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Protocol - Personal and Family History of Hearing Loss

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Description:

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.

Protocol:

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.

a. Write down what type of operation, or why the operation was performed

b. Which ear?

c. Which year? (approximately)

8.1.

[] left ear

[] right ear

8.2.

[] left ear

[] right ear

8.3.

[] left ear

[] right ear

8.4.

[] left ear

[] right ear

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.**

a. Sex

b. Year of birth

c. Age at onset of hearing difficulties

d. Cause of hearing difficulties (if known)

17.1.

[] M
[] F

17.2.

[] M
[] F

17.3.

[] M
[] F

17.4.

[] M
[] F

** 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.**

a. Sex

b. Year of birth

c. Age at onset of hearing difficulties

d. Cause of hearing difficulties (if known)

19.1.

[] M
[] F

19.2.

[] M
[] F

19.3.

[] M
[] F

19.4.

[] M
[] F

** 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)

[ ] 2-5 tablets a week

[ ] 2-5 tablets a day

[ ] 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.

Type of Weapon

44.1. Estimate the total number of shots fired

44.2. Did you use ear protection?

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

Light weapons

(rifles/shotguns)

[ ] less than 10 shots
[ ] 10–100 shots
[ ] 101–1,000 shots
[ ] 1,001–10,000 shots
[ ] more than 10,000 shots
[ ] always
[ ] most of the time
[ ] more than 50% of the time
[ ] less than 50% of the time
[ ] never
[ ] plugs
[ ] earmuff
[ ] 'active' protection
[ ] several

Heavy weapons

(artillery/bazookas)

[ ] less than 10 shots
[ ] 10–100 shots
[ ] 101–1,000 shots
[ ] 1,001–10,000 shots
[ ] more than 10,000 shots
[ ] always
[ ] most of the time
[ ] more than 50% of the time
[ ] less than 50% of the time
[ ] never
[ ] plugs
[ ] earmuff
[ ] 'active' protection
[ ] several

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.

Protocol Name from Source:

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

Availability:

Publicly available

Personnel and Training Required
None
Equipment Needs
Respondents will need a copy of the questionnaire.
Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Life Stage:

Adult

Participants:

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.

Specific Instructions:
None
Selection Rationale

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.

Language

Danish, Dutch, English, Finnish, German, Italian

Standards
StandardNameIDSource
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
Derived Variables

None

Process and Review

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

Source

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.

General References

None

Protocol ID:

