respondent ---------------------------

Number

of

personsl

5,029

3,388

1,641

Quality of response

Total

Omissions or

inconsistencies

II None I Few I Many

Percent distribution

===4 38”6144”’!‘“6

100.0 I33.0 47.0 20.0

100.0 50.0 40.5 9.5

lExcludes 375 questionnaires on which the respondent was unidentified.

naire. This may be particularly true inthis study whiqh

included many persons in the older age groups. The

difficulty that older persons had with thisquestionnaire

is reflected by the data intableIV,which shows that the

quality of response decreased asage increased.

Another interesting related fsctor is shown intable

V. The quality of response appears to be better when

some other person assisted in completing thequestionnaire. Twenty percent of the unassisted respondents

returned questionnaires withmanyomissions , whileless

than 10 percent of the assisted respondents returned

questionnaires with frequent errors.

These findings are different from the comparison

of the assisted and unassisted respondents in relation

to the hearing ability scale that was discussed previously in this report. The ability of theassistedrespondent to provide a better overall quality ofresponse

to thesupplementary questionnaire while having apoorer

Table VI. Number of persons responding to the hearing abili,ty supplement and percent distribution of the quality of response , according to type of respondent and age

Type of respondent and age

Unassisted respondent

All ages---------------.----------------

Under 17 years --------------------------------

17-44 years -----------------------------------

45-64 years -----------------------------------

65-74 years -----------------------------------

75+ years -------- -------- -------- -------- -----

Assisted respondent

All ages --------------------------------

Under 17 years --------------------------------

17-44 years -----------------------------------

45-64 years -------- ------.- -------- ---.---- ---

65-74 years-----------------------------------

75+ years -------------------------------------

Number

of

persons

3,388

7%

1,183

816

568

1,641

317

197

342

295

490

Quality of response

Omissions or

Total inconsistencies

None Few Many

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

33.01 47.01 20.0

I I

36.1 61.1 2.8

49.6 43.1

34.2 49.0 1;:;

25.0 47.1 27.9

18.8 47.4 33,8

lExcludes the 375 questionnaires on which the respondent was unidentified.

m

14
ability to respond to the scale statements in question 1

may be explained as follows: Since a person is called

upon to assist in completing thesupplement, he could

be expected to be more competent in following the

questionnaire instructions and providing the answers to

the factual questions. However, the ability to interpret

the subjective impressions required for completing the

scale in question 1 may be more difficult for the person

who is lending his assistance.

Table VI shows the relationship between age, the

need for assistance to complete the questionnaire, and

the quality of response. It is readily evident that the

older unassisted respondents experienced considerable

difficulty in trying to answer the survey questionnaire.

The data presented here on quality of response

points up the need for exercising considerable caution

in using complex mail questionnaires, especially if the

study involves many persons in the older age brackets.

Furthermore, these data indicate that the quality of the

data may be improved if assistance in preparing the

questionnaire is available or given to elderly respondents.

15
APPENDIX II

HEARING ABILITY SURVEY QUESTIONNAIRE

CON FI DENTIAL - l%is information is collected for the U.S. PubIic Health Service under authority of Public

Law 652 of the 84th congress (7o .%at 4S% 42 U.S.C. 305). AH information which wOuld Pe~it identification of & individual will be held strictly confidential, will be used only by persons engaged in and for the

PIMPO=S of Cbe =WY and wiIl not b= disclOs=d Or releas=d tO O*ers fOr any o*er PIX’POSCS(22 FR l@7).

FORMNHS-D-1 U.S. DEPARTMENT OF COMMERCE

(5-2S-62) BuREAU OF THE CENSUS

ACTING AS COLLECTING AGENT FOR THE

U.S. PUBLIC HEALTH SERVICE

NATIONAL HEALTH SURVEY

(Hearing Ability)

I

Name of person for whom this form should be filled out I

GENERAL INSTRUCTIONS

Please answer aH of the questionsin this form tba apply co you. Most of the questions -an be

d

mswered by cbeckingonc of the boxes, like this: @ In some ofchequestions, more tban one

box may rechecked for your answer. In a few questions, anumber (such asage)is asked for. In

a few others, a written description or explanation is required.

