Tinnitus Questionnaire

This quiz is useful to help identify the degree of problems that your tinnitus may be causing you. Mark your answers next to each question.

Name

Tinnitus questions

Because of your Tinnitus is it difficult for you to concentrate?

Does the loudness of your Tinnitus make it difficult for you to hear people?

Does your Tinnitus make you angry?

Does your Tinnitus make you confused?

Because of your Tinnitus are you desperate?

Do you complain a great deal about your Tinnitus?

Because of your tinnitus do you have trouble falling asleep at night?

Do you feel as though you cannot escape from your Tinnitus?

Does your Tinnitus interfere with your ability to enjoy social activities (such as going out to dinner, to the cinema)?

Because of your Tinnitus do you feel frustrated?

Because of your Tinnitus do you feel that you have a terrible disease?

Does your Tinnitus make it difficult 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 relationships with members of your family and 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 do you often feel tired?

Because of your Tinnitus do you feel depressed?

Does your Tinnitus make you feel anxious?

Do you feel 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?

Now please rank your tinnitus, on a scale of 1 to 10, with regard to severity, annoyance, and effect on your life. Please do not include hearing difficulties when you answer these questions.

How strong, or loud, was your tinnitus, on average, over the last month? “0” would be “no tinnitus”; “10” would be “as loud as you can imagine.”

How much has tinnitus annoyed you, on average, over the last month? “0” would be “not annoying at all”; “10” would be “as annoying as you can imagine.”

How much did tinnitus affect or impact your life , on average, over the last month? “0” would be “not at all”; “10” would be “extreme.”

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