Protocol Overview

October 20, 2010

This section will be completed when reviewed by an Expert Review Panel.

The Age-Related Hearing Impairment instrument is a self-administered questionnaire which asks about an individual’s hearing impairment history, history of ear diseases and operations, family history, and history of exposure to loud noises.

None

Hearing impairment

Please only give one answer to each question. When the question calls for you to enter a year field then please enter as yyyy.

1. Do you have any difficulty with your hearing?

         [ ] No

         [ ] Yes

If ‘YES’,

1.1. In which ear(s) do you have a hearing difficulty?

         [ ] Left

         [ ] Right

         [ ] Both

1.2. At what age did you first notice a hearing difficulty?

         [ ] I have had a hearing difficulty since I was born

         [ ] My hearing difficulty developed during my childhood years (before the age of 15)

         [ ] My hearing difficulty developed between the ages of 15 and 40

         [ ] My hearing difficulty developed after the age of 40

1.3. How quickly did your hearing difficulty develop?

         [ ] Suddenly (over a few days)

         [ ] Over a few months

         [ ] Over several years

1.4. Do you know the reason for your hearing difficulty? (If there is a separate cause for each of your ears, please note them accordingly).

         [ ] I have no idea about the cause of my hearing problem

         [ ] Yes

___________________________________________________________

___________________________________________________________

1.5. Does your hearing vary from day to day?

         [ ] No

         [ ] Yes, in both ears

         [ ] Yes, in my left ear

         [ ] Yes, in my right ear

2. Do you find it very difficult to follow a conversation if there is background noise (e.g. TV, radio, children playing)?

         [ ] No

         [ ] Yes

3. Are you particularly sensitive to loud sounds?

         [ ] No

         [ ] Yes

4. Do you sometimes feel a fullness or blockage in your ears?

         [ ] No

         [ ] Yes, in my left ear

         [ ] Yes, in my right ear

         [ ] Yes, in both ears

5. Nowadays, do you ever get noises in your head or ears (tinnitus) which usually last longer than five minutes?

         [ ] No

         [ ] Yes

Ear diseases and balance

6. Have you ever had an ear disease that has caused your hearing to get worse?

         [ ] No

         [ ] Yes

7. Have you ever had discharge of blood or pus, or smelly discharge (not wax) from either ear?

         [ ] No

         [ ] I don’t know

         [ ] From my left ear

         [ ] From my right ear

         [ ] From both ears

8. Have you ever had an ear operation?

         [ ] No

         [ ] I don’t know

         [ ] Yes

If ‘YES’, please also answer the following questions (a–c). Please fill in one row for each operation.

9. Have you ever suffered from attacks of dizziness in which things seem to spin around you?

         [ ] No

         [ ] Yes, within the last year

         [ ] Yes, more than a year ago

10. Do you feel unsteady when walking in the dark?

         [ ] No

         [ ] Yes

Hereditary Factors

From a genetical point of view it is important that we establish where your ancestors originated from.

11. Concerning your grandparents:

11.1. Where did your mother’s father (your maternal grandfather) originate from?

Country:____________________ Region: ____________________

11.2. Where did your mother’s mother (your maternal grandmother) originate from?

Country:____________________ Region: ____________________

11.3. Where did your father’s father (your paternal grandfather) originate from?

Country:____________________ Region: ____________________

11.4. Where did your father’s mother (your paternal grandmother) originate from?

Country:____________________ Region: ____________________

12. As far as you know, does/did your mother have hearing problems?

         [ ] No

         [ ] Yes

If ‘YES’,

12.1. What was her year of birth? _____________________

12.2. What was her occupation? ______________________________________

12.3. At what age did her hearing problems start? ___________________________

12.4. What is/was the cause of her hearing problem (if known)? _________________

13. If she is dead, how old was she when she died? ___________________________

14. As far as you know does/did your father have hearing problems?

         [ ] No

         [ ] Yes

If ‘YES’,

14.1. What was his year of birth? _____________________

14.2. What was his occupation? _________________________________________

14.3. At what age did his hearing problems start? ____________________

14.4. What is/was the cause of his hearing problems (if known)? _______________

15. If he is dead, how old was he when he died? ______________

16. Do you have any brothers or sisters with normal hearing?

         [ ] No

         [ ] Yes: (how many of your brothers/sisters have normal hearing?) _________

17. Do you have any brothers or sisters with hearing difficulties?

         [ ] No

         [ ] Yes: (how many of your brothers/sisters have hearing difficulties?) _________

If ‘YES’, please answer the following questions (a–d). Please fill in one row for each brother/sister with hearing difficulties.**

** If needed, you can add extra copies of this page.

18. Do you have any children with normal hearing?

         [ ] No

         [ ] Yes: (how many of your children have normal hearing?) ____________

19. Do you have any children with hearing difficulties?

         [ ] No

         [ ] Yes: (how many of your children have hearing difficulties?) _________

If ‘YES’, please also answer the following questions (a–d). Please fill in one row for each child with hearing difficulties.**

** If needed, you can add extra copies of this page.

20. Do you have uncles, aunts, cousins, nephews, or nieces with hearing difficulties?

         [ ] No

         [ ] Yes

21. Do you know if any of your relatives have already participated in this investigation?

         [ ] As far as I know, none of my relatives has already participated in this investigation

         [ ] One of my relatives has already participated in this investigation (please write down the name of your relative and the relation between you) _____________________

General Health

22. Do you suffer from migraine?

         [ ] No

         [ ] Yes

If ‘YES’,

22.1. How often do you generally have attacks?

         [ ] Often (more than one attack a month)

         [ ] Regularly (an attack once a month on average)

         [ ] Sporadically (between 4 and 10 times a year)

         [ ] Rarely (less than one attack every 3 months)

23. Have you ever suffered a hearing loss from meningitis or encephalitis?

         [ ] No

         [ ] I don’t know

         [ ] Yes: in _________________ (write down in which year(s) approximately)

24. Have you ever had a whiplash injury?

         [ ] No

         [ ] I don’t know

         [ ] Yes: in _________________ (write down in which year(s) approximately)

25. Have you ever been knocked unconscious (e.g., in a traffic accident, contact sport, a fight or after a fall)?

         [ ] No

         [ ] I don’t know

         [ ] Yes: in _________________ (write down in which year(s) approximately)

