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. 2017 Feb;37(1):51–57. doi: 10.14639/0392-100X-1041

Table I.

Chronic Ear Survey (CES).

Activity Restriction-Based Subscale
A1 Because of your ear problem, you don't swim or shower without protecting your ear.
□ definitely true □ true □ don't know □ false □ definitely false
A2 At the present time, how severe a limitation is the necessity to keep water out of your ears?
□ very severe □ severe □ moderate □ mild □ very mild □ none
A3 In the past 4 weeks, has your ear problem interfered with your social activities with friends, family, or groups?
qall of the time □ most of the time □ a good bit of the time □ some of the time □ a little of the time □ none
Symptom Subscale
S1 Your hearing loss is:
□ very severe □ severe □ moderate □ mild □ very mild □ none
S2 Drainage from your ear is:
□ very severe □ severe □ moderate □ mild □ very mild □ none
S3 Pain from your ear is:
□ very severe □ severe □ moderate □ mild □ very mild □ none
S4 Odor from your ear is very bothersome to you and/or others:
□ definitely true □ true □ don't know □ false □ definitely false
S5 The hearing loss in your affected ear bothers you:
□ all of the time □ most of the time □ a good bit of the time □ some of the time □ a little of the time □ none
S6 In the past 6 months, please estimate the frequency that your affected ear has drained:
□ constantly □ >5 times, but not constantly □ 3-4 times □ 1-2 times □ not at all
S7 The odor from your affected ear bothers you and/or others:
□ all of the time □ most of the time □ a good bit of the time □ some of the time □ a little of the time □ none
Medical Resource Utilisation Subscale
M1 In the past 6 months, how many separate times have you visited your physician, specifically about your ear problem?
□ >6 times □ >5 times, but not constantly □ 3-4 times □ 1-2 times □ not at all
M2 In the past 6 months, how many separate times have you used oral antibiotics to treat your ear infection?
□ >6 times □ >5 times, but not constantly □ 3-4 times □ 1-2 times □ not at all
M3 In the past 6 months, how many separate times have ear drops been necessary to treat your ear condition?
□ >6 times □ >5 times, but not constantly □ 3-4 times □ 1-2 times □ not at all