Tinnitus and hyperacusis therapy specialist unit

Hyperacusis Impact Questionnaire (Parent version)

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 for your child because of certain environmental sounds which seemed too loud to them but other people could tolerate them well?

For each question please select one number based on how you are feeling now. (Use “✓” to indicate your answer)

1. Feeling anxious when hearing loud noises	0 – 1 day	2 – 6 days	7 – 10 days	11 – 14 days
2. Avoiding certain places because it is too noisy	0 – 1 day	2 – 6 days	7 – 10 days	11 – 14 days
3. Lack of concentration in noisy places	0 – 1 day	2 – 6 days	7 – 10 days	11 – 14 days
4. Difficulty in being calm in noisy places	0 – 1 day	2 – 6 days	7 – 10 days	11 – 14 days
5. Difficulty in carrying out certain day-to-day activities/tasks in noisy places	0 – 1 day	2 – 6 days	7 – 10 days	11 – 14 days
6. Lack of enjoyment from leisure activities in noisy places	0 – 1 day	2 – 6 days	7 – 10 days	11 – 14 days
7. Experiencing low mood because of their intolerance to sound	0 – 1 day	2 – 6 days	7 – 10 days	11 – 14 days
8. Getting tired quickly in noisy places	0 – 1 day	2 – 6 days	7 – 10 days	11 – 14 days