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 treating tinnitus is appropriately diagnosing and measuring tinnitus. Below are some of the tests hearing health professionals can perform to evaluate tinnitus.
Audiometric Evaluations for Hearing Loss and Tinnitus
Trained audiologists and other hearing health 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 functioning of the middle ear, specifically the mobility of the tympanic membrane and the conduction bones.
- Acoustic reflex testing: An objective test that measures the contraction of the middle ear muscles in response to loud sounds.
- Otoacoustic emission testing: The use of very sensitive microphones to objectively measure the movement of hair cells within the inner ear.
It is important to determine the specific gaps in a tinnitus patient’s hearing, because this often correlates to the nature and quality of their particular tinnitus. (For instance, high-frequency hearing loss often corresponds with high-frequency tinnitus.) Moreover, specific hearing markers may inform different potential treatment options for tinnitus.
When evaluating tinnitus cases, hearing health professionals use a supplemental set of tests. While there is currently no way to objectively test for tinnitus, there are several protocols to measure the patient’s subjective perception of tinnitus sound, pitch, and volume. Specifically, the doctor may test:
- Tinnitus sound matching: The presentation of common tinnitus sounds back to patients, to help them identify their specific perception of tinnitus. The health professional may adjust the pitch and layer multiple sounds to create an exact audio recreation of the the tinnitus. Sound matching provides an important baseline for subsequent tinnitus management therapies, which are often customized for each patient.
- Minimum masking level: The volume 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 his/her tinnitus and can be used in subsequent tinnitus masking and sound therapies.
- Loudness discomfort level: The volume at which external sound becomes uncomfortable 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 an extreme sensitivity to noise.
A hearing health professional may administer additional tests, depending on the patient’s specific symptoms, medical history, and/or attenuating risk factors. In some extreme situations, an MRI (magnetic resonance imaging) may be appropriate for someone experiencing tinnitus; however, MRIs should only be administered in cases when independent clinical evaluation suggests specific (and rare) tinnitus etiologies.
Tests To Measure Tinnitus Burden
Tinnitus doesn’t just impact hearing; it can cause a cascade of negative mental, cognitive, and physical consequences. The difference between tinnitus being a minor or major issue of the patients' is less often related to how loud tinnitus is, but rather how the tinnitus impacts other facets of patients' lives.
As such, clinicians and researchers have developed inventory tests to measure the subjective burden a patient experiences because of tinnitus. There are several varieties of these tests, but they all operate by quantifying the patient’s personal reaction 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 provided for general informational purposes only and should not be used for self-diagnosis or self-treatment. ATA recommends that you share your completed form with your hearing health professional prior to 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 handicap or later as well as a way to measure treatment outcome.
- 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 the intrusiveness of tinnitus, the sense of control the patient has, cognitive interference, sleep disturbance, auditory issues, relaxation issues, quality of life, and emotional distress.
- Tinnitus Severity Index
- Tinnitus Primary Functions Questionnaire
The Tinnitus Primary Functions Questionnaire was developed both for clinical trials and for use in the clinic. There is a 12 and a 20 item version. It focuses on the four main areas that can be affected by tinnitus, 1) Thoughts and Emotions, 2) Hearing, 3) Sleep and 4) concentration. It has been translated into several languages and is used worldwide.
- Tinnitus Handicap Questionnaire
The Tinnitus Handicap Questionnaire was one of the first developed for clinical trials. It has been translated into several languages and is used worldwide.
- Visual Analog Scales