Please answer the question below to the best of your ability. After you choose your answer, the next question will appear. At the end of the survey, you will be provided with a score, and you may send this score to us so we may discuss any hearing loss issues you are having.

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

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

Does your tinnitus make you angry?

Does your tinnitus make you feel confused?

Because of your tinnitus, do you feel desperate?

Do you complain a great deal about your tinnitus?

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

Do you feel as though you cannot escape your tinnitus?

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

Because of your tinnitus, do you feel frustrated?

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

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

Does your tinnitus interfere with your job or household responsibilities?

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

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

Does your tinnitus make you upset?

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

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

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

Because of your tinnitus, do you often feel tired?

Because of your tinnitus, do you feel depressed?

Does your tinnitus make you feel anxious?

Do you feel that you can no longer cope with your tinnitus?

Does your tinnitus get worse when you are under stress?

Does your tinnitus make you feel insecure?

Yes Sometimes No

You received a score of 100

Slight Impact – Your tinnitus does not interfere with daily activities.

Your results indicate tinnitus may not be affecting your quality of life. For more information about tinnitus, contact our office today.

Mild Impact – Your tinnitus may occasionally interfere with sleep but not daily activities.

Your results indicate your tinnitus may be affecting your quality of life. We recommend you contact our office today for an appointment with one of our hearing healthcare providers to discuss your unique tinnitus.

Moderate Impact – Your tinnitus can be distracting, even in busy environments.

Severe Impact – Your tinnitus can interfere with sleep patterns and any activity.