Tinnitus and hyperacusis therapy specialist unit

Noise Impact Questionnaire (parent version)

Please answer each item to the best of your ability as close as possible to what you think was your child’s experience. Over the last 2 weeks, how often would you say the following has occurred to your child because of exposure to noises when they were at home or outdoors, for example noise from neighbours, airplanes, trains, power lines, road traffic, industrial workshops, entertainment venues (when they are not actually on the road, or in the workshop or the venue in question), or noise related to plumbing, air conditioning and other domestic appliances?

1. Feeling irritated or angry	0-1 day	2-6 days	7-10 days	11-14 days
2. Avoiding some places or having to shut the doors/windows because of the noise	0-1 day	2-6 days	7-10 days	11-14 days
3. Lack of concentration?	0-1 day	2-6 days	7-10 days	11-14 days
4. Difficulty in carrying out some day-to-day activities/tasks?	0-1 day	2-6 days	7-10 days	11-14 days
5. Lack of enjoyment from leisure activities?	0-1 day	2-6 days	7-10 days	11-14 days
6. Feeling helpless?	0-1 day	2-6 days	7-10 days	11-14 days
7. Sleep difficulties?	0-1 nights	2-6 nights	7-10 nights	11-14 nights
8. Reducing the noise using headphones, earplugs or background music?	0-1 day	2-6 days	7-10 days	11-14 days