26. Have you ever had a heart attack?

         [ ] No

         [ ] Yes: in _________________ (write down in which year(s) approximately)

27. Have you ever had heart surgery?

         [ ] No

         [ ] Yes

If ‘YES’,

27.1. What operation(s)? (Please describe) ___________________________________________

_______________________________________________

27.2. In which year(s) approximately? ________________________

28. Have you ever had coronary artery catheterization?

         [ ] No

         [ ] Yes

If ‘YES’,

28.1. What type of intervention(s) (e.g., stent, balloon dilatation)? __________________________

______________________________________________

28.2. In which year(s) approximately? __________________________

29. Have you ever had a stroke?

         [ ] No

         [ ] I don’t know

         [ ] Yes: in _________________ (write down in which year(s) approximately)

30. Have you ever had an operation on your carotid artery?

         [ ] No

         [ ] I don’t know

         [ ] Yes: in _________________ (write down in which year(s) approximately)

31. Do you suffer from intermittent claudication? (This is if you can’t walk more than 200 metres, because you get cramps in your legs, and when you stand still for a moment the pain gets better).

         [ ] No

         [ ] I don’t know

         [ ] Yes

32. Do you have other problems with your heart or circulation?

         [ ] No

         [ ] Yes: ___________________________________________ (please write down which problems)

33. Do you suffer from diabetes?

         [ ] No

         [ ] I don’t know

         [ ] Yes

If ‘YES’,

33.1. Do you need insulin?

         [ ] No

         [ ] Yes

34. Please indicate if you suffer from one or more of the following diseases:

If you suffer from one or more of these diseases, please describe your disease on the last row (34.14).

34.1. Osteoporosis

         [ ] No

         [ ] Yes

34.2. Osteoarthritis

         [ ] No

         [ ] Yes

34.3. Multiple sclerosis (MS)

         [ ] No

         [ ] Yes

34.4. Epilepsy

         [ ] No

         [ ] Yes

34.5. Lung problems

         [ ] No

         [ ] Yes

34.6. Allergy

         [ ] No

         [ ] Yes

34.7. Diseases of the stomach or intestines

         [ ] No

         [ ] Yes

34.8. Kidney diseases

         [ ] No

         [ ] Yes

34.9. Liver diseases

         [ ] No

         [ ] Yes

34.10. Skin diseases

         [ ] No

         [ ] Yes

34.11. Psychiatric problems

         [ ] No

         [ ] Yes

34.12. Blood diseases

         [ ] No

         [ ] Yes

34.13. Diseases of the thyroid gland

         [ ] No

         [ ] Yes

34.14. Please describe your disease(s):

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

35. Please indicate if you suffer from one or more of the following autoimmune diseases:

35.1. Rheumatoid arthritis (rheumatism)

         [ ] No

         [ ] Yes

35.2. Inflammatory bowel disease (Crohn’s disease / colitis ulcerosa)

         [ ] No

         [ ] Yes

35.3. Lupus erythematosus

         [ ] No

         [ ] Yes

35.4. Psoriasis

         [ ] No

         [ ] Yes

35.5. Wegener’s granulomatosis

         [ ] No

         [ ] Yes

35.6. Vasculitis

         [ ] No

         [ ] Yes

35.7. Nephritis

         [ ] No

         [ ] Yes

35.8. Hashimoto thyroiditis

         [ ] No

         [ ] Yes

35.9. Cogan’s syndrome

         [ ] No

         [ ] Yes

35.10. Behcet’s syndrome

         [ ] No

         [ ] Yes

35.11. Other autoimmune diseases:

__________________________________________________________________

__________________________________________________________________

36. Have you ever had other operations (not covered by the previous questions)?

         [ ] No

         [ ] Yes: (Please list any operations you have had and the year they were performed)

36.1.

___________________________ in:___________

36.2.

___________________________ in:___________

36.3.

___________________________ in:___________

36.4.

___________________________ in:___________

36.1.

___________________________ in:___________

37. Do you have other serious health problems that are not covered by the previous questions?

         [ ] No

         [ ] Yes

If ‘YES’,

37.1. Please describe these problems:

___________________________________________________________________

Medication

38. Have you ever been treated for a serious infection with an antibiotic (other than penicillin) which was administered by injection/drip for a week or more?

         [ ] No

         [ ] Yes

38.1. If ‘YES’, for what sort of infections did you receive these antibiotics?

_______________________________________________________________

38.2. In which year(s) approximately?______________________

39. Have you had cancer or leukemia?

         [ ] No

         [ ] Yes

If ’YES,

39.1. Which kind of cancer or leukemia?

____________________________________________________________

39.2. Have you been treated with chemotherapy or other medication for this condition?

         [ ] No

         [ ] Yes

39.3 If ‘YES’, with_____________________________________________________ (please fill in which medication if you know it)

39.3 in __________________________ (in which year(s) approximately)

40. Have you ever received radiotherapy to your head or neck for a tumour?

         [ ] No

         [ ] Yes

If ‘YES’

40.1. What kind of tumour(s)? ________________________________________

40.2. In which year(s) approximately? __________________________

41. On average how often do you take painkillers?

         [ ] never

         [ ] less than 1 tablet a month

         [ ] less than 1 tablet a week (but more than one each month)

         [ ] more than 5 tablets a day

42. Do you take aspirin on a daily basis for your heart or to dilute your blood?

         [ ] No

         [ ] Yes

42.1. If ‘YES’, how long have you been taking aspirin so far?

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43. Please list all of the medication you have taken on a regular basis (for more than 3 months) in the last year or that you are taking now on a regular basis.

Please write down the medical reason why you had or have to take this medication. If necessary you can add an additional copy of this page.

43.1. Name drug: ________________________

43.2. Medical reason: ________________________

43.3. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.4. Name drug: ________________________

43.5. Medical reason: ________________________

43.6. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.7. Name drug: ________________________

43.8. Medical reason: ________________________

43.9. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.10. Name drug: ________________________

43.11. Medical reason: ________________________

43.12. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.13. Name drug: ________________________

43.14. Medical reason: ________________________

43.15. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.16. Name drug: ________________________

43.17. Medical reason: ________________________

43.18. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.19. Name drug: ________________________

43.20. Medical reason: ________________________

43.21. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.22. Name drug: ________________________

43.23. Medical reason: ________________________

43.24. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.25. Name drug: ________________________

43.26. Medical reason: ________________________

43.27. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

43.28. Name drug: ________________________

43.29. Medical reason: ________________________

43.30. Duration of treatment

         [ ]  3 months – 1 year

         [ ]  1 – 5 years

         [ ]  more than 5 years

Noise Exposure

44. Have you ever fired a gun?

         [ ] No

         [ ] Yes

If ‘YES’, please answer the following questions.

