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Tinnitus Reaction Questionnaire

How to complete this Questionnaire:

  • This questionnaire is designed to find out what sort of effects tinnitus has had on your lifestyle, general well-being, etc.
  • Some of the effects below may apply to you, some may not.
  • Please answer all questions by circling the number that best reflects how your tinnitus has affected you over the past week.
0 = Not at all
1 = a little of the time
2 = some of the time
3 = a good deal of the time
4 = almost all of the time
My tinnitus has made me unhappy

My tinnitus has made me feel tense

My tinnitus has made me feel irritable

My tinnitus has made me feel angry

My tinnitus has led me to cry

My tinnitus has has led me to avoid quiet situations

My tinnitus has has made me feel less interested in going out.

My tinnitus has has made me feel depressed

My tinnitus has made me fell annoyed

My tinnitus has made me feel confused

My tinnitus has "driven me crazy"

My tinnitus has interfered with my enjoyment of life

My tinnitus has made it hard for me to concentrate

My tinnitus has made it hard for me to relax

My tinnitus has has made me feel distressed

My tinnitus has has made me feel helpless

My tinnitus has has made me feel frustrated with things

My tinnitus has interfered with my ability to work

My tinnitus has led me to despair.

My tinnitus has led me to avoid noisy situations

My tinnitus has made me feel hopeless about the future.

My tinnitus has interfered with my sleep.

My tinnitus has led me to think about suicide.

My tinnitus has made me feel panicky

My tinnitus has made me feel tormented.

My tinnitus has made me feel tormented.

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Time's up

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