TINNITUS HANDICAP INVENTORY Form
The aim of this questionnaire is to find out what problem tinnitus might be giving you. Check yes, sometimes, or no for each question.
|Because of your tinnitus is it difficult for you to concentrate?
|Does the loudness of your tinnitus make it difficult for you to hear?
|Does your tinnitus make you angry?
|Does your tinnitus make you feel confused?
|Because of your tinnitus do you feel desperate?
|Do you complain a great deal about your tinnitus?
|Because of your tinnitus do you have trouble falling asleep?
|Do you feel as though you cannot escape your tinnitus?
|Does your tinnitus interfere with your ability to enjoy social activities such as going out to dinner, cinema?
|Because of your tinnitus do you feel frustrated?
|Because of your tinnitus do you feel you have a terrible disease?
|Does your tinnitus make it difficult for you to enjoy life?
|Does your tinnitus interfere with your job or household responsibilities?
|Because of your tinnitus do you find that you are often irritable?
|Because of your tinnitus is it difficult for you to read?
|Does your tinnitus make you upset?
|Do you feel that your tinnitus has placed stress on your relationship with members of your family, friends?
|Do you find it difficult to focus your attention away from your tinnitus and on to other things?
|Do you feel that you have no control over your tinnitus?
|Because of your tinnitus are you often tired?
|Because of your tinnitus do you feel depressed?
|Does your tinnitus make you feel anxious?
|Do you feel that you can no longer cope with your tinnitus?
|Does your tinnitus get worse when you are under stress?
|Does your tinnitus make you feel insecure?
HOW TO SCORE THE QUESTIONNAIRE
YES = 4
SOMETIMES = 2
NO = 0
0-16 Slight (Only heard in quiet environments)
18-36 Mild (Easily masked by environmental sounds and easily forgotten with activities)
38-56 Moderate (Noticed in presence of background noise, although daily activities can still be performed)
58-76 Severe (Almost always heard, leads to disturbed sleep patterns and can interfere with daily activities)
78-100 Catastrophic (Always heard, disturbed sleep patterns, difficulty with any activities)