This quiz is useful to help identify the
degree of problems that your tinnitus may be causing
you.
Print out this questionnaire and mark your answers next
to each question.
| |
|
4 |
0 |
2 |
| 1. |
Because of your Tinnitus
is it difficult for you to concentrate? |
Yes |
No |
Sometimes |
| 2. |
Does the loudness of
your Tinnitus make it difficult for you to hear
people? |
Yes |
No |
Sometimes |
| 3. |
Does your Tinnitus make
you angry? |
Yes |
No |
Sometimes |
| 4. |
Does your Tinnitus make
you confused? |
Yes |
No |
Sometimes |
| 5. |
Because of your Tinnitus
are you desperate? |
Yes |
No |
Sometimes |
| 6. |
Do you complain a great
deal about your Tinnitus? |
Yes |
No |
Sometimes |
| 7. |
Because of your tinnitus
do you have trouble falling asleep at night? |
Yes |
No |
Sometimes |
| 8. |
Do you feel as though
you cannot escape from your Tinnitus? |
Yes |
No |
Sometimes |
| 9. |
Does your Tinnitus interfere
with your ability to enjoy social activities (such
as going out to dinner, to the cinema)? |
Yes |
No |
Sometimes |
| 10. |
Because of your Tinnitus
do you feel frustrated? |
Yes |
No |
Sometimes |
| 11. |
Because of your Tinnitus
do you feel that you have a terrible disease? |
Yes |
No |
Sometimes |
| 12. |
Does your Tinnitus make
it difficult to enjoy life? |
Yes |
No |
Sometimes |
| 13. |
Does your Tinnitus interfere
with your job or household responsibilities? |
Yes |
No |
Sometimes |
| 14. |
Because of your Tinnitus
do you find that you are often irritable? |
Yes |
No |
Sometimes |
| 15. |
Because of your Tinnitus
is it difficult for you to read? |
Yes |
No |
Sometimes |
| 16. |
Does your Tinnitus make
you upset? |
Yes |
No |
Sometimes |
| 17. |
Do you feel that your
Tinnitus has placed stress on your relationships
with members of your family and friends? |
Yes |
No |
Sometimes |
| 18. |
Do you find it difficult
to focus your attention away from your Tinnitus
and on to other things? |
Yes |
No |
Sometimes |
| 19. |
Do you feel that you
have no control over your Tinnitus? |
Yes |
No |
Sometimes |
| 20. |
Because of your Tinnitus
do you often feel tired? |
Yes |
No |
Sometimes |
| 21. |
Because of your Tinnitus
do you feel depressed? |
Yes |
No |
Sometimes |
| 22. |
Does your Tinnitus make
you feel anxious? |
Yes |
No |
Sometimes |
| 23. |
Do you feel you can
no longer cope with your Tinnitus? |
Yes |
No |
Sometimes |
| 24. |
Does your Tinnitus get
worse when you are under stress? |
Yes |
No |
Sometimes |
| 25. |
Does your Tinnitus make
you feel insecure? |
Yes |
No |
Sometimes |
| |
TOTAL SCORE PER COLUMN |
|
|
|
| Reference : McCombe, A., Bagueley,
D., Coles, R., McKenna, L., McKinney, C. & Windle-Taylor,
P. (2001), Guidelines for the grading of tinnitus
severity : the results of a working group commissioned
by the British Association of Otolaryngologists,
Head and Neck Surgeons, 1999, Clin Otolaryngol 26,
388-393. |
| TOTAL
YOUR POINTS and then compare your
total with the grade levels below. |