45. During your leisure time, are you/have you been regularly (more than once a week) exposed to loud sound or noise (so that you have to shout to make yourself heard by someone who was more than 1 m away from you)?

         [ ] No

         [ ] Yes

If you answered ‘YES’, please also answer the following questions (44.1—44.5).

45.1. What kind of loud sound? ___________________________________________

45.2. For how many years have you been exposed to this loud sound? ______________

45.3. How many hours per week have you been exposed to this loud sound?

         [ ] 1–3 hours each week

         [ ] 3–10 hours each week

         [ ] 1–3 hours each day

         [ ] More than 3 hours each day

45.4. Did you use ear protection?

         [ ] Always

         [ ] Most of the time

         [ ] More than 50% of the time

         [ ] Less than 50% of the time

         [ ] Never

45.5. If any, which type of ear protection did you use?

         [ ] Plugs

         [ ] Earmuff

         [ ] ’Active’ protection

         [ ] Several

Occupational Information

46. What is/was your job?

____________________________________________________________

47. Have you been exposed to solvents (e.g., thrichloroethylene, toluene, evaporations from paints or lacquers) for more than one year in one of your jobs?

         [ ] No

         [ ] Yes

If ‘YES’,

47.1. Which solvents? ____________________________________________________________

47.2. In which year did the solvent exposure start? _______________

47.3. For how many years were you exposed to solvents? ______________

47.4. For how many hours per day were you exposed to solvents?

         [ ] Less than 1 hour each day

         [ ] 1–5 hours each day

         [ ] More than 5 hours each day

48. Do you suffer from white finger syndrome/Raynaud’s syndrome caused by excessive vibration (e.g., pneumatic hammers or drills)?

         [ ] No

         [ ] I don’t know

         [ ] Yes

49. Have you ever worked for more than 1 year in a place where you had to raise your voice to make yourself heard by someone standing 1 m away from you?

         [ ] No

         [ ] Yes

If you answered ‘YES’, please also answer the following questions (48.1–48.10). If you have worked for different companies, or for the same company but in different workplaces (with a different noise level), please fill in the following questions for each ’job’.

1st job (add additional copies for other jobs if necessary)

49.1. Please describe the job and give the name of the company ___________________________

49.2. Please describe the most important noise source(s) _________________________________

49.3. In which year did you start to do this job? ____________________________

49.4. How many years have you been doing this job? _____________________

49.5. What was the noise level (if you are aware of it) in dB? _________________

49.6. What was the noise dose (equivalent noise level if you are aware of it) in dBs? ___________

49.7. How many hours per day were you exposed to noise?

         [ ] Less than 1 hour each day

         [ ] 1–5 hours each day

         [ ] More than 5 hours each day

49.8. Was this a constant loud noise or an impulse noise (i.e., noise with (ir)regular high peaks of sound, like hammering)?

         [ ] Constant noise

         [ ] Impulse noise

         [ ] Both

49.9. Did you use noise protection?

         [ ] Always

         [ ] Most of the time

         [ ] More than 50% of the time

         [ ] Less than 50% of the time

         [ ] Never

49.10. If any, which type of noise protection did you use?

         [ ] Plugs

         [ ] Earmuff

         [ ] ’Active’ protection

         [ ] Several

Background Information

50. What is your height? ___________cm (feet and inches)

51. What is your weight? ___________kg (stones and pounds)

52. Are you left or right handed?

         [ ] left handed

         [ ] right handed

53. Are you susceptible to sunburn?

         [ ] very much

         [ ] much

         [ ] not very much

         [ ] not at all

54. What is the color of your eyes?

         [ ] very light blue or very light grey

         [ ] blue

         [ ] grey

         [ ] green

         [ ] light brown

         [ ] dark brown

55. Have you ever smoked regularly?

         [ ] No

         [ ] Yes

If you answered "yes" please also answer the following questions (54.1–54.5).

55.1. At which age did you start smoking? __________

55.2. For how many years did you (have you) smoke(d) up to now? __________

55.3. Approximately how many cigarettes do (did) you smoke on average?

         [ ] Less than 5 each day

         [ ] 5–10 each day

         [ ] 10–20 each day

         [ ] More than 20 each day

55.4. Approximately how many cigars or cigarellos do (did) you smoke on average each day? __________

55.5. Approximately how much pipe tobacco (grams) do (did) you smoke each day? __________

56. Do you drink alcohol regularly (every week)?

         [ ] No

         [ ] Yes

If ‘YES’,

57.1. How many drinks do you have on average? (A small bottle of beer – 25cl, red or white wine – 12cl, or a small glass of spirits – 4cl counts as 1 drink).

         [ ] Less than 1 drink each week

         [ ] 1–5 drinks each week

         [ ] 1–3 drinks each day

         [ ] More than 3 drinks each day

Scoring Instructions

Please see Fransen et al., 2008 for a complete description of the statistical analysis used for these questions. Also, supplementary table 4 contains information on how the different variables were coded in this statistical analysis.

