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Tinnitus Library

Tinnitus Handicap Inventory (article)

by Barry Keate

The Tinnitus Handicap Inventory (THI) is a self-administered test that Ear, Nose & Throat physicians (otolaryngologists), audiologists and other clinicians use to help determine the degree of distress suffered by the tinnitus patient. It is widely used in medical offices and in clinical trials to determine the effectiveness of a given therapy.

Tinnitus is classified as a condition rather than a disease.1 Among the various pathologies that may cause or contribute to tinnitus are otitis media, otosclerosis, Meniere’s disease, presbycusis, exposure to noise and ototoxic drugs, sudden deafness, head trauma, acoustic neuroma, meningitis and temporomandibular joint (TMJ) dysfunction.

No single pathology includes all the affected patients. Because of this and because tinnitus varies greatly by the individual, it is impossible to objectively evaluate it with instrumentation. Furthermore, studies show that the level of distress is not related to the pitch or loudness of the condition. It became necessary to develop an alternative tool that focused instead on the impact of tinnitus on a person’s activities of daily living.

The Tinnitus Handicap Inventory is the most recent, most reliable, and most widely used of several questionnaires developed over the last 20 years. Beginning in the early 1990’s, The Tinnitus Effect Questionnaire, the Tinnitus Severity Scale, the Tinnitus Handicap Questionnaire and the Subjective Tinnitus Severity Scale have all been tried and eventually discarded.

Craig W. Newman, PhD, with two other researchers developed the Tinnitus Handicap Inventory in 1996 and it is the default questionnaire used to this day.2 It consists of 25 questions divided into 3 subgroups: functional, emotional and catastrophic. Eleven items are included in the functional scale, 9 in the emotional scale and 5 in the catastrophic scale. Prefixes in the numbered questions are used to indicate to which subgroup the question belongs.

It is important to note that question 24, relating to the effect of stress on tinnitus, has the highest correlation to the total score. Stress is a fundamental element in determining the degree of distress.

Results of a clinical study show that only those who are severely handicapped by tinnitus tend to regard it as a terrible, medical condition. Lack of control and inability to escape are common feelings among many people with tinnitus.3

Studies have also indicated that the minimum change in THI score that can be considered clinically relevant is a reduction of 6-7 points.4

The Tinnitus Handicap Inventory is included below. For those who wish to take the test and print it without the article, click here.

TINNITUS HANDICAP INVENTORY

The aim of this questionnaire is to find out what problem tinnitus might be giving you. Check yes, sometimes, or no for each question. The Tinnitus Handicap Inventory (THI) is a self-administered test that Ear, Nose & Throat physicians (otolaryngologists), audiologists and other clinicians use to help determine the degree of distress suffered by the tinnitus patient. It is widely used in medical offices and in clinical trials to determine the effectiveness of a given therapy.

Tinnitus is classified as a condition rather than a disease.1 Among the various pathologies that may cause or contribute to tinnitus are otitis media, otosclerosis, Meniere’s disease, presbycusis, exposure to noise and ototoxic drugs, sudden deafness, head trauma, acoustic neuroma, meningitis and temporomandibular joint (TMJ) dysfunction.

No single pathology includes all the affected patients. Because of this and because tinnitus varies greatly by the individual, it is impossible to objectively evaluate it with instrumentation. Furthermore, studies show that the level of distress is not related to the pitch or loudness of the condition. It became necessary to develop an alternative tool that focused instead on the impact of tinnitus on a person’s activities of daily living.

The Tinnitus Handicap Inventory is the most recent, most reliable, and most widely used of several questionnaires developed over the last 20 years. Beginning in the early 1990’s, The Tinnitus Effect Questionnaire, the Tinnitus Severity Scale, the Tinnitus Handicap Questionnaire and the Subjective Tinnitus Severity Scale have all been tried and eventually discarded.

Craig W. Newman, PhD, with two other researchers developed the Tinnitus Handicap Inventory in 1996 and it is the default questionnaire used to this day.2 It consists of 25 questions divided into 3 subgroups: functional, emotional and catastrophic. Eleven items are included in the functional scale, 9 in the emotional scale and 5 in the catastrophic scale. Prefixes in the numbered questions are used to indicate to which subgroup the question belongs.

It is important to note that question 24, relating to the effect of stress on tinnitus, has the highest correlation to the total score. Stress is a fundamental element in determining the degree of distress.

Results of a clinical study show that only those who are severely handicapped by tinnitus tend to regard it as a terrible, medical condition. Lack of control and inability to escape are common feelings among many people with tinnitus.3

Studies have also indicated that the minimum change in THI score that can be considered clinically relevant is a reduction of 6-7 points.4

The Tinnitus Handicap Inventory is included below. For those who wish to take the test and print it without the article, click here.

TINNITUS HANDICAP INVENTORY

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)


References

1 - Passi, S. Ralli, G. Capparelli, E. Mammone, A. Scacciatelli, D. Cianfrone, G. The THI Questionnaire: Psychometric Data for Reliability and Validity of the Italian Version. International Tinnitus Journal, Vol. 14, No. 1, Jan/Feb/Mar, 2008.

2 - Newman, C. Jocobson , G. Spitzer, J. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1996;122(2):143-148.

3 - Handscomb, L. Analysis of Responses to Individual Items on the Tinnitus Handicap Inventory according to Severity of Tinnitus Handicap. American Journal of Audiology, Vol. 15 102-107, December 2006.

4 - Zemen, F. et al. Tinnitus Handicap Inventory for Evaluating Treatment Effects: Which Changes are Clinically Relevant. Otolaryngology-Head and Neck Surgery, March 2011.