Tinnitus Functional Index
This is a standard form as used by health professionals to measure your tinnitus and to monitor change over time.
1. Over the PAST WEEK ... *
How STRONG or LOUD was your tinnitus? 0=none 10=loud
2. Over the PAST WEEK ... What percentage of your time awake *
were you consciously AWARE OF your tinnitus? 0=0% 10=100% or all the time
3. Over the PAST WEEK ... What percentage of your time awake *
were you consciously ANNOYED by your tinnitus? 0=0% 10=100%
4. Over the PAST WEEK ... Did you feel IN CONTROL *
in regard to your tinnitus? 0=total control 10=never in control
5. Over the PAST WEEK ... How easy was it for you *
to COPE with your tinnitus? 0=very easy 10=impossible
6. Over the PAST WEEK ... How easy was it for you *
to IGNORE your tinnitus? 0=easy 10=impossible to ignore
7 Over the PAST WEEK ... Your ability to *
CONCENTRATE? 0=no interference 10=intense interference
8 Over the PAST WEEK ... Your ability to *
THINK CLEARLY? 0=no interference 10=intense interference
9. Over the PAST WEEK ... Your ability to FOCUS ATTENTION *
on other things besides your tinnitus? 0=no interference 10=total interference
10 Over the PAST WEEK ... How often did your tinnitus make it *
difficult to FALL ASLEEP or STAY ASLEEP? 0=no difficulty 10=always difficult
11 Over the PAST WEEK ...How often did your tinnitus cause you *
difficulty in getting AS MUCH SLEEP as you needed? 0=no difficulty 10=always difficult
12. Over the PAST WEEK ... ...How much of the time did your tinnitus keep you from SLEEPING as *
DEEPLY or as PEACEFULLY as you would have liked? 0=none 10=all of the time
13 Over the PAST WEEK .... how much has your tinnitus interfered with...... *
Your ability to HEAR CLEARLY? 0=never 10=total interference
14 Over the PAST WEEK .... how much has your tinnitus interfered with Your ability to *
UNDERSTAND PEOPLE who are talking? 0=no interference 10=total interference
15 Over the PAST WEEK .... how much has your tinnitus interfered with Your ability to *
FOLLOW CONVERSATIONS in a group or at meetings? 0=no interference 10=total interference
16 Over the PAST WEEK .... how much has your tinnitus interfered with your *
QUIET RESTING ACTIVITIES? 0=no interference 10=total interference
17 Over the PAST WEEK .... how much has your tinnitus interfered with *
Your ability to RELAX? 0= no interference 10=total interference
18. Over the PAST WEEK .... how much has your tinnitus interfered with your *
ability to enjoy PEACE AND QUIET? 0=no interference 10=total interference
19 Over the PAST WEEK .... how much has your tinnitus interfered with your *
enjoyment of SOCIAL ACTIVITIES? 0=no interference 10=total interference
20 Over the PAST WEEK .... how much has your tinnitus interfered with *
Your ENJOYMENT OF LIFE? 0=no interference 10=total interference
21 Over the PAST WEEK .... how much has your tinnitus interfered with your *
RELATIONSHIPS with family, friends and other people? 0=no interference 10=total interference
22. Over the PAST WEEK .. How often did your tinnitus cause you to have difficulty performing your WORK OR OTHER *
TASKS, such as home maintenance, school work, or caring for children or others? 0=no difficulty 10=always difficult
23 Over the PAST WEEK ....How ANXIOUS or WORRIED *
has your tinnitus made you feel? 0=no anxiety 10=extreme anxiety
24 Over the PAST WEEK ....How BOTHERED or UPSET *
have you been because of your tinnitus? 0=not bothered 10=extremely upset
25 Over the PAST WEEK ....How DEPRESSED *
were you because of your tinnitus? 0=no depression 10=very depressed
Email address please. *
Thank you for completing this index. You can enter comments below or email me at Norman@Tinnix.org
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