Export Variables

Variable Name	Variable ID	Variable Description	Version	Mapping
PX201501_Coronary_Artery_Catheterization_Year	PX201501280200	In which year(s) approximately?	4	N/A
PX201501_Stroke	PX201501290000	Have you ever had a stroke?	4	N/A
PX201501_Stroke_Year	PX201501290100	Have you ever had a stroke? (write down in which year(s) approximately	4	N/A
PX201501_Carotid_Artery_Operation	PX201501300000	Have you ever had an operation on your carotid artery?	4	N/A
PX201501_Carotid_Artery_Operation_Year	PX201501300100	Have you ever had an operation on your carotid artery? (write down in which year(s) approximately)	4	N/A
PX201501_Intermittent_Claudication	PX201501310000	Do you suffer from intermittent claudication? (this is if you can't walk more than 200 metres, because you get cramps in your legs, and when you stand still for a moment the pain gets better)	4	N/A
PX201501_Other_Heart_Problems	PX201501320000	Do you have other problems with your heart or circulation?	4	N/A
PX201501_Other_Heart_Problems_Describe	PX201501320100	Do you have other problems with your heart or circulation? (please write down which problems)	4	N/A
PX201501_Diabetes	PX201501330000	Do you suffer from diabetes?	4	N/A
PX201501_Need_Insulin	PX201501330100	Do you need insulin?	4	Variable Mapping
PX201501_Osteoporosis	PX201501340100	Osteoporosis	4	N/A
PX201501_Osteoarthritis	PX201501340200	Osteoarthritis	4	N/A
PX201501_Multiple_Sclerosis	PX201501340300	Multiple sclerosis (MS)	4	N/A
PX201501_Epilepsy	PX201501340400	Epilepsy	4	N/A
PX201501_Lung_Problems	PX201501340500	Lung problems	4	N/A
PX201501_Allergy	PX201501340600	Allergy	4	N/A
PX201501_Stomach_Intestines	PX201501340700	Diseases of the stomach or intestines	4	N/A
PX201501_Kidney_Disease	PX201501340800	Kidney diseases	4	N/A
PX201501_Liver_Diseases	PX201501340900	Liver diseases	4	N/A
PX201501_Skin_Diseases	PX201501341000	Skin diseases	4	N/A
PX201501_Psychiatric_Problems	PX201501341100	Psychiatric problems	4	N/A
PX201501_Blood_Diseases	PX201501341200	Blood diseases	4	N/A
PX201501_Thyroid_Diseases	PX201501341300	Diseases of the thyroid gland	4	N/A
PX201501_Describe_Disease	PX201501341400	Please describe your disease(s):	4	N/A
PX201501_Rheumatoid_Arthritis	PX201501350100	Rheumatoid arthritis (rheumatism)	4	N/A
PX201501_Inflammatory_Bowel_Disease	PX201501350200	Inflammatory bowel disease (Crohn's disease / colitis ulcerosa)	4	N/A
PX201501_Lupus	PX201501350300	Lupus erythematosus	4	N/A
PX201501_Psoriasis	PX201501350400	Psoriasis	4	N/A
PX201501_Wegeners_Granulomatosis	PX201501350500	Wegener's granulomatosis	4	N/A
PX201501_Vasculitis	PX201501350600	Vasculitis	4	N/A
PX201501_Nephritis	PX201501350700	Nephritis	4	N/A
PX201501_Hashimoto_Thyroiditis	PX201501350800	Hashimoto thyroiditis	4	N/A
PX201501_Cogans_Syndrome	PX201501350900	Cogan's syndrome	4	N/A
PX201501_Behcets_Syndrome	PX201501351000	Behcet's syndrome	4	N/A
PX201501_Other_Autoimmune_Diseases	PX201501351100	Other autoimmune diseases	4	N/A
PX201501_Other_Operation	PX201501360000	Have you ever had other operations (not covered by the previous questions)?	4	N/A
PX201501_Other_Operation1_Type	PX201501360101	Other operation 1 type	4	N/A
PX201501_Other_Operation1_Year	PX201501360102	Other operation 1 year	4	N/A
PX201501_Other_Operation2_Type	PX201501360201	Other operation 2	4	N/A
PX201501_Other_Operation2_Year	PX201501360202	Other operation 2 year	4	N/A
PX201501_Other_Operation3_Type	PX201501360301	Other operation 3	4	N/A
PX201501_Other_Operation3_Year	PX201501360302	Other operation 3 year	4	N/A
PX201501_Other_Operation4_Type	PX201501360401	Other operation 4	4	N/A
PX201501_Other_Operation4_Year	PX201501360402	Other operation 4 year	4	N/A
PX201501_Other_Serious_Health_Problems	PX201501370000	Do you have other serious health problems that are not covered by the previous questions?	4	N/A
PX201501_Other_Serious_Health_Problems_Describe	PX201501370100	Please describe these problems:	4	N/A
PX201501_Antibiotic_Drip	PX201501380000	Have you ever been treated for a serious infection with an antibiotic (other than penicillin) which was administered by injection/drip for a week or more?	4	N/A
PX201501_Antibiotic_Drip_Infection	PX201501380100	If 'YES', for what sort of infections did you receive these antibiotics?	4	N/A
PX201501_Antibiotic_Drip_Year	PX201501380200	In which year(s) approximately?	4	N/A
PX201501_Cancer	PX201501390000	Have you had cancer or leukaemia?	4	Variable Mapping
PX201501_Cancer_Type	PX201501390100	Which kind of cancer or leukaemia?	4	Variable Mapping
PX201501_Cancer_Chemotherapy_Medication	PX201501390200	Have you been treated with chemotherapy or other medication for this condition?	4	N/A
PX201501_Cancer_Chemotherapy_Medication_Type	PX201501390201	Have you been treated with chemotherapy or other medication for this condition? If 'YES', with: ______ (please fill in which medication if you know it)	4	N/A
PX201501_Cancer_Chemotherapy_Medication_Year	PX201501390202	Have you been treated with chemotherapy or other medication for this condition? in __________ (in which year(s) approximately)	4	N/A
PX201501_Radiotherapy_Tumor	PX201501400000	Have you ever received radiotherapy to your head or neck for a tumour?	4	N/A
PX201501_Radiotherapy_Tumor_Type	PX201501400100	Have you ever received radiotherapy to your head or neck for a tumour? What kind of tumour(s)?	4	N/A
PX201501_Radiotherapy_Tumor_Year	PX201501400200	Have you ever received radiotherapy to your head or neck for a tumour? In which year(s) approximately?	4	N/A
PX201501_Painkiller_Frequency	PX201501410000	On average how often do you take painkillers?	4	N/A
PX201501_Daily_Aspirin	PX201501420000	Do you take aspirin on a daily basis for your heart or to dilute your blood?	4	N/A
PX201501_Daily_Aspirin_How_Long	PX201501420100	Do you take aspirin on a daily basis for your heart or to dilute your blood? If 'YES', how long have you been taking aspirin so far?	4	N/A
PX201501_Regular_Medication1_Name	PX201501430100	Name drug	4	N/A
PX201501_Regular_Medication1_Reason	PX201501430200	Medical reason:	4	N/A
PX201501_Regular_Medication1_Duration	PX201501430300	Duration of treatment	4	N/A
PX201501_Regular_Medication2_Name	PX201501430400	Name drug:	4	N/A
PX201501_Regular_Medication2_Reason	PX201501430500	Medical reason:	4	N/A
PX201501_Regular_Medication2_Duration	PX201501430600	Duration of treatment	4	N/A
PX201501_Regular_Medication3_Name	PX201501430700	Name drug:	4	N/A
PX201501_Regular_Medication3_Reason	PX201501430800	Medical reason:	4	N/A
