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.
| YES | SOMETIMES | NO | ||
| F1 | Because of your tinnitus is it difficult for you to concentrate? | |||
| F2 | Does the loudness of your tinnitus make it difficult for you to hear? | |||
| E3 | Does your tinnitus make you angry? | |||
| F4 | Does your tinnitus make you feel confused? | |||
| C5 | Because of your tinnitus do you feel desperate? | |||
| E6 | Do you complain a great deal about your tinnitus? | |||
| F7 | Because of your tinnitus do you have trouble falling asleep? | |||
| C8 | Do you feel as though you cannot escape your tinnitus? | |||
| F9 | Does your tinnitus interfere with your ability to enjoy social activities such as going out to dinner, cinema? | |||
| E10 | Because of your tinnitus do you feel frustrated? | |||
| C11 | Because of your tinnitus do you feel you have a terrible disease? | |||
| F12 | Does your tinnitus make it difficult for you to enjoy life? | |||
| F13 | Does your tinnitus interfere with your job or household responsibilities? | |||
| F14 | Because of your tinnitus do you find that you are often irritable? | |||
| F15 | Because of your tinnitus is it difficult for you to read? | |||
| E16 | Does your tinnitus make you upset? | |||
| E17 | Do you feel that your tinnitus has placed stress on your relationship with members of your family, friends? | |||
| F18 | Do you find it difficult to focus your attention away from your tinnitus and on to other things? |
| YES | SOMETIMES | NO | ||
| C19 | Do you feel that you have no control over your tinnitus? | |||
| F20 | Because of your tinnitus are you often tired? | |||
| E21 | Because of your tinnitus do you feel depressed? | |||
| E22 | Does your tinnitus make you feel anxious? | |||
| C23 | Do you feel that you can no longer cope with your tinnitus? | |||
| F24 | Does your tinnitus get worse when you are under stress? | |||
| E25 | Does your tinnitus make you feel insecure? |
HOW TO SCORE THE QUESTIONNAIRE
YES = 4
SOMETIMES = 2
NO = 0
TOTAL SCORE
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)
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