Tool · Hearing Goals & Visit Prep Builder

Hearing Goals & Visit Prep Builder

Turn vague worries like “I miss things in groups” or “listening is exhausting” into a short, clear prep sheet you can bring to your audiology or ENT visit.

5–8 minutes Works on phones, tablets, and computers Helpful for adults, caregivers, and clinicians

This tool doesn’t triage emergencies and doesn’t replace medical care. It simply organizes what you want help with so you can use your visit time well. If you’re worried about sudden changes, pain, or new dizziness, use the Care Navigator or seek urgent care instead.

Build your visit story

Check a few boxes and jot a few words. You don’t need perfect language to get help—this is just a starting point you and your clinician can edit together.

Step 1 of 5 You can always go back and change things.

Step 1

Urgent Symptoms & Safety Check

Before preparing for a routine visit, we must check for symptoms that require immediate emergency medical care or prompt ENT evaluation.

Have you or the person you’re helping experienced any of these symptoms?

Select all that apply. If none apply, check "None of these".

Sudden hearing loss within the past 3 days (≤ 72 hours) Hearing dropped rapidly or noticeably over a few hours or days.

Sudden loss with severe vertigo or numbness/weakness Spinning dizziness, unsteady balance, or facial/arm weakness.

Hearing loss following ear trauma or blast Direct hit to ear/head or sudden loud explosive exposure.

Active ear drainage, discharge, or severe ear pain Fluid, pus, or blood from the ear canal, or intense pain.

Rapid progression or fluctuating hearing over weeks Hearing changes week to week with ear fullness or episodes.

Persistent ringing or buzzing in one ear only Unilateral tinnitus without ringing in the other ear.

Noticeable asymmetry between your ears One ear hears substantially worse than the other ear.

None of these — changes have been gradual No sudden drops, severe pain, drainage, or acute spinning vertigo.

Step 2

Who are you filling this out for?

This tells the clinician whose voice this summary is trying to reflect.

Myself I’m getting ready for my own visit.

An older adult family member I’m helping a parent, grandparent, or older relative.

Someone I support Partner, friend, adult child, or other person I help.

Clinician using this with a patient I’m an audiologist, ENT, or other clinician filling this out in care.

Tip: Many caregivers and clinicians use “I” language in the visit, even if they helped fill this out.

Step 3

Biggest listening situations that matter right now

Pick the situations where it would feel meaningful to have things go even a little bit better.

Where is listening hardest or most important?

Choose as many as apply. If nothing fits, use “Other.”

Work meetings & professional conversations In-person, remote, or hybrid.

Classes, trainings, or school Classroom, lectures, or group learning.

Family dinners & holidays Multi-talker conversations at home.

Restaurants & noisy places Cafés, parties, or background noise.

Phone calls Regular calls, work calls, family calls.

Video calls & telehealth Zoom, Teams, FaceTime, or video visits.

TV, movies, & streaming Needing captions, high volume, or volume conflicts.

Outdoors & safety Traffic, alarms, sirens, hearing someone call.

One-on-one in quiet Even quiet, simple chats take significant work.

Other important situations Anything else that really matters to you.

In your own words, what feels most important to improve?

A sentence or two is plenty: “I’d love to follow group conversations at work without pretending,” for example.

Step 4

Communication Burden Screen (HHI-S)

The Hearing Handicap Inventory (HHI-S) is a validated 10-item clinical tool measuring the functional and emotional impact of hearing difficulties on daily life (adapted from Newman et al. 1990 and Ventry & Weinstein 1982). Scores range from 0 to 40 (Mild: 0–8, Moderate: 10–24, Severe: 26–40). Note: This measures perceived functional communication burden and daily lifestyle impact, not audiometric hearing loss thresholds.

1. Does a hearing problem cause you to use the phone less often than you would like?

Yes (4)

Sometimes (2)

No (0)

2. Does a hearing problem cause you to feel embarrassed when meeting new people?

Yes (4)

Sometimes (2)

No (0)

3. Does a hearing problem cause you to avoid groups of people?

Yes (4)

Sometimes (2)

No (0)

4. Does a hearing problem make you irritable or frustrated?

Yes (4)

Sometimes (2)

No (0)

5. Does a hearing problem cause you difficulty when talking to family members?

Yes (4)

Sometimes (2)

No (0)

6. Does a hearing problem cause you difficulty when attending parties or gatherings?

Yes (4)

Sometimes (2)

No (0)

7. Does a hearing problem cause you to feel limited or held back in life?

Yes (4)

Sometimes (2)

No (0)

8. Does a hearing problem cause you difficulty when visiting friends or neighbors?

Yes (4)

Sometimes (2)

No (0)

9. Does a hearing problem cause you to feel left out of conversations?

Yes (4)

Sometimes (2)

No (0)

10. Does a hearing problem cause you difficulty in restaurants or noisy places?

Yes (4)

Sometimes (2)

No (0)

What other day-to-day impacts show up?

Pick anything that sounds familiar—even if it doesn’t happen every day.

