Tinnitus and hyperacusis therapy specialist unit

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…)

For each question please select one number based on how you are feeling now.

(Use “✓” to indicate your answer)

1. Lack of concentration
2. Feeling anxious
3. Delay in falling asleep
4. Difficulty going back to sleep if woken up during the night
5. Lack of enjoyment of certain activities
6. Inability to perform day-to-day activities/tasks
7. Feeling irritable
8. Low mood
9. Feeling worried
For Hearing Healthcare Professionals