Speech Spatial Qualities
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Speech Spatial Qualities. Advice about answering the questions. Please answer the following questions, then go on to the questions about your hearing. The following questions inquire about aspects of your ability and experience hearing and listening in different situations.

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Speech Spatial Qualities

Advice about answering the questions

Please answer the following questions, then go on to the questions about your hearing

The following questions inquire about aspects of your ability and experience hearing and listening in different situations.

For each question, put a mark, such as a cross (x), anywhere on the scale shown against each question that runs from 0 through to 10. Putting a mark at 10 means that you would be perfectly able to do or experience what is described in the question. Putting a mark at 0 means you would be quite unable to do or experience what is described.

As an example, question 1 asks about having a conversation with someone while the TV is on at the same time. If you are well able to do this then put a mark up toward the right-hand end of the scale. If you could follow about half the conversation in this situation put the mark around the mid-point, and so on.

We expect that all the questions are relevant to your everyday experience, but if a question describes a situation that does not apply to you, put a cross in the “not applicable” box. Please also write a note next to that question explaining why it does not apply in your case.

Your name :

Today’s date :

Your age:

Please check one of these options:

I have no hearing aid/s

I use one hearing aid (leftear )

I use one hearing aid (rightear)

I use two hearing aids (bothears)

If you have been using hearing aid/s, for how long?

______ years

______ months

or

_____ weeks

If you have two aids and have used them for different lengths of time, please write down both.

SSQ 5.6 page 1


Speech Spatial Qualities (Part 1: Speech hearing)

Not at all

Not at all

Not at all

Not at all

Not at all

Perfectly

Perfectly

Perfectly

Perfectly

Perfectly

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 2


Speech Spatial Qualities (Part 1: Speech hearing, continued)

Not at all

Not at all

Not at all

Not at all

Not at all

Perfectly

Perfectly

Perfectly

Perfectly

Perfectly

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 3


Speech Spatial Qualities (Part 1: Speech hearing, continued)

Not at all

Not at all

Not at all

Not at all

Perfectly

Perfectly

Perfectly

Perfectly

Not applicable

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 4


Speech Spatial Qualities (Part 2: Spatial hearing)

Not at all

Not at all

Not at all

Not at all

Not at all

Perfectly

Perfectly

Perfectly

Perfectly

Perfectly

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 5


Speech Spatial Qualities (Part 2: Spatial hearing, continued)

Not at all

Not at all

Not at all

Not at all

Not at all

Perfectly

Perfectly

Perfectly

Perfectly

Perfectly

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 6


Speech Spatial Qualities (Part 2: Spatial hearing, continued)

Not at all

Not at all

Not at all

Perfectly

Perfectly

Perfectly

Not applicable

Not applicable

Not applicable

Inside my head

Out there

Not applicable

Much closer

Not closer

Not applicable

SSQ 5.6 page 7


Speech Spatial Qualities (Part 2: Spatial hearing, continued)

Much further

Not at all

Not further

Perfectly

Not applicable

Not applicable

SSQ 5.6 page 8


Speech Spatial Qualities (Part 3: Qualities of hearing) continued)

Not at all

Jumbled

Not at all

Not at all

Not at all

Not jumbled

Perfectly

Perfectly

Perfectly

Perfectly

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 9


Speech Spatial Qualities (Part 3: Qualities of hearing, continued)

Not at all

Not at all

Not at all

Not at all

Not at all

Perfectly

Perfectly

Perfectly

Perfectly

Perfectly

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 10


Speech Spatial Qualities (Part 3: Qualities of hearing, continued)

Concentrate hard

Lots of effort

Unnatural

Not at all

Not at all

Not need to concentrate

Natural

Perfectly

No effort

Perfectly

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 11


Speech Spatial Qualities (Part 3: Qualities of hearing, continued)

Not at all

Not at all

Perfectly

Perfectly

Not easily ignore

Easily ignore

Not applicable

Not applicable

Not applicable

SSQ 5.6 page 12


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