Tinnitus Handicap Inventory (THI) — Free Online Tinnitus Distress Test

What the THI measures

The Tinnitus Handicap Inventory (THI) measures how much tinnitus, the experience of ringing, buzzing, hissing or humming in the ears without an outside sound, gets in the way of your life. Its 25 questions cover three areas:

• Functional — effects on concentration, hearing others, sleep, work and social life.
• Emotional — frustration, irritability, anxiety, low mood and strain on relationships.
• Catastrophic — feelings of being unable to cope, loss of control, or fear that the tinnitus signals something serious.

The THI does not measure how loud the sound is. Two people with similar tinnitus can score very differently, because distress depends a great deal on how the brain and mind respond to the sound.

Who it is for

• Adults who notice ringing or other sounds in their ears and want to understand how much it is affecting them.
• People already under an ear, nose and throat doctor or audiologist who want to track change over time.
• People whose tinnitus is affecting their sleep, mood or concentration.

How it works in the app

You answer 25 questions with Yes, Sometimes or No. The app adds up your score, shows your severity grade, and suggests a next step. Because a 20-point change is the threshold for meaningful change, retaking the THI every few months, or before and after treatment, is a useful way to track progress.

THI score interpretation

Scores follow the five-grade scheme proposed by a British Association of Otolaryngologists working group (McCombe et al., 2001), as commonly applied to the THI:

Score	Grade	What it usually means	Suggested next step
0-16	1 — Slight	Usually heard only in quiet; easily masked	Reassurance; an ENT or audiology check if new
18-36	2 — Mild	Easily masked by everyday sound; may affect sleep at times	ENT or audiology review; sound enrichment and sleep habits
38-56	3 — Moderate	Noticed even with background noise; daily activities still possible	Audiology review plus psychological support such as CBT
58-76	4 — Severe	Almost always heard; disturbs sleep and interferes with daily life	Specialist tinnitus care and psychological therapy
78-100	5 — Catastrophic	Always heard; major disruption to sleep and functioning	Prompt specialist review and mental health support

This is a measure of tinnitus-related handicap, not a diagnosis. If tinnitus is new, only in one ear, pulsing in time with your heartbeat, or comes with sudden hearing loss or dizziness, see a doctor promptly whatever your score.

Validation and evidence

The THI was developed by Craig Newman, Gary Jacobson and Jaclyn Spitzer at Henry Ford Hospital and published in 1996. A 45-item draft was tested in 84 patients and refined into the 25-item version, which was tested in 66 patients and showed excellent internal consistency (Cronbach's alpha 0.93), significant correlations with ratings of annoyance, sleep disruption, depression and concentration, and no significant age or gender effects. A 1998 follow-up found high test-retest reliability and a 95% confidence interval of 20 points. The five-grade severity scheme comes from a 1999 British working group, published in 2001, which noted that much of tinnitus severity relates to the person's psychological response. In India, a Kannada version in 140 patients showed Cronbach's alpha of 0.885, and a Hindi version in 100 patients showed test-retest reliability of 0.98.

References

1. Newman CW, Jacobson GP, Spitzer JB. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1996;122(2):143-148. PubMed
2. Newman CW, Sandridge SA, Jacobson GP. Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome. J Am Acad Audiol. 1998;9(2):153-160. PubMed
3. McCombe A, Baguley D, Coles R, et al. Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999. Clin Otolaryngol Allied Sci. 2001;26(5):388-393. PubMed
4. Zacharia T, Naik PV, Sada S, et al. Development and standardization of tinnitus handicap inventory in Kannada. Int Tinnitus J. 2012;17(2):117-123. PubMed
5. Singh V, Abinashi AA, Kumar R, Chaudhary AK. Standardisation of Tinnitus Handicap Inventory in Hindi. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 2):1515-1522. PubMed

What the test does not tell you

• It does not find the cause. Hearing loss, noise exposure, ear wax, infections, medicines and other conditions need an ENT or audiology examination.
• It does not measure loudness or pitch. Those are measured with audiological tests.
• It is not a psychiatric diagnosis. A high score shows distress, not an anxiety or depressive disorder, although it is worth screening for both.
• One score is a snapshot. Changes smaller than 20 points may just be normal variation.

Tinnitus, anxiety and sleep

Tinnitus often becomes most distressing at night, in quiet rooms, and during stressful periods. Worry about the sound can make it more noticeable, which in turn feeds more worry and poorer sleep. Breaking that cycle is often where the biggest gains are.

• Check for anxiety with the GAD-7, and read about anxiety and how it is treated.
• Check your sleep with the Sleep Quality Test, and read about sleep disorders.
• Reduce the distress. Cognitive behavioural therapy with a Mindtalk psychologist targets the worry, attention and sleep patterns that keep tinnitus distress going.

If tinnitus is leaving you feeling hopeless or unable to cope, please talk to someone the same day: iCall 9152987821 or the Cadabams 24/7 line +91 97414 76476.