Survey Text

1991
1990
1977
1971
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1991
Survey form view entire document:  text  image
Mark box or ask:
5a. (Without a hearing aid) Can -- usually hear and understand what a person says without seeing his face if that person whispers to -- from across a quiet room?

0[] Under 3 (7)
1[] Yes (6a)
2[] No
9[] DK

b. (Without a hearing aid) Can -- usually hear and understand what a person says without seeing his face if that person talks in a normal voice to -- from across a quiet room?

1[] Yes (6a)
2[] No
9[] DK

c. (Without a hearing aid) Can -- usually hear and understand what a person says without seeing his face if that person shouts to -- from across a quiet room?

1[] Yes (6b)
2[] No
9[] DK

d. (Without a hearing aid) Can -- usually hear and understand what a person says without seeing his face if that person speaks loudly into -- better ear?

1[] Yes (6b)
2[] No (6b)
9[] DK (6b)

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1990
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Now I will ask some questions about hearing.
1a. Which statement best describes -- hearing in [his/her] left ear (without a hearing aid)?

1[] Good
2[] Little trouble
3[] Lot of trouble
4[] Deaf

Mark box or ask.

0[] Under 3 (Item N3)

2a. (Without a hearing aid) Can -- usually hear and understand what a person says without seeing his face if that person whispers to [him/her] from across a quiet room?

1[] Yes (3a)
2[] No

b. (Without a hearing aid) Can -- usually hear and understand what a person says without seeing his face if that person talks in a normal voice to [him/her] from across a quiet room?

1[] Yes (3a)
2[] No

c. (Without a hearing aid) Can -- usually hear and understand what a person says without seeing his face if that person shouts to [him/her] from across a quiet room?

1[] Yes (3b)
2[] No

d. (Without a hearing aid) Can -- usually hear and understand a person if that person speaks loudly into [his/her] better ear?

1[] Yes (3b)
2[] No (3b)

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1977
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3a. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person WHISPERS to him from across a quiet room?

[] Under 3 (R2)
1 [] Y (R2)
2 [] N

b. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person TALKS IN A NORMAL VOICE to him from across a quiet room?

1 [] Y (R2)
2 [] N

c. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person SHOUTS to him from across a quiet room?

1 [] Y (R2)
2 [] N

d. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND a person if that person SPEAKE LOUDLY into his better ear?

1 [] Y (R2)
2 [] N

e. (Without a hearing aid) Can -- usually tell the sound of speech from other sounds and noises?

1 [] Y (R2)
2 [] N

f. (Without a hearing aid) Can -- usually tell one kind of noise from another?

1 [] Y (R2)
2 [] N

g. (Without a hearing aid) Can -- hear loud noises?

1 [] Y
2 [] N

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1971
Survey form view entire document:  text  image

40a. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person WHISPERS to him from across a quiet room?
[] Y (41a)
[] N


b. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person TALKS IN A NORMAL VOICE to him from across a quiet room?

[] Y (41a)
[] N


c. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND what a person says without seeing his face if that person SHOUTS to him from across a quiet room?

[] Y (41b)
[] N


d. (Without a hearing aid) Can -- usually HEAR AND UNDERSTAND a person if that person SPEAKS LOUDLY into his better ear?

[] Y (41b)
[] N


e. (Without a hearing aid) Can -- usually tell the sound of speech from other sounds and noises?

[] Y (41b)
[] N


f. (Without a hearing aid) Can -- usually tell one kind of noise from another?

[] Y (41b)
[] N


g. (Without a hearing aid) Can -- hear loud noises?

[] Y (41b)
[] N (41b)