Audiology Services

TINNITUS HANDICAP INVENTORY

Once submitted, a copy of this questionnaire will be sent to our office.

    Your Name*

    Your Email*

    Phone*

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

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

    Does your Tinnitus make you angry?
    YesSometimesNo

    Does your Tinnitus make you feel confused?
    YesSometimesNo

    Because of your Tinnitus, do you feel desperate?
    YesSometimesNo

    Do you complain a great deal about your Tinnitus?
    YesSometimesNo

    Because of your Tinnitus, do have trouble falling asleep at night?
    YesSometimesNo

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

    Does your Tinnitus interfere with your ability to enjoy social activities? (e.g. going out to dinner, to the movies, etc.)
    YesSometimesNo

    Because of your Tinnitus, do you feel frustrated?
    YesSometimesNo

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

    Does your Tinnitus make it difficult for you to enjoy your life?*
    YesSometimesNo

    Does your Tinnitus interfere with your job or household responsibilities?
    YesSometimesNo

    Because of your Tinnitus, do you find that you often are irritable?
    YesSometimesNo

    Because of your Tinnitus, is it difficult for you to read?
    YesSometimesNo

    Does your Tinnitus make you upset?
    YesSometimesNo

    Do you feel that your Tinnitus has placed stress on your relationships (e.g. family members or friends)?
    YesSometimesNo

    Do you find it difficult to focus your attention away from your Tinnitus on to other things?
    YesSometimesNo

    Do you feel you have no control over your Tinnitus?
    YesSometimesNo

    Because of your Tinnitus, do you feel tired?
    YesSometimesNo

    Because of your Tinnitus, do you often feel depressed?
    YesSometimesNo

    Does your Tinnitus make you feel anxious?
    YesSometimesNo

    Do you feel you can no longer cope with your Tinnitus?
    YesSometimesNo

    Does your Tinnitus get worse under stress?
    YesSometimesNo

    Does your Tinnitus make you feel insecure?
    YesSometimesNo

    Why Wait? You don’t have to live with ringing in your ears.

    Why Wait? You don’t have to live with ringing in your ears.