Tinnitus Handicap Inventory TINNITUS HANDICAP INVENTORYName *FirstLastDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email *INSTRUCTIONS: The purpose of this questionnaire is to identify difficulties you may be experiencing because of your tinnitus. Please answer every question. Please do not skip and questions.1. Because of your tinnitus, is it difficult for you to concentrate? *YESSOMETIMESNO1. Because of your tinnitus, is it difficult for you to concentrate? *YESSOMETIMESNO3. Does your tinnitus make you angry? *YESSOMETIMESNO4. Does your tinnitus make you feel confused? *YESSOMETIMESNO5. Because of your tinnitus, do you feel desperate? *YESSOMETIMESNO7. Because of your tinnitus, do you have trouble falling to sleep at night? *YESSOMETIMESNO8. Do you feel as though you cannot escape your tinnitus? *YESSOMETIMESNO9. Does your tinnitus interfere with your ability to enjoy your social activities (such as going out to dinner, to the movies)? *YESSOMETIMESNO10. Because of your tinnitus, do you feel frustrated? *YESSOMETIMESNO11. Because of your tinnitus, do you feel that you have a terrible disease? *YESSOMETIMESNO12. Does your tinnitus make it difficult for you to enjoy life? *YESSOMETIMESNO13. Does your tinnitus interfere with your job or household responsibilities? *YESSOMETIMESNO14. Because of your tinnitus, do you find that you are often irritable? *YESSOMETIMESNO15. Because of your tinnitus, is it difficult for you to read? *YESSOMETIMESNO17. Do you feel that your tinnitus problem has placed stress on your relationships with members of your family and friends? *YESSOMETIMESNO18. Do you find it difficult to focus your attention away from your tinnitus and on other things? *YESSOMETIMESNO19. Do you feel that you have no control over your tinnitus? *YESSOMETIMESNO20. Because of your tinnitus, do you often feel tired? Yes Sometimes No *YESSOMETIMESNO21. Because of your tinnitus, do you feel depressed? *YESSOMETIMESNO22. Does your tinnitus make you feel anxious? *YESSOMETIMESNO23. Do you feel that you can no longer cope with your tinnitus? *YESSOMETIMESNO24. Does your tinnitus get worse when you are under stress? *YESSOMETIMESNO25. Does your tinnitus make you feel insecure? *YESSOMETIMESNO* Indicates a required answerEmailSubmit