LOUD SOUNDS SURVEY

This short survey is part of a research project from Boston University. It asks about loud sounds/noises you encounter in your life.

Your reply is anonymous.

 

ABOUT YOU...

1. YOUR AGE:

2. MALE   FEMALE

3. YOUR EDUCATION:
In middle- or high- school now Finished high school
1-4 years of college Post-graduate work or degree(s)

 

ABOUT YOUR EXPOSURE TO LOUD SOUND...


4. WHAT IS THE SINGLE MOST MAJOR SOURCE OF LOUD SOUND/NOISE IN YOUR LIFE?
Music Music—headphones Hunting or shooting
Power tools Street noise Power boats or jetskis
Car racing Heavy machinery Motorcycles
If none of the above, please write in your major source of loud sound here:

4a. Do you have more than one significant source of loud sound in your life? If so, please list the secondary source(s) here.
Music Music—headphones Hunting or shooting
Power tools Street noise Power boats or jetskis
Car racing Heavy machinery Motorcycles
If your secondary loud sound source(s) is not listed, please write it in:

 

5. YOUR EXPOSURE TO LOUD SOUND/NOISE IS FROM:
Work      Leisure     Both

6. YOUR EXPOSURE TO LOUD SOUND/NOISE IS:
Every day Almost every day Occasional (varies greatly)

7. APPROXIMATE AMOUNT OF CONTINUOUS EXPOSURE TO LOUD SOUND—WITHOUT A QUIET BREAK:
Less than 1/2 hour at a time 1/2 to one hour at a time
One to two hours at a time Two to four hours at a time
Four to six hours at a time Six to eight hours at a time, or more

 

ABOUT YOUR MAJOR SOURCE OF LOUD SOUND...

8. PLEASE DESCRIBE THE FEELING YOU GET FROM THE SOUND YOU LISTED AS YOUR MAJOR SOURCE OF LOUD SOUND (QUESTION 4):

Great!

Good

Indifferent (neutral)

Bad

Terrible!

It varies: sometimes it's good, sometimes it's bad

Please check one of the six buttons above. If you wish to describe the feeling in more detail, use this space as well:

 

NOW: PLEASE IMAGINE TALKING WITH SOMEONE IN THE PRESENCE OF YOUR MAJOR LOUD SOUND.

9. PLEASE SELECT THE BEST DESCRIPTION OF THE EFFORT REQUIRED FOR CONVERSATION IN THE PRESENCE OF THE LOUD SOUND.

Conversation is the same as in a quiet environment.

The sound makes conversation slightly more difficult than in a quiet environment.
The sound makes conversation much more difficult, compared to a quiet environment.
The sound makes conversation extremely difficult—except short, shouted commands and questions.
The sound makes conversation impossible.

 

10. PLEASE RATE THE EFFORT REQUIRED FOR CONVERSATION IN THE PRESENCE OF THE LOUD SOUND, COMPARED TO CONVERSATIONAL EFFORT IN QUIET.
Same as in quiet 1.5 times as much effort Twice as much effort
2.5 times as much effort 3 times as much effort 3.5 times as much effort
4 times as much effort 5 times as much effort 10 times as much effort

 

ABOUT YOUR HEARING...

11. DO YOU EXPERIENCE TINNITUS (ROARING, RINGING, BUZZING, HISSING, MUFFLED SOUND, OR HIGH-PITCHED NOISE IN EARS) AFTER EXPOSURE TO LOUD SOUND?
Rarely or never A few times per year
About once a month More than once a month

 


12. DO YOUR EARS HURT AFTER EXPOSURE TO LOUD SOUND?
Rarely or never A few times per year
About once a month More than once a month

13. HAS YOUR HEARING DECREASED AS A RESULT OF EXPOSURE TO LOUD SOUND?
I am sure it has decreased I am sure it has not changed
I think it has decreased I think it has not changed

 

14. DO YOU WEAR EARPLUGS OR OTHER HEARING PROTECTION WHEN YOU ARE EXPOSED TO LOUD SOUND?
Rarely or never Sometimes
Usually Always

 

15. DO YOU BELIEVE LOUD SOUND CAN DAMAGE YOUR HEARING PERMANENTLY?
Yes  No I am not sure


16. OTHER COMMENTS ABOUT LOUD SOUND OR NOISE, OR ABOUT THIS FORM?

Clicking "send this form" gives us permission to add your anonymous responses to our database, which may be used for publication or public presentation. Some of the questions are required in order to use your information. If you have skipped any required questions you will get a message asking you to go back and complete them. Thank you!