PX201501_Regular_Medication3_Duration	PX201501430900	Duration of treatment	4	N/A
PX201501_Regular_Medication4_Name	PX201501431000	Name drug:	4	N/A
PX201501_Regular_Medication4_Reason	PX201501431100	Medical reason:	4	N/A
PX201501_Regular_Medication4_Duration	PX201501431200	Duration of treatment	4	N/A
PX201501_Regular_Medication5_Name	PX201501431300	Name drug:	4	N/A
PX201501_Regular_Medication5_Reason	PX201501431400	Medical reason:	4	N/A
PX201501_Regular_Medication5_Duration	PX201501431500	Duration of treatment	4	N/A
PX201501_Regular_Medication6_Name	PX201501431600	Name drug:	4	N/A
PX201501_Regular_Medication6_Reason	PX201501431700	Please list all of the medication you have taken on a regular basis (for more than 3 months) in the last year or that you are taking now on a regular basis Please write down the medical reason why you had or have to take this medication. If necessary you can add an additional copy of this page Medical reason:	4	N/A
PX201501_Regular_Medication6_Duration	PX201501431800	Please list all of the medication you have taken on a regular basis (for more than 3 months) in the last year or that you are taking now on a regular basis Please write down the medical reason why you had or have to take this medication. If necessary you can add an additional copy of this page Duration of treatment	4	N/A
PX201501_Regular_Medication7_Name	PX201501431900	Name drug:	4	N/A
PX201501_Regular_Medication7_Reason	PX201501432000	Medical reason:	4	N/A
PX201501_Regular_Medication7_Duration	PX201501432100	Duration of treatment	4	N/A
PX201501_Regular_Medication8_Name	PX201501432200	Name drug:	4	N/A
PX201501_Regular_Medication8_Reason	PX201501432300	Medical reason:	4	N/A
PX201501_Regular_Medication8_Duration	PX201501432400	Duration of treatment	4	N/A
PX201501_Regular_Medication9_Name	PX201501432500	Name drug:	4	N/A
PX201501_Regular_Medication9_Reason	PX201501432600	Medical reason:	4	N/A
PX201501_Regular_Medication9_Duration	PX201501432700	Duration of treatment	4	N/A
PX201501_Regular_Medication10_Name	PX201501432800	Name drug:	4	N/A
PX201501_Regular_Medication10_Reason	PX201501432900	Medical reason:	4	N/A
PX201501_Regular_Medication10_Duration	PX201501433000	Duration of treatment	4	N/A
PX201501_Ever_Fired_Gun	PX201501440000	Have you ever fired a gun?	4	N/A
PX201501_Light_Weapons_Number_Shots	PX201501440100	Light weapons (rifles/shotguns). Estimate the total number of shots fired.	4	N/A
PX201501_Light_Weapons_Ear_Protection	PX201501440200	Light weapons (rifles/shotguns). Did you use ear protection?	4	N/A
PX201501_Light_Weapons_Ear_Protection_Type	PX201501440300	Light weapons (rifles/shotguns). If any, which type of ear protection did you use?	4	N/A
PX201501_Heavy_Weapons_Number_Shots	PX201501440400	Heavy weapons (artillery/bazookas). Estimate the total number of shots fired.	4	N/A
PX201501_Heavy_Weapons_Ear_Protection	PX201501440500	Heavy weapons (artillery/bazookas). Did you use ear protection?	4	N/A
PX201501_Heavy_Weapons_Ear_Protection_Type	PX201501440600	Heavy weapons (artillery/bazookas). If any, which type of ear protection did you use?	4	N/A
PX201501_Leisure_Time_Loud_Noise	PX201501450000	During your leisure time, are you/have you been regularly (more than once a week) exposed to loud sound or noise (so that you have to shout to make yourself heard by someone who was more than 1 m away from you)?	4	N/A
PX201501_Leisure_Time_Loud_Noise_Type	PX201501450100	What kind of loud sound?	4	N/A
PX201501_Leisure_Time_Loud_Noise_Years	PX201501450200	For how many years have you been exposed to this loud sound?	4	N/A
PX201501_Leisure_Time_Loud_Noise_HoursPerWeek	PX201501450300	How many hours per week have you been exposed to this loud sound?	4	N/A
PX201501_Leisure_Time_Loud_Noise_EarProtection	PX201501450400	Did you use ear protection?	4	N/A
PX201501_Leisure_Time_Loud_Noise_EarProtectionType	PX201501450500	If any, which type of ear protection did you use?	4	N/A
PX201501_Occupation	PX201501460000	What is/was your job?	4	N/A
PX201501_Occupational_Exposure_To_Solvents	PX201501470000	Have you been exposed to solvents (e.g., thrichloroethylene, toluene, evaporations from paints or lacquers) for more than one year in one of your jobs?	4	N/A
PX201501_Occupational_Exposure_To_Solvents_Type	PX201501470100	Which solvents?	4	N/A
PX201501_Occupational_Exposure_To_Solvents_Start	PX201501470200	In which year did the solvent exposure start?	4	N/A
PX201501_Occupational_Exposure_To_Solvents_Years	PX201501470300	For how many years were you exposed to solvents?	4	N/A
PX201501_Occupational_Exposure_To_Solvents_HoursPerDay	PX201501470400	For how many hours per day were you exposed to solvents?	4	N/A
PX201501_White_Finger_Syndrome	PX201501480000	Do you suffer from white finger syndrome/Raynaud's syndrome caused by excessive vibration (e.g., pneumatic hammers or drills)?	4	N/A
PX201501_Loud_Working_Environment	PX201501490000	Have you ever worked for more than 1 year in a place where you had to raise your voice to make yourself heard by someone standing 1 m away from you?	4	N/A
PX201501_Loud_Working_Environment_Job	PX201501490100	Please describe the job	4	N/A
PX201501_Loud_Working_Environment_Company	PX201501490101	Please give the name of the company	4	N/A
PX201501_Loud_Working_Environment_NoiseSource	PX201501490200	Please describe the most important noise source(s)	4	N/A
PX201501_Loud_Working_Environment_Start	PX201501490300	In which year did you start to do this job?	4	N/A
PX201501_Loud_Working_Environment_Years	PX201501490400	How many years have you been doing this job?	4	N/A
PX201501_Loud_Working_Environment_NoiseLevel	PX201501490500	What was the noise level (if you are aware of it) in dB?	4	N/A
PX201501_Loud_Working_Environment_NoiseDose	PX201501490600	What was the noise dose (equivalent noise level if you are aware of it) in dBs?	4	N/A
PX201501_Loud_Working_Environment_HoursPerDay	PX201501490700	How many hours per day were you exposed to noise?	4	N/A
PX201501_Loud_Working_Environment_Constant_Impulse	PX201501490800	Was this a constant loud noise or an impulse noise (i.e., noise with (ir)regular high peaks of sound, like hammering)?	4	N/A
PX201501_Loud_Working_Environment_Use_NoiseProtection	PX201501490900	Did you use noise protection?	4	N/A
PX201501_Loud_Working_Environment_NoiseProtection_Type	PX201501491000	If any, which type of noise protection did you use?	4	N/A
PX201501_Height	PX201501500000	What is your height?	4	N/A
PX201501_Height_Units	PX201501500100	What is your height? Units	4	N/A
