Tinnitus Handicap
Inventory scorer

Method notes

What the Tinnitus Handicap Inventory is

The Tinnitus Handicap Inventory, usually shortened to THI, is a 25-item self-report questionnaire. It asks how tinnitus affects parts of daily life such as concentration, hearing people, sleep, reading, work, household duties, relationships, mood, and a sense of control. The word handicap in the title refers to the effect a person reports. It does not label the person, identify a disease, or describe the loudness of the sound by itself.

Newman, Jacobson, and Spitzer developed the 25-item inventory in 1996. The published version uses three response choices for every item: yes, sometimes, and no. The questionnaire groups its content into functional, emotional, and catastrophic areas, but this page calculates only the published total and the published severity band. It does not create a new subscore or add a weight that is not part of the instrument.

The purpose of a self-report instrument is to give a person and a clinician a shared way to talk about impact. Two people with similar hearing test results can describe very different effects in sleep, focus, social activity, or mood. The THI records that reported difference. It is one part of a tinnitus assessment, alongside history, ear examination, hearing testing, and questions about balance, medicines, noise exposure, and other symptoms.

How to complete the 25 items

Read each item and select the response that fits your experience. The original form asks you not to skip an item. This page keeps the original order and wording so the calculation is traceable. If a question feels difficult, choose the response that best matches your experience over the period you have in mind. Avoid trying to predict what a clinician wants to hear. The score is only useful when it reflects your own report.

Answer the whole set

The first items ask about concentration, hearing people, anger, confusion, desperation, complaints, falling asleep, and feeling unable to escape the sound. The middle items ask about social activities, frustration, fear of a terrible disease, enjoyment of life, responsibilities, irritability, reading, being upset, relationships, attention, and control. The last items ask about tiredness, depression, anxiety, coping, stress, and insecurity. The range is broad because tinnitus impact is not limited to one moment or one setting.

Answering all 25 items also prevents the total from looking lower simply because a question was left blank. The browser requires a choice in every group before it shows a total. It does not save the answers to an account or send them to a server. If you leave the page, the current selections are not a clinical record.

The scoring formula

The published calculation is simple. A yes answer contributes 4 points. A sometimes answer contributes 2 points. A no answer contributes 0 points. Add the 25 item values:

Total = (number of yes answers × 4) + (number of sometimes answers × 2) + (number of no answers × 0)

For example, 8 yes answers and 5 sometimes answers produce 8 × 4 = 32 points and 5 × 2 = 10 points. The total is 42. The remaining 12 no answers add 0. The largest possible result is 25 × 4 = 100, and the smallest is 25 × 0 = 0. Because the only non-zero values are even, completed totals are even numbers. That is why the published band table has gaps at 17, 37, 57, and 77 rather than a rule for those totals.

The tool counts the same values in the browser. It does not average answers, divide by 25, convert the result to a percentage, or compare the result with a local user database. A score is a number from this instrument, not a measurement in decibels and not an estimate of inner-ear damage.

The published severity bands

The published THI interpretation uses five bands. This page uses the labels and ranges specified for the instrument: slight 0-16, mild 18-36, moderate 38-56, severe 58-76, and catastrophic 78-100. The bands describe the degree of tinnitus handicap reported on the questionnaire. They do not predict a particular medical finding or decide which care a person needs.

The label is not a judgment and it is not a diagnosis. It is a shorthand for the range into which the total falls. The same person can receive different totals on different days because tinnitus perception, attention, sleep, stress, illness, and the listening environment can change. A change in score is worth describing with its timing and context rather than treating one number as a complete picture.

How to read a result

Start with the total and band, then look at the items that shaped it. A high total can come from many different patterns. One person may select yes for concentration and work items. Another may select yes for sleep, mood, or relationships. The total combines these areas, so the item pattern often gives a more useful starting point for a conversation than the band alone.