If the person for whom the information is requested is a child, a parent or guardian should -answer

the aue scions for him or her.

SECTION A

(Please do not omit any part ./ Questions I and 2 even tbougb one or more of fbe statements may not

appear to be directly related to your present ability to bear. )

1. WITHOUT using a hearing aid, what can you how

(Please check the “Yes’” or “No” box after each statement. )

I can hear loud noises.

Most of the time 1 can tell one kind of noise fmm another.

If 1 hear a sound, most of the time 1 can tell if it is a person’s voice or not.

I can hear and understand a few words a person says if I can see his face and lips.

I

I cm hear and understand a few words a person says without seeing his face and lips. Ill

\,h can ear and understand most of tbe things a person says if I cart see his face and lips. Ill

I

I can ha r and understand most of the things a person says without seeing his face and lips. I I I

Most of the time I can ham and understand a discussion between severaf people without

seeing cbeir faces and Iips,

, !

I can hear and undwstand a telephone conversation on an ordinary telephone (that is a

telephone without m amplifier).

2. Please describe how well you can hear, without using a homing aid, by checking ona of the statements

below for -ch car. For example, a person who is deaf in his left car and has good hearing in his right

ear would check the following In left ear - box (d); In right ear - box (e).

I

In I*ft -r t

In right oar

(a) ❑ My hearing is good ,

I

(e) n My hearing is good

(b) ❑ I have a little trouble hearing ~ (f) ❑ I have a little trouble hearing

I

(c) ❑ I have a lot of trouble hearing ~ (g) ❑ I have a lot of trouble hearing

(d) ❑ I am deaf i

(h) ❑ I am deaf

If you have checked that your hearing is good in both ears-(a) and (e) checked, skip the questions cm Pages 2

and 3 and turn co tiction D on Page 4.

I

If you have any trouble hearing at all, please go on and answer the F estions that follow on Pages 2 and 3. 1

16
I

SECTION B I

3. How old were you when you beg.. to have hearing trouble or grow deaf?

(Please check tbe first box that applies and enter year as appropriate. )

❑ At birth ❑ I W,S abollt_ years old

❑ I was less than one year old. ❑ : ~..ot sure, but I know it w.. before

_ YC2C$ old.

4. (a) Since your hearing trouble began, has your hearing g.a!trn WORSE, has it improved, or is it iust about

the same? (Please check one box. )

❑ My hearing is now wore than when I first began to have bearing trouble.

❑ My hearing is now bdt.r than when I first began to have hearing trouble.

❑ My hearing is just about the same as when I first began to b.ve hearing trouble.

(1/ you have checked that your hearing has gotten worse, please answer tbe following question. )

(b) Hew old were you when it got as poor as it is now?

(Please check the /irst box that applies and enter year as appmpria!e. )

❑ I WLS about — YCZLS oId.

❑ I am not sue, but I know it was before I was _ years old.

❑ Neither of the above applies--it is getting worse all the time.

5. What was tho caust of your hmring trouhlo or deofncss?

❑ It was caused by a sickness, illness or disease. ❑ ~~r”om deaf or with pool

What illness?

❑ It was caused by an accident or injury.

❑ %mething else caused it.

(Please describe ii)

Wot kind of iniury wos it?

❑ I don’t know wi-iat caused it.

How did it happen?

6. Basid*s your htoring troubla or deafrmss, do you hove any othm troublo with your ars?

❑ Yes D No

If ‘“Yes, ”

What kind of trouble? (Please check as many bezes as a~ly. )

D Noises or ringing in the head or ear 0 Dizziness

❑ Earaches or pains i. the ear ❑ Any ocher uo.ble. Wh.t kind?

I

❑ Running ears

I

7. (a) At work or school and at horns, what arc cdl tht ways you usc to toll etfmr psoplo what you wont?

(Please check each way that you use. J

❑ I talk to them ❑ I usc sign languaxe.

