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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.
First Name
Surname
DOB
Email
Phone number
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