Missing words or pieces Catching only parts of sentences.

Needing repeats Asking “what?” or “huh?” frequently.

Listening fatigue Exhausted from listening by day's end.

Headaches or stress Tension or strain after listening.

Worry about job or school Fear of missing info or being judged.

Tension in relationships Conflicts around communication at home.

Anything you wish your clinician really understood about your experience?

For example: “I feel guilty asking my partner to repeat” or “I’m exhausted by 3pm.”

Step 5

What’s already been tried, and what support feels realistic?

This helps your clinician see the bigger picture and match next steps to where you are right now.

What has been tried so far?

Check anything that applies—even if it didn’t work or was used briefly.

Hearing test / audiogram At any clinic or screening program.

Hearing aids (current) Fitted by an audiologist or dispenser.

Hearing aids (past) Stopped using them or in a drawer.

OTC devices / amplifiers Retail, pharmacy, or online devices.

Cochlear / other implants Evaluations, consultations, or surgery.

Bone-anchored / CROS For single-sided or conductive loss.

Communication strategies Facing talkers, lighting, turn-taking.

Apps & captions Live transcription, captioned calls.

Nothing yet This visit is the starting point.

What kind of support feels realistic right now?

You don’t have to do everything at once. It’s okay to ask for small, paced steps.

Ready to talk about devices Explore hearing aids, implants, or accessories.

Start with strategies & education Want tips, realistic expectations, and coaching.

Feeling overwhelmed Need 1–2 small doable steps, not an overhaul.

Caregiver / partner support Guidance on how family can communicate better.

Anything else about support, pacing, or timing?

For example: “Cost is a major worry,” “I can’t travel often,” or “I want to move slowly.”

Hearing Goals & Visit Prep Builder – Visit Summary

Generated from the UCSF EARS Hearing Goals & Visit Prep Builder to help organize concerns and questions for this visit.

Your visit prep sheet

This draft updates as you answer questions on the left. You don’t need perfect words—this just helps you and your clinician start in the right place.

Draft · You can edit

Perspective: An adult filling this out for themselves.

Communication Burden (HHI-S) 0 / 40

Mild Communication Burden

Hearing difficulties cause minimal daily friction. Focus on communication strategies, smartphone features, and environmental habits.

Standard: HHI-S reflects perceived functional and emotional communication burden in daily life, not decibel hearing loss on an audiogram.

What I most want help with is…

Getting a clearer picture of how hearing is affecting everyday life and what realistic next steps might help.

As you select situations and worries on the left, this line will update in your own words. It’s okay if it feels imperfect—your clinician can tweak the language with you.

Top goals for this visit

Based on the selections and notes above, these are the main things to focus on today:

Understand how current hearing levels connect to everyday listening challenges, especially in key situations.
Explore a mix of tools—devices, strategies, and education—that could reduce listening effort or feeling left out.
Leave with 1–3 concrete, realistic “next steps” to try before the next visit.

You can cross things out, rewrite, or add notes by hand. This page belongs to you.

Questions I plan to ask

These questions are generated from what you selected. During the visit, you can check off the ones you’ve discussed and add new ones.

Could we review any past or recent hearing tests and connect them to the situations described, especially in noise?
Are there options beyond hearing aids—like remote microphones, captioning tools, or phone features—that might fit the situations that matter most?
What communication strategies or environmental changes do you recommend to reduce listening effort day to day?
Given this hearing pattern, how often should monitoring or repeat testing happen?
Are there classes, online resources, or programs you recommend for learning communication strategies or self-advocacy?

You don’t have to ask every question. Circle the ones that feel most important and skip or modify the rest.

For your clinician

This page was generated by the UCSF EARS Hearing Goals & Visit Prep Builder, an educational tool designed to help patients, families, and clinicians organize concerns and questions ahead of a visit.

It does not provide a diagnosis, determine candidacy for any device or procedure, or replace clinical evaluation. Please interpret this information within your own clinical judgment and the patient’s history and exam.

Next steps you can explore later

These UCSF EARS tools and articles can help you go deeper after today’s visit:

If the list above looks short, that’s okay—your clinician can help you choose what to focus on first.

Suggested Next Steps

Prepare for Your Appointment

Get personalized questions and conversation guides for your visit with an audiologist.

Use Hearing Coach →

Explore Hearing Devices

Compare OTC devices, prescription hearing aids, cochlear implants, and assistive technology.

Explore Devices →

Urgent Symptoms?

Sudden hearing loss in 72 hours, severe dizziness, or ear pain requires prompt medical evaluation.

Emergency Guide →

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Medical Disclaimer: This resource is developed by UCSF Audiology for educational and informational purposes only. It does not substitute for clinical medical advice, formal diagnosis, or treatment recommendations. Always consult a licensed audiologist, otolaryngologist (ENT physician), or primary care doctor regarding hearing health decisions. If you experience sudden hearing loss (within 24–72 hours), severe acute vertigo, or ear trauma, seek immediate medical evaluation at an emergency department or urgent care clinic.