Is your Tinnitus present every day?
Is you Tinnitus generally tolerable?
Do you use a masking device, such as a fan or radio, to sleep?
Does your Tinnitus cause distraction? If so, how?
Does your Tinnitus cause loss of concentration? If so, how?
Does your Tinnitus regularly interfere with your sleep? If so, how?
Does your tinnitus cause you emotional or mental distress, anxiety or depression? If so, how?
How often are you consciously AWARE OF your tinnitus?
How STRONG or LOUD is your tinnitus?
What percentage of your time awake are you ANNOYED by your tinnitus?
Do you feel IN CONTROL in regard to your tinnitus?
How easy is it for you to COPE with your tinnitus?
How easy is it for you to IGNORE your tinnitus?
Does your tinnitus interfere with your ability to CONCENTRATE?
Does your tinnitus interfere with your ability to THINK CLEARLY? If so, how?
Does your tinnitus interfere with your ability to FOCUS ATTENTION on other things besides your tinnitus? If so, how?
Does your tinnitus make it difficult to FALL ASLEEP or STAY ASLEEP?
Does your tinnitus cause you difficulty in getting AS MUCH SLEEP as you needed?
Does your tinnitus keep you from SLEEPING as DEEPLY or as PEACEFULLY as you would have liked?
Does your Tinnitus interfere with Your ability to HEAR CLEARLY?
Does your Tinnitus interfere withYour ability to UNDERSTAND PEOPLE who are talking?
Does your Tinnitus interfere with your ability to FOLLOW CONVERSATIONS in a group or at meetings?
Does your Tinnitus interfere with your QUIET RESTING ACTIVITIES?
Does your Tinnitus interfere with your ability to RELAX?
Does your Tinnitus interfere with your ability to enjoy “PEACE AND QUIET”?
Does your Tinnitus interfere with your enjoyment of SOCIAL ACTIVITIES?
Does your Tinnitus interfere with your ENJOYMENT OF LIFE?
Does your Tinnitus interfere with your RELATIONSHIPS with family, friends and other people?
Does 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?
How ANXIOUS or WORRIED has your tinnitus made you feel?
How BOTHERED or UPSET have you been because of your tinnitus?
How DEPRESSED were you because of your tinnitus?
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