These questions are to find out how badly your ear problems affect you. No machine can do this: only you can tell us. We expect the results from this questionnaire to help us understand which of your ear symptoms is the most important to you. Knowing this will help us improve the ways patients with ear problems are looked after.

Please answer the questions below by considering carefully each question asked, and then ringing the appropriate number; the numbers each refer to a particular description. There are no right or wrong answers, but please try to think carefully about each question before ringer the appropriate number. Please consider each problem as it has been over the past six months.

For the following questions, please indicate how severe the various elements described affect you, using the scale below and by ringing the appropriate number:

• 0 - Doesn’t bother me at all
• 1 - A minor inconvenience
• 2 - A moderate inconvenience
• 3 - A major inconvenience but I can cope
• 4 - A major inconvenience and I am finding it hard to cope
• 5 - The worst thing that has ever affected my life

For the following questions, please indicate how often the various elements described affect you using the scale below and by ringing the appropriate number:

• 0 - Less frequent than once every 6 months
• 1 - At least once every 6 months
• 2 - At least once every 3 months
• 3 - At least once every month
• 4 - At least once a week
• 5 - Most days in the week