❑ I write notes. •l Some ocier WI;. HOW?

•l I spell with my fingers

(b) PI.OSQ put a circl. around tho way you US* the most.

8. (a) At work or school and at home, what arc all the ways ethar PWPIO US* to tall YOU what th-y want?

(Please check each way that they use. )

❑ l%ey tdk to me. ❑ 1’hey use sign 18nguage.

❑lllmy write notes. ❑ %me other way. HOW?

❑l%ey spell with their fingers.

(b) P1.aso put a circla around the way they US* the most.

I

9. Have YOUcvw attmdad a school or CIOSSfor them with

poor hearing or a school or class for tho deaf? IJ Yes ❑ No I

10. Have you ●VWhad any training in lip reading

(spocch reading)? ❑ Yes ❑ No

11. HIJVOyou ●ver had any training in spo-h or sp-ch

correction because of your poor hexing or doaftwss? •l Yes ❑ No I

12. Have you ●ver had any training in haaring (Iossons to

help you understand bettar what you hear)? IJ Yes ❑ No

17
SECTION C

(The questions in this section re/er t o the use of hearing aids. )

3. Have you ever tried a hearing aid? ❑ iYes ❑ No (l~’:N$J “ skip to Section D on

4. Have you ever had o hearing aid for your own use? •1 Yes ❑ No (1/ “No, “ skip to Sectioti D on

Page 4)

5. (a) If you have a hearing aid NOW, please check here - •1

AND check one of the boxes below to indicate when you got it.

If you do NOT have a headng aid NOW, please check here ~ •1

AND check one of the boxes below b indicate when you got the last one you had.

When did you get it?

❑ This year (1962) ❑ 6-10 years ago

❑ Last year (1961) ❑ More than 10 years ago

II 2-5 years ago

The remaining parts of Question 15 apply to your present hearing aid if you have one now. If YOUdo not

have a hearing aid now, they apply to the lost hearing aid you had.

(b) What kind of hearing aid is (was) it? (Please check one hoxl

{

❑ Fits into one ear

{

❑ Fits against one side

Air conduction Bone conduction of the head

•1 ::~tl::::;:s ❑ Fi:h:~i:t&~$:$t~m:f

(.) Where are (were) the amplifier and batteries worn when you us. (used) the hearing aid?

.(Please check one box)

❑ Above the neck ❑ Below the neck

(d) Why did You choose this (that) particular kind of hearing aid?

(Please check one box)

❑ It was prescribed by a medical doctor ❑ It was advised by a hearing aid dealer

❑ It was prescribed by a hearing clinic ❑ Some other reason (Please explain)

❑ A friend or relative told me about it

❑ I saw it advertised

(e) Abo.t how long did it tak. to get used to it? (please check one box)

❑ Less than . . . mod ❑ More than six months

❑ One to six months D Never have gotten used to it

6. (a) Do you use a hearing aid now? ❑ Yes ❑ No (1/ “No,” skip to Section D on

page 4)

(b) How much do you use it? (Please check one box on each line) Does

(If you do not work, go to school, etc., check tbe “Does not Most Once

not

apply” column. )

of the in a Never

aPPIY time while

Artwork ? . . . . . . . . . . . . . . . . . . . . ..OO

At school? . . . . . . . . . . ...*. . . . . ...*-

At church? . . . . . . . . . . . . . . * ~........

Atthemovies? . . . . . . . . . . . . . . . . . . . . . .

Listening toradio or TV? . . . ...” . . . . . . . . .

Ac home? . . . . . . . . . . . . . . . . . . . . . . . . .

; ::..;:.!,.

,, \),,j&

,, .?;,,,,;/

(c) How well sati.fied or. you with the hearing old you are now using? (Please check one box)

❑ Very well satisfied ❑ Fairly well satisfied ❑ Not satis~ed at all

Question 17 of Section Con Page 4

18
SECTION C - Continued

17 WITH your hearing aid, what can you hear? (PIease cLeck the “Yes” or “No” box a/rer Yes No

each sfafemenf)

I can heax loud noises.

llosc of the time 1 can tell one kind of noise from anocimr.

