Tinnitus is generally a subjective condition, but there are clinical ways to measure its audiometric qualities and impact on the patient.

The first step in the treatment of tinnitus is the correct diagnosis and measurement of tinnitus. Below are some of the tests hearing healthcare professionals may perform to evaluate tinnitus.

Audiometric evaluations for hearing loss and tinnitus

Trained audiologists and other hearing healthcare professionals have tools and clinical protocols to help evaluate and diagnose tinnitus. Because tinnitus is so often caused by hearing loss, most audiologists will begin with a comprehensive audiological evaluation that measures the patient’s overall hearing health. General hearing tests include:

• Speech recognition test: A subjective measure of how well the patient hears and can repeat certain words. Sometimes called speech audiometry.
• Pure tone audiogram: A subjective test that measures the patient’s hearing across multiple frequencies (measured in Hertz) and volumes (measured in decibels).
• Tympanogram: An objective test that measures the function of the middle ear, specifically the mobility of the eardrum and the ossicles.
• Acoustic reflex test: An objective test that measures the contraction of the muscles of the middle ear in response to loud sounds.
• Otoacoustic emissions test: The use of highly sensitive microphones to objectively measure the movement of hair cells in the inner ear.

It is important to determine the specific gaps in a tinnitus patient’s hearing because this often correlates with the nature and quality of their particular tinnitus. (For example, high-frequency hearing loss often corresponds to high-frequency tinnitus.) Furthermore, specific hearing markers can inform different potential treatment options for tinnitus.

When evaluating cases of tinnitus, hearing healthcare professionals use an additional set of tests. Although there is currently no way to objectively test for tinnitus, there are several protocols for measuring the patient’s subjective perception of tinnitus sound, pitch, and loudness. Specifically, the doctor may test:

• Tinnitus sound customization: The presentation of common tinnitus sounds back to patients to help them identify their specific perception of tinnitus. Healthcare professionals can adjust the pitch and layer multiple sounds to create an accurate sound reproduction of tinnitus. Sound fitting provides an important baseline for subsequent treatments to treat tinnitus, which are often tailored to each patient.
• Minimum masking level: The loudness at which an external narrowband noise masks (or covers) the perception of tinnitus. Determining the minimum masking level provides an approximate measure of how loud a patient perceives their tinnitus and can be used in subsequent tinnitus masking and sound therapies.
• Discomfort with loudness: The loudness at which external sound becomes unpleasant or painful for a tinnitus patient. This measurement informs the feasibility of sound therapy, masking, and hearing aids as potential tinnitus treatments. Determining loudness discomfort levels is particularly important for patients with extreme sensitivity to noise.

A hearing health professional may administer additional tests depending on the patient’s specific symptoms, medical history, and/or debilitating risk factors. In some extreme situations, an MRI (magnetic resonance imaging) may be appropriate for a person experiencing tinnitus; However, MRIs should only be administered in cases where independent clinical evaluation suggests specific (and rare) tinnitus etiologies.

Tests for measuring tinnitus burden

Tinnitus doesn’t just affect hearing; it can cause a cascade of negative mental, cognitive and physical consequences. The difference between tinnitus being a minor or major problem for patients is less often related to how loud the tinnitus is, but rather how tinnitus affects other facets of patients’ lives.

As such, clinicians and researchers have developed inventory tests to measure the subjective burden a patient experiences due to tinnitus. There are several variations of these tests, but they all work by quantifying the patient’s personal response to tinnitus:

You can download copies of the documents below which are hyperlinked if a copy of the questionnaire is available. Please note: this form is for general information purposes only and should not be used for self-diagnosis or self-treatment. ATA recommends that you share your completed form with your hearing care professional before taking any action.

• Tinnitus Handicap Inventory
  The Tinnitus Handicap Inventory was developed as a brief, easily administered way to evaluate the disabling consequences of tinnitus. It has potential for use in an initial evaluation of disability or later as well as a way to measure treatment outcomes.
• Tinnitus Reaction Questionnaire
  The TRQ is a scale designed to assess the psychological distress associated with tinnitus.
• Tinnitus functional index
  The TFI has eight subscales that address tinnitus intrusiveness, the patient’s sense of control, cognitive interference, sleep disturbances, auditory problems, relaxation problems, quality of life, and emotional distress.
• Tinnitus Severity Index
• Questionnaire for tinnitus primary functions
  The Tinnitus Primary Functions Questionnaire was developed both for clinical trials and for use in the clinic. There is a version with 12 and 20 elements. It focuses on the four main areas that can be affected by tinnitus, 1) thoughts and feelings, 2) hearing, 3) sleep and 4) concentration. It has been translated into several languages ​​and is used all over the world.
• Tinnitus Handicap Questionnaire
  The Tinnitus Handicap Questionnaire was one of the first to be developed for clinical trials. It has been translated into several languages ​​and is used all over the world.
• Visual analog scales