Tinnitus Handicap Inventory (THI)

Patient's Name *

Date of Birth *

Phone # *

Email *

What location are you visiting? *
AmherstWilliamsvilleOrchard ParkTonawanda

Because of your tinnitus is it difficult for you to concentrate? *
YesNoSometimes

Does the loudness of your tinnitus make it difficult for you to hear people? *
YesNoSometimes

Does your tinnitus make you angry? *
YesNoSometimes

Does your tinnitus make you confused? *
YesNoSometimes

Because of your tinnitus are you desperate? *
YesNoSometimes

Do you complain a great deal about your tinnitus? *
YesNoSometimes

Because of your tinnitus do you have trouble falling to sleep at night? *
YesNoSometimes

Do you feel as though you cannot escape your tinnitus? *
YesNoSometimes

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

Because of your tinnitus do you feel frustrated? *
YesNoSometimes

Because of your tinnitus do you feel that you have a terrible disease? *
YesNoSometimes

Does your tinnitus make it difficult for you to enjoy life? *
YesNoSometimes

Does your tinnitus interfere with your job or household responsibilities? *
YesNoSometimes

Because of your tinnitus do you find that you are often irritable? *
YesNoSometimes

Because of your tinnitus is it difficult for you to read? *
YesNoSometimes

Does your tinnitus make you upset? *
YesNoSometimes

Do you feel that your tinnitus has placed stress on your relationships with members of your family and friends? *
YesNoSometimes

Do you find it difficult to focus your attention away from your tinnitus and on to other things? *
YesNoSometimes

Do you feel that you have no control over your tinnitus? *
YesNoSometimes

Because of your tinnitus do you often feel tired? *
YesNoSometimes

Because of your tinnitus do you feel depressed? *
YesNoSometimes

Does your tinnitus make you feel anxious? *
YesNoSometimes

Do you feel you can no longer cope with your tinnitus? *
YesNoSometimes

Does your tinnitus get worse when you are under stress? *
YesNoSometimes

Does your tinnitus make you feel insecure? *
YesNoSometimes

On a scale of 0 to 10, with 0 being "not bothered" and 10 being "extremely bothered," please rate your tinnitus: *
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