PX201501_Weight	PX201501510000	What is your weight?	4	Variable Mapping
PX201501_Weight_Units	PX201501510100	What is your weight? Units	4	Variable Mapping
PX201501_Handedness	PX201501520000	Are you left or right handed?	4	N/A
PX201501_Susceptible_To_Sunburn	PX201501530000	Are you susceptible to sunburn?	4	N/A
PX201501_Eye_Color	PX201501540000	What is the color of your eyes?	4	N/A
PX201501_Smoked_Regularly	PX201501550000	Have you ever smoked regularly?	4	N/A
PX201501_Age_Started_Smoking	PX201501550100	At which age did you start smoking?	4	N/A
PX201501_Years_Smoked	PX201501550200	For how many years did you (have you) smoke(d) up to now?	4	N/A
PX201501_Average_Number_Cigarettes_Smoked	PX201501550300	Approximately how many cigarettes do (did) you smoke on average?	4	N/A
PX201501_Average_Number_Cigars	PX201501550400	Approximately how many cigars or cigarellos do (did) you smoke on average each day?	4	N/A
PX201501_Amount_Pipe_Tobacco	PX201501550500	Approximately how much pipe tobacco (grams) do (did) you smoke each day?	4	N/A
PX201501_Drink_Alcohol_Regularly	PX201501560000	Do you drink alcohol regularly (every week)?	4	N/A
PX201501_Average_Number_Drinks	PX201501570100	How many drinks do you have on average? (A small bottle of beer - 25cl, red or white wine - 12cl, or a small glass of spirits - 4cl counts as 1 drink)	4	N/A
PX201501_Difficulty_Hearing	PX201501010000	Do you have any difficulty with your hearing?	4	N/A
PX201501_Which_Ear_Affected	PX201501010100	In which ear(s) do you have a hearing difficulty?	4	N/A
PX201501_Age_First_Noticed_Hearing_Difficulty	PX201501010200	At what age did you first notice a hearing difficulty?	4	N/A
PX201501_How_Quickly_Difficulty_Developed	PX201501010300	How quickly did your hearing difficulty develop?	4	N/A
PX201501_Reason_For_Difficulty	PX201501010400	Do you know the reason for your hearing difficulty? (if there is a separate cause for each of your ears, please note them accordingly)	4	N/A
PX201501_Reason_For_Difficulty_Describe	PX201501010401	Do you know the reason for your hearing difficulty? (if there is a separate cause for each of your ears, please note them accordingly) Describe:	4	N/A
PX201501_Hearing_Vary_Day_To_Day	PX201501010500	Does your hearing vary from day to day?	4	N/A
PX201501_Background_Noise	PX201501020000	Do you find it very difficult to follow a conversation if there is background noise (e.g. TV, radio, children playing)?	4	N/A
PX201501_Sensitive_Loud_Sounds	PX201501030000	Are you particularly sensitive to loud sounds?	4	N/A
PX201501_Fullness_In_Ears	PX201501040000	Do you sometimes feel a fullness or blockage in your ears?	4	N/A
PX201501_Tinnitus	PX201501050000	Nowadays, do you ever get noises in your head or ears (tinnitus) which usually last longer than five minutes?	4	N/A
PX201501_Disease_Caused_Hearing_Get_Worse	PX201501060000	Have you ever had an ear disease that has caused your hearing to get worse?	4	N/A
PX201501_Ear_Discharge	PX201501070000	Have you ever had discharge of blood or pus, or smelly discharge (not wax) from either ear?	4	N/A
PX201501_Ear_Operation	PX201501080000	Have you ever had an ear operation?	4	N/A
PX201501_EarOperation1_Type	PX201501080101	Write down what type of operation, or why the operation was performed	4	N/A
PX201501_EarOperation1_Which_Ear	PX201501080102	Which ear?	4	N/A
PX201501_EarOperation1_Year	PX201501080103	Which year? (approximately)	4	N/A
PX201501_EarOperation2_Type	PX201501080201	Write down what type of operation, or why the operation was performed	4	N/A
PX201501_EarOperation2_Which_Ear	PX201501080202	Which ear?	4	N/A
PX201501_EarOperation2_Year	PX201501080203	Which year? (approximately)	4	N/A
PX201501_EarOperation3_Type	PX201501080301	Write down what type of operation, or why the operation was performed	4	N/A
PX201501_EarOperation3_Which_Ear	PX201501080302	Which ear?	4	N/A
PX201501_EarOperation3_Year	PX201501080303	Which year? (approximately)	4	N/A
PX201501_EarOperation4_Type	PX201501080401	Write down what type of operation, or why the operation was performed	4	N/A
PX201501_EarOperation4_Which_Ear	PX201501080402	Which ear?	4	N/A
PX201501_EarOperation4_Year	PX201501080403	Which year? (approximately)	4	N/A
PX201501_Dizziness	PX201501090000	Have you ever suffered from attacks of dizziness in which things seem to spin around you?	4	N/A
PX201501_Unsteady_In_Dark	PX201501100000	Do you feel unsteady when walking in the dark?	4	N/A
PX201501_Mothers_Father_Country	PX201501110101	Where did your mother's father (your maternal grandfather) originate from? Specify Country	4	N/A
PX201501_Mothers_Father_Region	PX201501110102	Where did your mother's father (your maternal grandfather) originate from? Specify Region	4	N/A
PX201501_Mothers_Mother_Country	PX201501110201	Where did your mother's mother (your maternal grandmother) originate from? Specify Country	4	N/A
PX201501_Mothers_Mother_Region	PX201501110202	Where did your mother's mother (your maternal grandmother) originate from? Specify Region	4	N/A
PX201501_Fathers_Father_Country	PX201501110301	Where did your father's father (your paternal grandfather) originate from? Specify Country	4	N/A
PX201501_Fathers_Father_Region	PX201501110302	Where did your father's father (your paternal grandfather) originate from? Specify Region	4	N/A
PX201501_Fathers_Mother_Country	PX201501110401	Where did your father's mother (your paternal grandmother) originate from? Specify Country	4	N/A
PX201501_Fathers_Mother_Region	PX201501110402	Where did your father's mother (your paternal grandmother) originate from? Specify Region	4	N/A
PX201501_Mother_Have_Hearing_Problems	PX201501120000	As far as you know, does/did your mother have hearing problems?	4	N/A
PX201501_Mothers_Birth_Year	PX201501120100	What was her year of birth?	4	N/A
PX201501_Mothers_Occupation	PX201501120200	What was her occupation?	4	N/A
PX201501_Age_Mothers_Hearing_Problems_Started	PX201501120300	At what age did her hearing problems start?	4	N/A
PX201501_Cause_Of_Mothers_Hearing_Problem	PX201501120400	What is/was the cause of her hearing problem (if known)?	4	N/A
PX201501_Age_Mother_Died	PX201501130000	If she is dead, how old was she when she died?	4	N/A
PX201501_Father_Have_Hearing_Problem	PX201501140000	As far as you know does/did your father have hearing problems?	4	N/A
PX201501_Fathers_Birth_Year	PX201501140100	What was his year of birth?	4	N/A
PX201501_Fathers_Occupation	PX201501140200	What was his occupation?	4	N/A
PX201501_Age_Onset_Fathers_Hearing_Problem	PX201501140300	At what age did his hearing problems start?	4	N/A
