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Chronic Otitis Media Benefit Inventory (COMBI)

Authors: Phillips JS, Yung MW, Haggard M, Spencer H

The aim of this questionnaire is to find out how your ear problems have affected you since you have had ear surgery performed or another type of intervention.

Please answer the questions below by considering carefully each question asked, and then ticking the appropriate box. There are no right or wrong answers, but please try to think carefully about each question before ticking the appropriate box.

Once you have completed the questionnaire, please check that you have provided an answer to every question and do ask for help if you find it hard.
Patient Full Name*
Date of Birth*
MM slash DD slash YYYY
Mobile*
Symptom severity:
1. Since your operation/intervention, has the discharge or drainage from your ear been better or worse?*
Much worse
1 A little worse
2 No change
3 A little better
4 Much better
5
2. Since your operation/intervention, how would you define the change in having a ‘smelly ear’. Has this become better or worse?*
Much better
5 A little better
4 No change
3 A little worse
2 Much worse
1
3. Since your operation/intervention, has your hearing at home (e.g. requiring the volume of the TV or Radio to be turned up) got better or worse?*
Much more optimistic
5 A little more optimistic
4 No change
3 A little less optimistic
2 Much less optimistic
1
4. Since your operation/intervention, has your hearing when talking to people in groups (or when there are noisy surroundings) got better or worse?*
Much more embarrassed
1 A little more embarrassed
2 No change
3 A little less embarrassed
4 Much less embarrassed
5
5. Since your operation/intervention, has the discomfort in and/or around the ear got better or worse?*
Much more self-confidence
5 A little more self-confidence
4 No change
3 A little less self-confidence
2 Much less self-confidence
1
6. Since your operation/intervention, has your dizziness or feeling ‘off balance’ got better or worse?*
Much easier
5 Easier
4 No change
3 Harder
2 Much harder
1
7. Since your operation/intervention, has your tinnitus or noises in the ear got better or worse?*
Much more support
5 More support
4 No change
3 Less support
2 Much less support
1
Lifestyle, work and health service impact:
8. Regarding your normal daily activities at home and work, would you say that you have had more problems or less problems, since your operation/intervention?*
Much more often
1 More often
2 No change
3 Less often
4 Much less often
5
9. Regarding your ability to wash or shower or bathe as you would like to since your operation/intervention, have you been more fearful or less fearful of these activities causing an ear infection?*
Much more confident
5 More confident
4 No change
3 Less confident
2 Much less confident
1
10. Since your operation/intervention, have you seen your family doctor more often or less often, about your ear problems?*
Much more self conscious
1 A little more self-conscious
2 No change
3 A little less self-conscious
4 A little more self-conscious
5
11. Since your operation/intervention, have you needed to take medicines (including eardrops) for your ear problem more often or less often?*
Many more people
5 More people
4 No change
3 Fewer people
2 Much fewer people
1
General:
12. Since your operation/intervention, have your ear problems ‘got you down’ more or less than before?*
Much more often
1 More often
2 No change
3 Less often
4 Much less often
5

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Lower North Shore Clinic

Suite 114b, Lvl 1, Ascent Building
40 Yeo Street
Neutral Bay NSW 2089