If 1 hear a sound, most of cinc time I can rell if it is a person’s voice or not.

I can hear and understand a few words a person says if I can see his face and lips.

I can hear ❑nd understand a few words a person says without se+g his face and lips.

I can hear and understand most of the things a person says if I can see his face and Iips.

I can hear and understand most of the things a person says without seeing his face and lips.

Most of the time I can hear and understand a discussion becm.een several people without

seeing their faces and lips.

1 can hear and understand a telephone conversation on any cetephone.

SECTION D

1S. Has your hearing ever been tested by a medical doctor? Yes •l No (1/ “No.” go to Question 19)

(o) About how long ago was your hearing LAST tested by a medical doctor? (Please check o.. box)

❑ This year (1962) •1 4-5 years ago

❑ Last year (1961) U 6-10 years ago

•l 2-3 years ago ❑ ?.fore than 10 years ago

(b) Y!os the doctw who last tested your hearing an ear specialist or was he a general family doctor?

(Please check one box)

HMCCOI who was an em specialist a I don’t know

❑ General family doctor

(c) About how old were you wk.. your hewing was FIRST tested by . medical doctor?

I was abOur— YGuS old

I don’t know, but it was before I was _yCNS old.

19. Is your hearing testad regulorly,’for example, once or c1 Yes ❑ No

twice a yrnr?

20. Has your hearing ever been tested with an audimeter

(with earphones)? c1 Yes ❑ No

Comments - (Please use this space or attach an additional sheet 01 paper for any additional remarks you may

have about your bearing. )

Name of person who filled out this form Telephone No.

19

* U. S. GOVERNMENT PRINT~G OFFICE :1973 54 3-978/10
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS

Public Health Service publication No. 1000

Series 1.

Series 2,

Series 3.

Sem”es 4.

Series 10.

Series 11.

Series 12.

Series 20.

Series 21.

Series 22.

Programs and collection procedures. —Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions, data collection methcds used, definitions, and

other material necessary for understanding the data.

Reports number I-4

Data evaluation ad methods research. —Studies of new statistical methodology including: experimental

tests of new survey methods, studies of vital statistics collection methcds, new analytical techniques,

objective evaluations of reliability of collected data, contributions to statistical theory.

Reports number 1-12

Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the expository types of reports in the other series.

Reports number 1-4

Documents and committee repo~ts .—Final reports of major committees concerned with vital and health

statistics, and documents such as recommended model vital registration laws and revised birth and

death certificates.

Reports number 1 and 2

Data From the Health Interview Survey. —Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-related topics, based on data collected in

a continuing national household interview survey.

Reports number 1-23

Data From the Health Examination Survey.— Statistics based on the direct examination, testing, and

measurement of national samples of the population, including the medically defined prevalence of specific diseases, and distributions of the population with respect to various physical and physiological

measurements.

Reports number 1-11

Data From the Health RecoYds Swvey. —Statistics from records of hospital discharges and statistics

relating to the health characteristics of persons in institutions, and on hospital, medical, nursing, and

personal care received, based on national samples of establishments providing these services and

samples of the residents or patients.

Reports number 1 and 2

Data on mo?tality. —Various statistics on mortality other than as included in annual or monthly reportaspecial analyses by cause of death, age, and other demographic variables, also geographic and time

series analyses.

No reports to date

Data on natality, marm”age, and divoyce. —Various statistics on natality, marriage, and divorce other

than as included in annual or monthly reports-special analyses by demographic variables, also geographic and time series analyses, studies of fertilfty.

Reports number 1-6

Data FYom the National Natality and Mortality Surveys. —Statistics on characteristics of births and

deaths not available from the ;itsl records, b~sed on-sample surveys stemming from these records,

including such topics as mortality by socioeconomic class, medical experience in the last year of life,

characteristics of pregnancy, etc.

Reports number 1

For a list of titles of reports published in these series, write to: National Center for Health Statistics

U.S. Public Health Service

Washington, D.C. 20201