PX201501_Cause_Of_Fathers_Hearing_Problem	PX201501140400	What is/was the cause of his hearing problems (if known)?	4	N/A
PX201501_Age_Father_Died	PX201501150000	If he is dead, how old was he when he died?	4	N/A
PX201501_Siblings_With_Normal_Hearing	PX201501160000	Do you have any brothers or sisters with normal hearing?	4	N/A
PX201501_Number_Siblings_With_Normal_Hearing	PX201501160100	Do you have any brothers or sisters with normal hearing? (how many of your brothers/sisters have normal hearing?)	4	N/A
PX201501_Siblings_With_Hearing_Difficulties	PX201501170000	Do you have any brothers or sisters with hearing difficulties?	4	N/A
PX201501_Number_Siblings_With_Hearing_Difficulties	PX201501170100	Do you have any brothers or sisters with hearing difficulties? (how many of your brothers/sisters have hearing difficulties?)	4	N/A
PX201501_Sibling1_Sex	PX201501170101	Sex	4	N/A
PX201501_Sibling1_Birth_Year	PX201501170102	Year of birth	4	N/A
PX201501_Sibling1_Age_Onset_Hearing_Difficulty	PX201501170103	Age at onset of hearing difficulties	4	N/A
PX201501_Sibling1_Cause_Of_Hearing_Difficulty	PX201501170104	Cause of hearing difficulties (if known)	4	N/A
PX201501_Sibling2_Sex	PX201501170201	Sex	4	N/A
PX201501_Sibling2_Year_Of_Birth	PX201501170202	Year of birth	4	N/A
PX201501_Sibling2_Age_Onset_Hearing_Difficulty	PX201501170203	Age at onset of hearing difficulties	4	N/A
PX201501_Sibling2_Cause_Of_Hearing_Difficulty	PX201501170204	Cause of hearing difficulties (if known)	4	N/A
PX201501_Sibling3_Sex	PX201501170301	Sex	4	N/A
PX201501_Sibling3_Birth_Year	PX201501170302	Year of birth	4	N/A
PX201501_Sibling3_Age_Onset_Hearing_Difficulty	PX201501170303	Age at onset of hearing difficulties	4	N/A
PX201501_Sibling3_Cause_Of_Hearing_Difficulty	PX201501170304	Cause of hearing difficulties (if known)	4	N/A
PX201501_Sibling4_Sex	PX201501170401	Sex	4	N/A
PX201501_Sibling4_Birth_Year	PX201501170402	Year of birth	4	N/A
PX201501_Sibling4_Age_Onset_Hearing_Difficulty	PX201501170403	Age at onset of hearing difficulties	4	N/A
PX201501_Sibling4_Cause_Of_Hearing_Difficulty	PX201501170404	Cause of hearing difficulties (if known)	4	N/A
PX201501_Children_With_Normal_Hearing	PX201501180000	Do you have any children with normal hearing?	4	N/A
PX201501_Children_With_Normal_Hearing_Number	PX201501180100	Do you have any children with normal hearing? (how many of your children have normal hearing)	4	N/A
PX201501_Children_With_Hearing_Difficulty	PX201501190000	Do you have any children with hearing difficulties?	4	N/A
PX201501_Children_With_Hearing_Difficulty_Number	PX201501190100	Do you have any children with hearing difficulties? (how many of your children have hearing difficulties?)	4	N/A
PX201501_Child1_Sex	PX201501190101	Sex	4	N/A
PX201501_Child1_Birth_Year	PX201501190102	Year of birth	4	N/A
PX201501_Child1_Age_Onset_Hearing_Difficulty	PX201501190103	Age at onset of hearing difficulties	4	N/A
PX201501_Child1_Cause_Of_Hearing_Difficulty	PX201501190104	Cause of hearing difficulties (if known)	4	N/A
PX201501_Child2_Sex	PX201501190201	Sex	4	N/A
PX201501_Child2_Birth_Year	PX201501190202	Year of birth	4	N/A
PX201501_Child2_Age_Onset_Hearing_Difficulty	PX201501190203	Age at onset of hearing difficulties	4	N/A
PX201501_Child2_Cause_Of_Hearing_Difficulty	PX201501190204	Cause of hearing difficulties (if known)	4	N/A
PX201501_Child3_Sex	PX201501190301	Sex	4	N/A
PX201501_Child3_Birth_Year	PX201501190302	Year of birth	4	N/A
PX201501_Child3_Age_Onset_Hearing_Difficulty	PX201501190303	Age at onset of hearing difficulties	4	N/A
PX201501_Child3_Cause_Of_Hearing_Difficulty	PX201501190304	Cause of hearing difficulties (if known)	4	N/A
PX201501_Child4_Sex	PX201501190401	Sex	4	N/A
PX201501_Child4_Birth_Year	PX201501190402	Year of birth	4	N/A
PX201501_Child4_Age_Onset_Hearing_Difficulty	PX201501190403	Age at onset of hearing difficulties	4	N/A
PX201501_Child4_Cause_Of_Hearing_Difficulty	PX201501190404	Cause of hearing difficulties (if known)	4	N/A
PX201501_Other_Relatives_With_Hearing_Difficulty	PX201501200000	Do you have uncles, aunts, cousins, nephews, or nieces with hearing difficulties?	4	N/A
PX201501_Other_Relatives_Participated	PX201501210000	Do you know if any of your relatives have already participated in this investigation?	4	N/A
PX201501_Other_Relative_Name	PX201501210100	Do you know if any of your relatives have already participated in this investigation? (please write down the name of your relative and the relation between you)	4	N/A
PX201501_Other_Relative_Relation	PX201501210200	Do you know if any of your relatives have already participated in this investigation? (please write down the name of your relative and the relation between you)	4	N/A
PX201501_Migraine	PX201501220000	Do you suffer from migraine?	4	N/A
PX201501_Migraine_Frequency	PX201501220100	How often do you generally have attacks?	4	N/A
PX201501_Hearing_Loss_Meningitis_Encephalitis	PX201501230000	Have you ever suffered a hearing loss from meningitis or encephalitis?	4	N/A
PX201501_Hearing_Loss_Meningitis_Encephalitis_Year	PX201501230100	Have you ever suffered a hearing loss from meningitis or encephalitis? (write down in which year(s) approximately)	4	N/A
PX201501_Whiplash	PX201501240000	Have you ever had a whiplash injury?	4	N/A
PX201501_Whiplash_Year	PX201501240100	Have you ever had a whiplash injury? (write down in which year(s) approximately)	4	N/A
PX201501_Knocked_Unconscious	PX201501250000	Have you ever been knocked unconscious (e.g., in a traffic accident, contact sport, a fight or after a fall)?	4	N/A
PX201501_Knocked_Unconscious_Year	PX201501250100	Have you ever been knocked unconscious (e.g., in a traffic accident, contact sport, a fight or after a fall)? (write down in which year(s) approximately)	4	N/A
PX201501_Heart_Attack	PX201501260000	Have you ever had a heart attack?	4	N/A
PX201501_Heart_Attack_Year	PX201501260100	Have you ever had a heart attack? (write down in which year(s) approximately)	4	N/A
PX201501_Heart_Surgery	PX201501270000	Have you ever had heart surgery?	4	N/A
PX201501_Heart_Surgery_Type	PX201501270100	What operation(s)? (Please describe)	4	N/A
PX201501_Heart_Surgery_Year	PX201501270200	In which year(s) approximately?	4	N/A
PX201501_Coronary_Artery_Catheterization	PX201501280000	Have you ever had coronary artery catheterization?	4	N/A
PX201501_Coronary_Artery_Catheterization_Intervention	PX201501280100	What type of intervention(s) (e.g., stent, balloon dilatation)?	4	N/A

