Explanation: Aim is to understand the degree of your tinnitus. Just answer yes, no or sometimes.
1- Do you have difficulty to consentrate because of your tinnitus?
Yes Sometimes No
2- Do you have difficulty to hear human beings because of tinnitus?
Yes Sometimes No
3- Do you get nervous because of tinnitus?
Yes Sometimes No
4- Do you feel mixed up because fo tinnitus?
Yes Sometimes No
5- Do you feel hopeless because of tinnitus?
Yes Sometimes No
6- Are you complaint of tinnitus very much?
Yes Sometimes No
7- Do you get difficulty getting into sleep?
Yes Sometimes No
8- Do you feel that you cannot get rid of your tinnitus?
Yes Sometimes No
9- Does tinnitus prevent you to get joy from your social activities?
Yes Sometimes No
10- Do you feel handicapped because of tinnitus?
Yes Sometimes No
11- Do you think that you get a terrible disease because of your tinnitus?
Yes Sometimes No
12- Does tinnitus cause lost of your life joy?
Yes Sometimes No
13- Does it prevent to do your responsibilities?
Yes Sometimes No
14- Do yo feel touchy becuase of tinnitus?
Yes Sometimes No
15- Is it difficult to read because ıf tinnitus?
Yes Sometimes No
16- Does it make you sad?
Yes Sometimes No
17- Do you think that tinnitus causes pressure in your relations with your family and friends?
Yes Sometimes No
18- Do you think that it is difficult to seperate your ideas from tinnitus and concentrate on other things?
Yes Sometimes No
19- Do you feel that you have not any control on your tinnitus?
Yes Sometimes No
20- Do you feel tired frequently because of tinnitus?
Yes Sometimes No
21- Do you feel depressed because of tinnitus?
Yes Sometimes No
22- Does tinnitus make you feel nervous?
Yes Sometimes No
23- Do you think that you do not overcome with tinnitus anymore?
Yes Sometimes No
24- Does tinnitus become worse when you have problems?
Yes Sometimes No
25- Does tinnitus make you feel unsafe?
Yes Sometimes No
Evaluation of the questionnaire (Aksoy S. 2007)
4 0 2
Yes Sometimes No
First degree 0-16 Weak (Only can be heard in quiet places)
Second degree 18-36 Medium (Can be masked with noise and can be ignored while in activitiy)
Third degree 38-56 Moderate (Still routine activities can be performed even tinnitus is heard)
Fourth degree 58-76 Strong (Tinnitus is heard almost always and may disturb sleep and daily activities)
Fifth degree 78-100 Disaster (Heard always, disturbs sleep and causes difficulty in routine work)