201501

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX201501_Age_Father_Died PX201501150000 If he is dead, how old was he when he died? 4 N/A
PX201501_Age_First_Noticed_Hearing_Difficulty PX201501010200 At what age did you first notice a hearing difficulty? 4 N/A
PX201501_Age_Mothers_Hearing_Problems_Started PX201501120300 At what age did her hearing problems start? 4 N/A
PX201501_Age_Mother_Died PX201501130000 If she is dead, how old was she when she died? 4 N/A
PX201501_Age_Onset_Fathers_Hearing_Problem PX201501140300 At what age did his hearing problems start? 4 N/A
PX201501_Age_Started_Smoking PX201501550100 At which age did you start smoking? 4 N/A
PX201501_Allergy PX201501340600 Allergy 4 N/A
PX201501_Amount_Pipe_Tobacco PX201501550500 Approximately how much pipe tobacco (grams) do (did) you smoke each day? 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_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_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_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_Behcets_Syndrome PX201501351000 Behcet's syndrome 4 N/A
PX201501_Blood_Diseases PX201501341200 Blood diseases 4 N/A
PX201501_Cancer PX201501390000 Have you had 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_Cancer_Type PX201501390100 Which kind of cancer or leukaemia? 4 Variable Mapping
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_Cause_Of_Fathers_Hearing_Problem PX201501140400 What is/was the cause of his hearing problems (if known)? 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_Child1_Age_Onset_Hearing_Difficulty PX201501190103 Age at onset of hearing difficulties 4 N/A
PX201501_Child1_Birth_Year PX201501190102 Year of birth 4 N/A
PX201501_Child1_Cause_Of_Hearing_Difficulty PX201501190104 Cause of hearing difficulties (if known) 4 N/A
PX201501_Child1_Sex PX201501190101 Sex 4 N/A
PX201501_Child2_Age_Onset_Hearing_Difficulty PX201501190203 Age at onset of hearing difficulties 4 N/A
PX201501_Child2_Birth_Year PX201501190202 Year of birth 4 N/A
PX201501_Child2_Cause_Of_Hearing_Difficulty PX201501190204 Cause of hearing difficulties (if known) 4 N/A
PX201501_Child2_Sex PX201501190201 Sex 4 N/A
PX201501_Child3_Age_Onset_Hearing_Difficulty PX201501190303 Age at onset of hearing difficulties 4 N/A
PX201501_Child3_Birth_Year PX201501190302 Year of birth 4 N/A
PX201501_Child3_Cause_Of_Hearing_Difficulty PX201501190304 Cause of hearing difficulties (if known) 4 N/A
PX201501_Child3_Sex PX201501190301 Sex 4 N/A
PX201501_Child4_Age_Onset_Hearing_Difficulty PX201501190403 Age at onset of hearing difficulties 4 N/A
PX201501_Child4_Birth_Year PX201501190402 Year of birth 4 N/A
PX201501_Child4_Cause_Of_Hearing_Difficulty PX201501190404 Cause of hearing difficulties (if known) 4 N/A
PX201501_Child4_Sex PX201501190401 Sex 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_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_Cogans_Syndrome PX201501350900 Cogan's syndrome 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
PX201501_Coronary_Artery_Catheterization_Year PX201501280200 In which year(s) approximately? 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_Describe_Disease PX201501341400 Please describe your disease(s): 4 N/A
PX201501_Diabetes PX201501330000 Do you suffer from diabetes? 4 N/A
PX201501_Difficulty_Hearing PX201501010000 Do you have any difficulty with your hearing? 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_Dizziness PX201501090000 Have you ever suffered from attacks of dizziness in which things seem to spin around you? 4 N/A
PX201501_Drink_Alcohol_Regularly PX201501560000 Do you drink alcohol regularly (every week)? 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_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_Epilepsy PX201501340400 Epilepsy 4 N/A
PX201501_Ever_Fired_Gun PX201501440000 Have you ever fired a gun? 4 N/A
PX201501_Eye_Color PX201501540000 What is the color of your eyes? 4 N/A
PX201501_Fathers_Birth_Year PX201501140100 What was his year of birth? 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_Fathers_Occupation PX201501140200 What was his occupation? 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_Fullness_In_Ears PX201501040000 Do you sometimes feel a fullness or blockage in your ears? 4 N/A
PX201501_Handedness PX201501520000 Are you left or right handed? 4 N/A
PX201501_Hashimoto_Thyroiditis PX201501350800 Hashimoto thyroiditis 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_Hearing_Vary_Day_To_Day PX201501010500 Does your hearing vary from day to day? 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_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_Heavy_Weapons_Number_Shots PX201501440400 Heavy weapons (artillery/bazookas). Estimate the total number of shots fired. 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_How_Quickly_Difficulty_Developed PX201501010300 How quickly did your hearing difficulty develop? 4 N/A
PX201501_Inflammatory_Bowel_Disease PX201501350200 Inflammatory bowel disease (Crohn's disease / colitis ulcerosa) 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_Kidney_Disease PX201501340800 Kidney diseases 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_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_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_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_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_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_Light_Weapons_Number_Shots PX201501440100 Light weapons (rifles/shotguns). Estimate the total number of shots fired. 4 N/A
PX201501_Liver_Diseases PX201501340900 Liver diseases 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_Company PX201501490101 Please give the name of the company 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_HoursPerDay PX201501490700 How many hours per day were you exposed to noise? 4 N/A
PX201501_Loud_Working_Environment_Job PX201501490100 Please describe the job 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_NoiseLevel PX201501490500 What was the noise level (if you are aware of it) in dB? 4 N/A
PX201501_Loud_Working_Environment_NoiseProtection_Type PX201501491000 If any, which type of noise protection did you use? 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_Use_NoiseProtection PX201501490900 Did you use noise protection? 4 N/A
