CDC Surveillance Survey Questions on Hearing Loss
CDC gathers surveillance information related to hearing loss to learn more about its incidence and prevalence; assess progress on national goals; as well as help stakeholders make science-based, data-driven decisions.
The following four surveys each have different objectives, as CDC and the Office of Management and Budget do not want to duplicate efforts while surveying United States respondents.
The Behavioral Risk Factor Surveillance System (BRFSS) is a cross-sectional survey used to collect state and local data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. BRFSS is used as a tool for targeting and building health promotion activities in the United States and its territories.
The National Health and Nutrition Examination Survey (NHANES) is a program of studies that combines interviews and physical examinations (including audiological testing) to assess the health and nutritional status of adults and children in the United States.
The National Health Interview Survey (NHIS) is a large-scale household interview survey that collects data on health status, health care access, and progress toward achieving national health objectives. NHIS collects information on self-reported hearing ability each year and periodically includes more extensive information on noise exposure and hearing.
The National Survey of Family Growth (NSFG) gathers information on family life, marriage, divorce, pregnancy, infertility, contraceptives, men’s health, and women’s health. Survey results are used to plan health services and health education programs, and to do statistical studies of families, fertility, and health.
BRFSS is a telephone survey; the other three surveys are face to face. NHANES had the most extensive questions on hearing in the audiometry questionnaire (link above). The BRFSS disability question is in line with HHS guidance on data collection standards for race, ethnicity, sex, primary language, and disability status. NSFG is an abbreviated version of the HHS disability question. The NHIS hearing loss questions are from the Washington Group of Disability Statistics.
Other Disability and Hearing Loss Data Sources
- The National Center on Birth Defects and Disability (NCBDDD) houses the Disability and Health Data System (DHDS) an online source of state-level data on adults with disabilities, which displays data from BRFSS including serious difficulty hearing or deafness.
- Annual screening, diagnostic, and intervention data for the Early Hearing Detection and Intervention (EHDI) program is also published on the NCBDDD website.
The table below shows disability question(s) on hearing loss.
| Survey | Questions | Response | Mode of Data Collection |
|---|---|---|---|
| Behavioral Risk Factor Surveillance System | Some people who are deaf or have serious difficulty hearing use assistive devices to communicate by phone.
Are you deaf or do you have serious difficulty hearing? |
1 Yes 2 No 7 Don’t know / Not sure 9 Refused |
Telephone Survey |
| National Health and Nutrition Examination Survey | These next questions are about your hearing. Which statement best describes your hearing (without a hearing aid, personal sound amplifier, or other listening devices)? Would you say your hearing is excellent, good, that you have a little trouble, moderate trouble, a lot of trouble, or deaf?See all other NHANES Audiometry questions in the web link https://wwwn.cdc.gov/nchs/data/nhanes/2019-2020/questionnaires/AUQ_K.pdf |
1 Excellent 2 Good 3 A little trouble 4 Moderate hearing trouble 5 A lot of trouble 6 Dear 77 Refused 99 Don’t know |
Face to Face |
| National Health Interview Survey | Do you use a hearing aid? | 1 Yes 2 No 7 Don’t know 9 Refused |
Face to Face |
| How often do you use your hearing aid(s)? Would you say all of the time, some of the time, rarely, or never? | 1 All of the time 2 Some of the time 3 Rarely 4 Never 7 Refused 9 Don’t know |
||
| Do you have difficulty hearing ^HEARAID? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all? | 1 No difficulty 2 Some difficulty 3. A lot of Difficulty 7 Cannot do at all Refused 9 Don’t Know |
||
| National Survey of Family Growth | The following questions are about other health problems or impairments you have.
Do you have serious difficulty hearing? |
1 Yes 5 No |
Face to Face |
Washington Group Short Set on Functioning (WG-SS)
More information on the WG-SS source of hearing questions used in these data collections can be found at Washington Group on Disability Statistics Short Set on Functioning (WG-SS)external icon.
The National Health Interview Survey (NHIS) is a nationally representative, cross-sectional household interview survey conducted annually. The sample includes interviews completed each year with about 30,000 adults aged 18 years and over, and about 9,000 children aged 0–17 years. The last public-use data release occurred in September of 2020 and included hearing data collected in 2019.
NHIS asks a set of hearing-related questions of both the sample adult and sample child as part of the annual core questionnaire (i.e., questions are asked each year). The sample adult and sample child questions, taken from the Washington Group Short Set on Functioning (WG-SS), are shown below.
Hearing-related questions asked of sample adults aged 18 and older:
- Do you use a hearing aid? Yes/No
If yes: How often do you use your hearing aid(s)? Would you say all of the time, some of the time, rarely, or never?
- Do you have difficulty hearing, even when using your hearing aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
Hearing-related questions asked of sample children* aged 2–17:
- Does <fill: sample child’s name> use a hearing aid? Yes/No
- When using his/her/their hearing aid(s), does <fill: sample child’s name> have difficulty hearing sounds like people’s voices or music? Would you say no difficulty, some difficulty, a lot of difficulty, or cannot do this at all?
*A knowledgeable adult, usually a parent, answers for the sample child.
Note that a supplement on hearing and balance to be sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) is scheduled for 2023, but specific details of the content are not available at this time.
More information on the NHIS can be found at NHIS – National Health Interview Survey (cdc.gov), and data and documentation for the 2019 public-use release can be found at NHIS – 2019 NHIS (cdc.gov).
