THI Questionnaire
THI Questionnaire
THI Questionnaire
Patient Name:
Date:
INSTRUCTIONS: The purpose of this questionnaire is to identify difficulties that you may be experiencing
because of your tinnitus. Please answer every question. Please do not skip any questions.
1. Because of your tinnitus, is it difficult for you to concentrate?
Yes
Sometimes
No
2. Does the loudness of your tinnitus make it difficult for you to hear people?
Yes
Sometimes
No
Yes
Sometimes
No
Yes
Sometimes
No
Yes
Sometimes
No
Yes
Sometimes
No
Yes
Sometimes
No
Yes
Sometimes
No
9. Does your tinnitus interfere with your ability to enjoy your social activities
(such as going out to dinner, to the movies)?
Yes
Sometimes
No
Yes
Sometimes
No
11. Because of your tinnitus, do you feel that you have a terrible disease?
Yes
Sometimes
No
12. Does your tinnitus make it difficult for you to enjoy life?
Yes
Sometimes
No
13. Does your tinnitus interfere with your job or household responsibilities?
Yes
Sometimes
No
14. Because of your tinnitus, do you find that you are often irritable?
Yes
Sometimes
No
Yes
Sometimes
No
Yes
Sometimes
No
17. Do you feel that your tinnitus problem has placed stress on your relationships
with members of your family and friends?
Yes
Sometimes
No
18. Do you find it difficult to focus your attention away from your tinnitus and
on other things?
Yes
Sometimes
No
19. Do you feel that you have no control over your tinnitus?
Yes
Sometimes
No
Yes
Sometimes
No
Yes
Sometimes
No
Yes
Sometimes
No
23. Do you feel that you can no longer cope with your tinnitus?
Yes
Sometimes
No
24. Does your tinnitus get worse when you are under stress?
Yes
Sometimes
No
Yes
Sometimes
No
Total Score
Newman, C.W., Jacobson, G.P., Spitzer, J.B. (1996). Development of the Tinnitus
Handicap Inventory. Arch Otolaryngol Head Neck Surg, 122, 143-8.
x2
x0