PX201501_Loud_Working_Environment_Years PX201501490400 How many years have you been doing this job? 4 N/A
PX201501_Lung_Problems PX201501340500 Lung problems 4 N/A
PX201501_Lupus PX201501350300 Lupus erythematosus 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_Mothers_Birth_Year PX201501120100 What was her year of birth? 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_Mothers_Occupation PX201501120200 What was her occupation? 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_Multiple_Sclerosis PX201501340300 Multiple sclerosis (MS) 4 N/A
PX201501_Need_Insulin PX201501330100 Do you need insulin? 4 Variable Mapping
PX201501_Nephritis PX201501350700 Nephritis 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_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_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_HoursPerDay PX201501470400 For how many hours per day were you exposed to 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_Type PX201501470100 Which solvents? 4 N/A
PX201501_Occupational_Exposure_To_Solvents_Years PX201501470300 For how many years were you exposed to solvents? 4 N/A
PX201501_Osteoarthritis PX201501340200 Osteoarthritis 4 N/A
PX201501_Osteoporosis PX201501340100 Osteoporosis 4 N/A
PX201501_Other_Autoimmune_Diseases PX201501351100 Other autoimmune diseases 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_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_Relatives_Participated PX201501210000 Do you know if any of your relatives have already participated in this investigation? 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_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_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_Painkiller_Frequency PX201501410000 On average how often do you take painkillers? 4 N/A
PX201501_Psoriasis PX201501350400 Psoriasis 4 N/A
PX201501_Psychiatric_Problems PX201501341100 Psychiatric problems 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_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_Regular_Medication10_Duration PX201501433000 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_Medication1_Duration PX201501430300 Duration of treatment 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_Medication2_Duration PX201501430600 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_Medication3_Duration PX201501430900 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_Medication4_Duration PX201501431200 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_Medication5_Duration PX201501431500 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_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_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_Medication7_Duration PX201501432100 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_Medication8_Duration PX201501432400 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_Medication9_Duration PX201501432700 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_Rheumatoid_Arthritis PX201501350100 Rheumatoid arthritis (rheumatism) 4 N/A
PX201501_Sensitive_Loud_Sounds PX201501030000 Are you particularly sensitive to loud sounds? 4 N/A
PX201501_Sibling1_Age_Onset_Hearing_Difficulty PX201501170103 Age at onset of hearing difficulties 4 N/A
PX201501_Sibling1_Birth_Year PX201501170102 Year of birth 4 N/A
PX201501_Sibling1_Cause_Of_Hearing_Difficulty PX201501170104 Cause of hearing difficulties (if known) 4 N/A
PX201501_Sibling1_Sex PX201501170101 Sex 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_Sibling2_Sex PX201501170201 Sex 4 N/A
PX201501_Sibling2_Year_Of_Birth PX201501170202 Year of birth 4 N/A
PX201501_Sibling3_Age_Onset_Hearing_Difficulty PX201501170303 Age at onset of hearing difficulties 4 N/A
PX201501_Sibling3_Birth_Year PX201501170302 Year of birth 4 N/A
PX201501_Sibling3_Cause_Of_Hearing_Difficulty PX201501170304 Cause of hearing difficulties (if known) 4 N/A
PX201501_Sibling3_Sex PX201501170301 Sex 4 N/A
PX201501_Sibling4_Age_Onset_Hearing_Difficulty PX201501170403 Age at onset of hearing difficulties 4 N/A
PX201501_Sibling4_Birth_Year PX201501170402 Year of birth 4 N/A
PX201501_Sibling4_Cause_Of_Hearing_Difficulty PX201501170404 Cause of hearing difficulties (if known) 4 N/A
PX201501_Sibling4_Sex PX201501170401 Sex 4 N/A
PX201501_Siblings_With_Hearing_Difficulties PX201501170000 Do you have any brothers or sisters with hearing difficulties? 4 N/A
PX201501_Siblings_With_Normal_Hearing PX201501160000 Do you have any brothers or sisters with normal hearing? 4 N/A
PX201501_Skin_Diseases PX201501341000 Skin diseases 4 N/A
PX201501_Smoked_Regularly PX201501550000 Have you ever smoked regularly? 4 N/A
PX201501_Stomach_Intestines PX201501340700 Diseases of the stomach or intestines 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_Susceptible_To_Sunburn PX201501530000 Are you susceptible to sunburn? 4 N/A
PX201501_Thyroid_Diseases PX201501341300 Diseases of the thyroid gland 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_Unsteady_In_Dark PX201501100000 Do you feel unsteady when walking in the dark? 4 N/A
PX201501_Vasculitis PX201501350600 Vasculitis 4 N/A
PX201501_Wegeners_Granulomatosis PX201501350500 Wegener's granulomatosis 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_Which_Ear_Affected PX201501010100 In which ear(s) do you have a hearing difficulty? 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_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_Years_Smoked PX201501550200 For how many years did you (have you) smoke(d) up to now? 4 N/A
Research Domain Information
Measure Name:

Personal and Family History of Hearing Loss

Release Date:

October 20, 2010

Definition

This measure is a questionnaire to assess risk factors related to hearing loss.

Purpose

This measure can be used to assess familial, environmental, and other risk factors related to hearing loss.

Keywords

Family history, Clinical history, Exposure history, Age-Related Hearing Impairment Questionnaire, ARHI, Hearing impairment, Hearing difficulty, Noise, Ear disease, Balance, Operation, Surgery, Exposure, Tinnitus, Risk factors, Speech and Hearing