Use repeat scores carefully

If you repeat the THI, use the same wording, response choices, and time frame. Keep the date and note meaningful changes such as a new hearing difference, a noisy event, an illness, a medicine change, poor sleep, or a major stressor. A later score can help show whether the reported impact feels different, but it cannot prove why the change happened.

Do not compare a browser total with a loudness rating, an audiogram threshold, or another tinnitus questionnaire as if they were the same scale. They ask different questions. An audiogram measures hearing sensitivity by frequency. The THI asks about the effect of tinnitus on daily life. Neither one alone explains every tinnitus experience.

What this instrument cannot tell you

The THI cannot identify whether tinnitus comes from earwax, noise exposure, hearing loss, an ear infection, a medicine, a jaw or neck problem, a vascular sound, or another cause. It cannot determine whether tinnitus is in one ear or both, whether it is pulsatile, or whether a hearing change is sudden unless those details are discussed separately. It also cannot tell you what a hearing test will show.

The questionnaire is not a substitute for an ear examination or hearing assessment. An audiologist can measure hearing and discuss tinnitus assessment. An otolaryngologist can examine the ears, hearing pathway, and medical causes. A primary care clinician can review general health, medicines, and the right referral. The appropriate clinician depends on the symptoms and local care system.

Seek prompt medical advice for a sudden hearing change, new one-sided hearing loss, pulsatile tinnitus, facial weakness, severe dizziness, severe ear pain, or discharge with fever. These features are not answered by the THI total. The questionnaire should never delay care for a new or rapidly changing symptom.

Using the result in a clinical visit

You can bring the total, band, date, and the items that feel most important to an appointment. Explain whether the tinnitus began suddenly or gradually, whether it is in one ear or both, whether it pulses with your heartbeat, and whether there is hearing change, pain, discharge, dizziness, or facial weakness. Also mention recent loud sound exposure, head injury, illness, and medicine changes. These details help a clinician decide which examination or hearing test is appropriate.

A clinician may ask you to complete the THI again later, or may use another questionnaire for a different purpose. That does not mean one tool is right and another is wrong. Instruments have different question sets and scoring systems. The useful part is to name the instrument, use the published method, and keep the result attached to the date and context.

Keep the interpretation modest. A lower total may mean the reported impact feels lower at that time. A higher total may mean the reported impact feels greater. Neither statement explains the cause or promises a particular outcome. The result is a conversation aid, not an instruction to change medicine, purchase a device, or choose a procedure.

Reading the item pattern

The THI total is a summary, so it can hide useful detail. Look at which questions received yes or sometimes answers. Concentration, reading, hearing people, work, household duties, and social activity items describe functional effects. Questions about frustration, anger, irritability, upset, anxiety, depression, tiredness, and insecurity describe emotional effects. Questions about escape, control, coping, desperation, and fear of a terrible disease describe the catastrophic area used in the published instrument.

This pattern is not a set of separate diagnoses. It is a map of the areas affected in your own report. A person may have a modest total with one area that deserves attention, such as sleep or work. Another person may have a similar total spread across several areas. Bring the specific items that matter to you, because they can help a clinician ask more focused questions about sleep, communication, stress, mood, and daily tasks.

Write down context beside the score

Record the date, whether the tinnitus was steady or changing, which ear was involved, and whether hearing, balance, pain, discharge, or facial movement also changed. Note a recent loud sound, illness, head injury, medicine change, poor sleep, or unusual stress. These notes do not change the THI calculation. They preserve the setting in which the answers were given and make a later discussion more precise.

A browser score is easy to repeat, but repeat testing can also become tiring. Use it when the result will answer a clear question, such as describing a change since an appointment or recording a baseline before a clinical discussion. You do not need to complete it repeatedly in one day. The instrument works best as one structured report among several kinds of information.

Questions readers ask

Sources

• Newman, Jacobson, and Spitzer, Development of the Tinnitus Handicap Inventory, 1996.
• Vanderbilt University Medical Center Tinnitus Handicap Inventory form.
• McCombe and colleagues, Guidelines for the grading of tinnitus severity, 2001.