The National Survey of Family Growth (NSFG) is a household population survey representative of the U.S. population aged 15–49 years. The survey is conducted continuously, with the last data collection period occurring 2011–2019 and four sets of 2-year public-use data files released during that time. The last public-use data release occurred in October 2020 and included data collected from September 2017 to September 2019 on 11,347 respondents aged 15–49 (6,141 women and 5,206 men).
NSFG collects data on hearing from all survey participants.
In the October 2020 NSFG release, as in all NSFG surveys over the past decade, data on hearing was captured using a single item adapted from the six-item American Community Survey disability question set.
2011–2019 hearing-related question asked of sample respondents aged 15–49:
Do you have serious difficulty hearing? Yes/No
Beginning in January 2022, NSFG will be using the Washington Group Short Set on Functioning (WG-SS).
Hearing-related question asked of sample respondents aged 15-49:
Do you have difficulty hearing, even when using your hearing aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
NSFG is tentatively expecting to release the first 2-year file based on 2022–2023 data in Winter 2024. More information on the NSFG can be found at https://www.cdc.gov/nchs/nsfg/index.htm
The National Health and Nutrition Examination Survey (NHANES) is designed to assess the health and nutritional status of adults and children in the United States. Surveys were conducted on a periodic basis from 1960 to 1994. In 1999, NHANES became continuous and sampled about 5,000 persons each year. Public use data have been released on a biannual basis. Hearing measures have been included in the health examination surveys since 1960s.
The last public-use data release occurred between February and December of 2020 for data collected 2017–2018. These hearing questionnaire data were released to the public in July of 2020. The last public-use data on the hearing examination were collected 2015–2016 and released to the public in November and December of 2019. The hearing examination data collected 2017–2018 have not been released to the public.
Hearing questionnaire data collected 2017–2018 (available to the public):
Hearing questions were asked in the home by trained interviewers using the Computer-Assisted Personal Interview (CAPI) system. Persons 16 years of age and older and emancipated minors were interviewed directly. A proxy provided information for survey participants who were under 16 years of age and for participants who could not answer the questions themselves (a proxy for children under 16 years was usually a parent).
Survey participants aged 1 year and older were asked a question about the general hearing status (excellent, good, a little trouble, moderate hearing trouble, a lot of trouble, deaf).
Survey participants aged 6–19 years and 70 years and older (matching age groups for the hearing examination data collection) were further asked questions on the below topics.
Participants aged 6–19 or 70+ years with hearing trouble:
The Gallaudet Hearing Scale four questions
Age when began to have hearing loss
Main causes of hearing loss
All participants aged 6–19 or 70+ years
- History of ear infection
- Last time hearing tested by specialist
- Use a hearing aid, a personal sound amplifier, or cochlear implant
Participants aged 6–15 years
- History of receiving Special Education or Early Intervention Services
- History of loud noise exposure
Participants aged 16–19 and 70+ years
- Effect of hearing ability on daily life
- Problem with dizziness, lightheadedness, faint, unsteadiness, or imbalance
- Tinnitus (past 12 months)
- History of loud noise exposure (firearms, occupational, non-occupational)
- Hearing protection use
More information on the 2017–2018 audiometry questionnaire can be found at
https://wwwn.cdc.gov/nchs/data/nhanes/2017-2018/questionnaires/AUQ_J.pdf.
More information on the 2017–2018 audiometry questionnaire data and documentation for the public-use release can be found at
https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Questionnaire&CycleBeginYear=2017.
Hearing examination data collected in the 2015–2016 (available to the public):
The hearing examination data were collected in the 2015–2016 for participants aged 20-69 years. The hearing examination was conducted by trained examiners on participants in a dedicated sound-isolating room in the mobile examination center. There were four parts:
- Pre-exam question
A series of questions (ear tubes, a current cold or ear problem, or recent loud noise exposure) to identify conditions that would affect how audiometry testing is conducted or how results are interpreted.
- Otoscopy
A brief otoscopic physical examining the ear canals and eardrums to identify abnormalities which would require alternate audiometry procedures of influence interpretation of test results. Medical referral is required for impacted ear cerumen or abnormalities.
- Middle ear testing
A measurement of eardrum compliance to identify middle ear pathologies that might contribute to a hearing loss.
- Pure-tone air conduction audiometry
A measurement of hearing sensitivity across the range of human hearing. Hearing threshold testing was conducted on both ears of participants at seven frequencies (500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz).
Four audiometry examination data files are available to the public:
- Audiometry (AUX_I)
- Audiometry – Acoustic Reflex (AUXAR_I)
- Audiometry – Tympanometry (AUXTYM_I)
- Audiometry – Wideband Reflectance (AUXWBR_I)
More information on the 2015-2016 audiometry examination procedure manuals can be found at
https://wwwn.cdc.gov/nchs/nhanes/ContinuousNhanes/manuals.aspx?BeginYear=2015.
More information on the 2015-2016 audiometry examination data and documentation for the public-use release can be found at
https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Examination&CycleBeginYear=2015.
Hearing examination data collected 2017–2018:
The hearing examination data were collected 2017–2018 for participants aged 6–19 years and 70 years and older. The hearing examination was conducted by trained examiners on participants in a dedicated sound-isolating room in the mobile examination center. There were four parts of examination (same as the 2015–2016 data collection). However, a dedicated National Instruments hardware and Audiometric Research Tool software as an audiometer was used to replace the old audiometer.
The data have not been released to the public yet.
More information on the 2017–2018 audiometry examination procedure manuals can be found at
https://wwwn.cdc.gov/nchs/data/nhanes/2017-2018/manuals/2018-Audiometry-Procedures-Manual-508.pdf.
Hearing questionnaire and examination data collected 2019–March 2020:
Target age groups, questions, and examinations were the same as in the 2017–2018 data collection.