Tinnitus Impact Questionnaire (Parent)

Please answer each item to the best of your ability as close to your child’s experience as possible.

Over the last 2 weeks, how often would you say the following has occurred because of your child’s Tinnitus? Tinnitus is hearing a sound in the ears or head with no external source (e.g., buzzing, high-pitched whistle, hissing…)

(Use "✓" to indicate your answer)

1. Lack of concentration	0 - 1 day	2 - 6 days	7 - 10 days	11 - 14 days
2. Feeling anxious	0 - 1 day	2 - 6 days	7 - 10 days	11 - 14 days
3. Sleep difficulties (delay in falling sleep and/or difficulty getting back to sleep if woken up during the night)	0 - 1 night	2 - 6 nights	7 - 10 nights	11 - 14 nights
4. Lack of enjoyment from leisure activities	0 - 1 day	2 - 6 days	7 - 10 days	11 - 14 days
5. Inability to perform certain day-to-day activities/tasks	0 - 1 day	2 - 6 days	7 - 10 days	11 - 14 days
6. Feeling irritable	0 - 1 day	2 - 6 days	7 - 10 days	11 - 14 days
7. Low mood	0 - 1 day	2 - 6 days	7 - 10 days	11 - 14 days