Tinnitus Handicap Inventory

The Tinnitus Handicap Inventory (THI) is a validated, 25-item self-report instrument widely used to measure the perceived psychosocial and functional…

Questions: 25
Duration: 10 min
Original title: Tinnitus Handicap Inventory
Adaptation: Tinnitus Handicap Inventory
Authors: Newman, C.W., Jacobson, G.P. & Spitzer, J.B.
Created: 1996

The Tinnitus Handicap Inventory (THI) is a validated, 25-item self-report instrument widely used to measure the perceived psychosocial and functional distress associated with tinnitus. While subjective tinnitus lacks an objective audiological marker for distress, the THI translates the patient's lived experience into a quantifiable clinical metric. It captures how intrusive the sound is during daily tasks, the emotional toll it takes, and the catastrophic thinking it can trigger.

This validated measure helps anchor psychoeducation on the Cognitive Behavioral Model of Tinnitus, offering a structured baseline that captures more than just symptom loudness. Administering the THI over the course of treatment provides a reliable way to monitor habituation, track reductions in behavioral avoidance, and assess How Your Body Responds to Stress when interacting with the persistent sound.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

48/ 100

A standardized 25-item self-report questionnaire assessing the impact of tinnitus on the daily life of adult patients. It explores three dimensions: functional (limitations in activities of daily living, social, and cognitive functioning), emotional (anger, frustration, anxiety, depression, irritability), and catastrophic (despair, loss of control, inability to escape tinnitus). Used in ENT, hearing aid fitting, sophrology, and cognitive-behavioral management to quantify the perceived severity of tinnitus and monitor progress under treatment.

0–16

Very mild

18–36

Mild

38–56

Moderate

58–76

Severe

78–100

Catastrophic

Tinnitus is perceived even in the presence of environmental sound; however, daily activities are not impaired. It is perceived less under concentration. Interference with sleep and relaxing activities is not infrequent.

cliniquemixed · condition: tinnitus · 19–84 years · n = 1115 · Gos et al. (2020)

0100

M = 48.18 ± 25.27

Scoring

Sum (total score and subscale scores), total score from 0 to 100, each item is scored on a 3-point scale (from 0 to 4).

Catastrophic subscale

8/ 20

Probes the most severe reactions and catastrophic thinking about tinnitus, including lack of control, inability to escape, and fear of severe disease.

items 5, 8, 11, 19, 23

cliniquemixed · condition: tinnitus · 19–84 years · n = 1115 · Gos et al. (2020)

020

M = 10.81 ± 5.17

Emotional subscale

16/ 36

Concerns affective responses and reactions to tinnitus, such as anger, frustration, depression, and anxiety.

items 3, 6, 10, 14, 16, 17, 21, 22, 25

cliniquemixed · condition: tinnitus · 19–84 years · n = 1115 · Gos et al. (2020)

036

M = 16.84 ± 10.3

Functional subscale

24/ 44

Deals with role limitations caused by tinnitus in the areas of mental, social, occupational, and physical functioning.

items 1, 2, 4, 7, 9, 12, 13, 15, 18, 20, 24

cliniquemixed · condition: tinnitus · 19–84 years · n = 1115 · Gos et al. (2020)

044

M = 20.53 ± 11.71

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What the test measures

The THI evaluates the perceived handicap of tinnitus across three primary dimensions of daily functioning and psychological well-being.

Functional limitations: Impairments in mental focus, reading, occupational tasks, and social engagement, which are frequently compounded by Insomnia Disorders.
Emotional distress: Affective reactions to the sound, including anger, frustration, and symptoms of Depression.
Catastrophic thinking: Despair, feelings of loss of control, and catastrophic interpretations that often parallel Health Anxiety.

This measure is strictly intended for adults experiencing subjective tinnitus to determine the degree to which it interferes with their quality of life.

When and why to use it

Clinicians use the THI to evaluate baseline distress, design targeted interventions, and monitor symptom habituation over the course of therapy.

Intake assessment: To quantify the initial psychosocial toll of tinnitus and establish a clear clinical baseline.
Formulation and psychoeducation: To differentiate the raw audiological sensation from the patient's emotional and behavioral reactions.
Evaluating comorbidity: To flag severe emotional distress or Generalized Anxiety Disorder (GAD) symptoms that may require parallel intervention.
Monitoring progress: To track functional improvements objectively as patients begin Exploring Your Anxiety Experience and learn to separate the auditory signal from their distressed reaction.

