Tinnitus Self Test

YES

(4 POINTS)

SOMETIMES

(2 POINTS)

NO

(0 POINTS)

1 Because of your tinnitus is it difficult for you to concentrate? _ _ _
2 Does the loudness of your tinnitus make it difficult for you to hear people? _ _ _
3 Does your tinnitus make you angry? _ _ _
4 Does your tinnitus make you confused? _ _ _
5 Because of your tinnitus, are you desperate? _ _ _
6 Do you complain to others about your tinnitus? _ _ _
7 Because of your tinnitus do you have trouble falling asleep at night? _ _ _
8 Do you feel as though you cannot escape from your tinnitus? _ _ _
9  Does your tinnitus interfere with your ability to enjoy social activities? _ _ _
10 Because of your tinnitus do you feel frustrated? _ _ _
11 Because of your tinnitus do you feel that you have a terrible disease? _ _ _
12 Does your tinnitus make it difficult to enjoy life? _ _ _
13 Does your tinnitus interfere with your job or household responsibilities? _ _ _
14 Because of your tinnitus do you find that you are irritable? _ _ _
15 Because of your tinnitus is it difficult for you to read? _ _ _
16 Does your tinnitus make you upset? _ _ _
17 Do you feel that your tinnitus has placed stress on your relationships with friends or family members? _ _ _
18 Do you find it difficult to focus your attention away from your tinnitus? _ _ _
19 Do you feel you have no control over your tinnitus? _ _ _
20 Because of your tinnitus do you feel tired? _ _ _
21 Because of your tinnitus do you feel depressed? _ _ _
22 Does your tinnitus make you feel anxious? _ _ _
23 Do you feel you can no longer cope with your tinnitus? _ _ _
24 Does your tinnitus get worse when you are under stress? _ _ _
25 Does your tinnitus make you feel insecure? _ _ _

Scoring:

0-16: Slight or no handicap (grade 1)

18-36: Mild handicap (grade 2)

38-56: Moderate handicap (grade 3)

58-76: Severe handicap (grade 4)

78-100: Catastrophic handicap (grade 5)