| LP130692-9 | Because of your problem, do you have difficulty getting into or out of bed | COMPONENT | 1 |
| LP130693-7 | Does your problem significantly restrict your participation in social activities such as going out to dinner, the movies, dancing or to parties | COMPONENT | 1 |
| LP130694-5 | Because of your problem, do you have difficulty reading | COMPONENT | 1 |
| LP130695-2 | Does performing more ambitious activities such as sports or dancing or household chores such as sweeping or putting dishes away increase your problem | COMPONENT | 1 |
| LP130696-0 | Because of your problem, are your afraid to leave your home without having someone accompany you | COMPONENT | 1 |
| LP130697-8 | Because of your problem, are you embarrassed in front of others | COMPONENT | 1 |
| LP130698-6 | Do quick movements of your head increase your problem | COMPONENT | 1 |
| LP130699-4 | Because of your problem, do you avoid heights | COMPONENT | 1 |
| LP130700-0 | Does turning over in bed increase your problem | COMPONENT | 1 |
| LP130701-8 | Because of your problem, is it difficult for you to do strenuous housework or yard work | COMPONENT | 1 |
| LP130702-6 | Because of your problem, are you afraid people may think you are intoxicated | COMPONENT | 1 |
| LP130703-4 | My voice makes it difficult for people to hear me | COMPONENT | 1 |
| LP130704-2 | I run out of air when I talk | COMPONENT | 1 |
| LP130705-9 | People have difficulty understanding me in a noisy room | COMPONENT | 1 |
| LP130706-7 | The sound of my voice varies throughout the day | COMPONENT | 1 |
| LP130707-5 | My family has difficulty hearing me when I call them throughout the house | COMPONENT | 1 |
| LP130708-3 | I use the phone less often than I would like | COMPONENT | 1 |
| LP130709-1 | I'm tense when talking with others because of my voice | COMPONENT | 1 |
| LP130710-9 | I tend to avoid groups of people because of my voice | COMPONENT | 1 |
| LP130711-7 | People seem irritated with my voice | COMPONENT | 1 |
| LP130712-5 | People ask, what's wrong with your voice | COMPONENT | 1 |
| LP130713-3 | I speak with friends, neighbors, or relatives less often because of my voice | COMPONENT | 1 |
| LP130714-1 | People ask me to repeat myself when speaking face-to-face | COMPONENT | 1 |
| LP130715-8 | My voice sounds creaky and dry | COMPONENT | 1 |
| LP130716-6 | I feel as though I have to strain to produce voice | COMPONENT | 1 |
| LP130717-4 | I find other people don't understand my voice problem | COMPONENT | 1 |
| LP130718-2 | My voice difficulties restrict my personal and social life | COMPONENT | 1 |
| LP130719-0 | The clarity of my voice is unpredictable | COMPONENT | 1 |
| LP130720-8 | I try to change my voice to sound different | COMPONENT | 1 |
| LP130721-6 | I feel left out of conversations because of my voice | COMPONENT | 1 |
| LP130722-4 | I use a great deal of effort to speak | COMPONENT | 1 |
| LP130723-2 | My voice is worse in the evening | COMPONENT | 1 |
| LP130724-0 | My voice problem causes me to lose income | COMPONENT | 1 |
| LP130725-7 | My voice problem upsets me | COMPONENT | 1 |
| LP130726-5 | I am less outgoing because of my voice problem | COMPONENT | 1 |
| LP130727-3 | My voice makes me feel handicapped | COMPONENT | 1 |
| LP130728-1 | My voice gives out on me in the middle of speaking | COMPONENT | 1 |
| LP130729-9 | I feel annoyed when people ask me to repeat | COMPONENT | 1 |
| LP130730-7 | I feel embarrassed when people ask me to repeat | COMPONENT | 1 |
| LP130731-5 | My voice makes me feel incompetent | COMPONENT | 1 |
| LP130732-3 | I'm ashamed of my voice problem | COMPONENT | 1 |
| LP130849-5 | Do you have any difficulty with your hearing | COMPONENT | 1 |
| LP130850-3 | How quickly did your hearing difficulty develop | COMPONENT | 1 |
| LP130851-1 | Do you know the reason for your hearing difficulty | COMPONENT | 1 |
| LP130852-9 | Does your hearing vary from day to day | COMPONENT | 1 |
| LP130853-7 | Do you find it very difficult to follow a conversation if there is background noise | COMPONENT | 1 |
| LP130854-5 | Are you particularly sensitive to loud sounds | COMPONENT | 1 |
| LP130855-2 | Do you sometimes feel a fullness or blockage in your ears | COMPONENT | 1 |
| LP130856-0 | Do you ever get noises in your head or ears, tinnitus, which usually last longer than 5 minutes | COMPONENT | 1 |
| LP130857-8 | Have you ever had an ear disease that has caused your hearing to get worse | COMPONENT | 1 |