| Over the past 1 month, how much has each of the following been a problem for you? | No problem | Moderate problem | Severe problem | ||||
|---|---|---|---|---|---|---|---|
| 1. Pressure in the ears? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 2. Pain in the ears? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 3. A feeling that your ears are clogged or "under water"? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 4. Ear symptoms when you have a cold or sinusitis? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 5. Crackling or popping sounds in the ears? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 6. Ringing in the ears? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 7. A feeling that your hearing is nuffled? | 1 | 2 | 3 | 4 | 5 | 7 | 7 |