The Age-Related Hearing Impairment (ARHI) Questionnaire was chosen because it has been used in a large-scale multicenter study and provides excellent possibilities for data comparisons. Additionally, it contains questions on multiple topics such as family history and exposures to noise and toxic substances in a single questionnaire.

Fransen, E., Topsakal, V., Hendrickx, J., Van Laer, L., Huyghe, J. R., Van Eyken, E., Lemkens, N., Hannula, S., Maki-Tokko, E., Jensen, M., Demeester, K., Tropitzch, A., Bonaconsa, A., Mazzoli, M., Espeso, A., Verbruggen, K., Huyghe, J., Huygen, P.L., Kunst, S., Manninen, M., Diaz-Lacava, A., Steffens, M., Wienker, T. F., Pyykko, I., Cremers, C. W. R. J., Kremer, H., Dhooge, I., Stephens, D., Orzan, E., Pfister, M., Bille, M., Parving, A., Sorri, M., Van De Heyining, P., & Van Camp, G. (2008). Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: A European population-based multicenter study. Journal of the Association for Research in Otolaryngology, 9, 264–276.

Adult

Danish, Dutch, English, Finnish, German, Italian

The Age-Related Hearing Impairment (ARHI) Questionnaire has been successfully used with an age range of 55 to 65 for unrelated samples, and 55 to 75 for family samples. The Speech and Hearing Working Group recommends that it could also be used for individuals over 75 and as young as 18.

None

Respondents will need a copy of the questionnaire.

Standard	Name	ID	Source
Common Data Elements (CDE)	Family Medical History Hearing Loss Assessment Description Text	3139286	CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)	Pers fam hx hearing loss proto	63008-7	LOINC

None

Self-administered questionnaire

None

Requirement Category	Required
Average time of greater than 15 minutes in an unaffected individual	No
Major equipment	No
Specialized requirements for biospecimen collection	No
Specialized training	No

This section will be completed when reviewed by an Expert Review Panel.