A validated THI score provides an empirical measure of distress and habituation, ensuring clinical decisions are grounded in standardized data rather than subjective impressions of symptom severity.

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The questions

The purpose of this questionnaire is to identify difficulties that you may be experiencing because of your tinnitus. Please answer "Yes", "Sometimes", or "No" to each question. Please do not skip any questions.
1. Because of your tinnitus, is it difficult for you to concentrate?
Assesses the impact of the sound on the patient's ability to maintain cognitive focus.
- No
- Sometimes
- Yes
2. Because of the loudness of your tinnitus, is it difficult for you to hear people around you?
Probes whether the perceived volume of the tinnitus interferes with auditory communication.
- No
- Sometimes
- Yes
3. Does your tinnitus make you angry?
Evaluates feelings of anger or resentment triggered by the presence of the symptom.
- No
- Sometimes
- Yes
4. Do you feel confused because of your tinnitus?
Identifies cognitive disorientation or confusion attributed to the constant noise.
- No
- Sometimes
- Yes
5. Because of your tinnitus, do you feel desperate?
Flags severe psychological distress and feelings of hopelessness related to the condition.
- No
- Sometimes
- Yes
6. Do you complain a lot about your tinnitus?
Explores the behavioral expression of distress and the frequent need to voice complaints.
- No
- Sometimes
- Yes
7. Because of your tinnitus, do you have trouble falling asleep at night?
Assesses whether the symptom interferes with sleep onset, a common functional disruption.
- No
- Sometimes
- Yes
8. Do you feel like you can't escape your tinnitus?
Probes the sensation of being trapped by the inescapable nature of the sound.
- No
- Sometimes
- Yes
9. Does your tinnitus interfere with your enjoyment of social activities (like going to a restaurant, the movies...)?
Measures the degree of social withdrawal and the disruption of recreational engagement.
- No
- Sometimes
- Yes
10. Because of your tinnitus, do you feel frustrated?
Evaluates feelings of frustration stemming from the persistent auditory intrusion.
- No
- Sometimes
- Yes
11. Because of your tinnitus, do you feel that you have a terrible disease?
Identifies catastrophic health misinterpretations linked to the presence of the symptom.
- No
- Sometimes
- Yes
12. Because of your tinnitus, is it difficult for you to enjoy life?
Assesses the overall reduction in life satisfaction and anhedonia caused by the sound.
- No
- Sometimes
- Yes
13. Does your tinnitus interfere with your job or household responsibilities?
Explores the functional impairment of the condition on daily occupational and domestic tasks.
- No
- Sometimes
- Yes
14. Do you find that you are often irritable because of your tinnitus?
Evaluates the impact of the constant noise on emotional regulation and temper.
- No
- Sometimes
- Yes
15. Because of your tinnitus, is it difficult for you to read?
Assesses specific concentration impairments during quiet, sustained cognitive tasks like reading.
- No
- Sometimes
- Yes
16. Are you upset by your tinnitus?
Probes the general emotional distress and emotional volatility caused by the sound.
- No
- Sometimes
- Yes
17. Do you think your tinnitus problem has placed stress on your relationships with family and friends?
Measures the psychosocial strain the symptom places on interpersonal connections.
- No
- Sometimes
- Yes
18. Do you find it difficult to focus on things other than your tinnitus?
Evaluates the intrusive nature of the sound and the difficulty of shifting attentional focus.
- No
- Sometimes
- Yes
19. Do you feel that you have no control over your tinnitus?
Identifies a sense of helplessness and lack of perceived efficacy in managing the symptom.
- No
- Sometimes
- Yes
20. Because of your tinnitus, do you often feel tired?
Assesses secondary fatigue and exhaustion resulting from the chronic auditory strain.
- No
- Sometimes
- Yes
21. Because of your tinnitus, do you feel depressed?
Flags the presence of low mood and depressive symptoms linked to the condition.
- No
- Sometimes
- Yes
22. Does your tinnitus make you feel anxious?
Evaluates whether the persistence of the sound triggers anxiety or chronic worry.
- No
- Sometimes
- Yes
23. Do you feel you can no longer cope with your tinnitus?
Probes the exhaustion of the patient's coping resources and potential psychological crisis.
- No
- Sometimes
- Yes
24. Does your tinnitus get worse when you are under stress?
Assesses the bidirectional relationship between psychological stress and perceived symptom intensity.
- No
- Sometimes
- Yes
25. Does your tinnitus make you feel insecure?
Explores the impact of the condition on self-confidence and feelings of vulnerability.
- No
- Sometimes
- Yes