Tinnitus Functional Index

TINNITUS FUNCTIONAL INDEX (TFI)

Copyright Oregon Health & Science University 2008

Permission to use registered to Debbie Featherstone in 2012

Date*

Name:*

Your email*

PLEASE READ THE FOLLOWING STATEMENT ABOUT HOW YOUR TFI RESULTS MAY BE USED FOR RESEARCH PURPOSES

* I agree that the anonymous results of my TFI may be included in future research of the Tinnitus E-Programme, by Debbie Featherstone and NIHR NHBRC (National Institute of Hearing Research, Nottingham Biomedical Research Centre) and that my personal data is NOT for publication.

If you CAN agree, you will be helping with research of outcomes for the Tinnitus E-Programme

Please choose your answer from the dropdown menu:*

Please read each question below carefully. To answer a question, select ONE of the numbers listed for that question (in dropdown menu)

INTRUSIVENESS: Over the PAST WEEK

1. What percentage of your time awake were you consciously AWARE OF your tinnitus?*

2. How STRONG or LOUD was your tinnitus?*

3. What percentage of your time awake were you ANNOYED by your tinnitus?*

SENSE OF CONTROL: Over the PAST WEEK

4. Did you feel IN CONTROL in regard to your tinnitus?*

5. How easy was it for you to COPE with your tinnitus?*

6. How easy was it for you to IGNORE your tinnitus?*

CONCENTRATION: Over the PAST WEEK

7. How much has tinnitus interfered with your ability to CONCENTRATE?*

8. How much has tinnitus interfered with your ability to THINK CLEARLY?*

9. How much has tinnitus interfered with your ability to FOCUS ATTENTION on other things besides your tinnitus?*

SLEEP: Over the PAST WEEK

10. How often did your tinnitus make it difficult to FALL ASLEEP or STAY ASLEEP?*

11. How often did your tinnitus cause you difficulty in getting AS MUCH SLEEP as you needed?*

12. How much of the time did your tinnitus keep you from SLEEPING as DEEPLY or as PEACEFULLY as you would have liked?*

AUDITORY: Over the PAST WEEK, how much has your tinnitus interfered with...

13. Your ability to HEAR CLEARLY?*

14. Your ability to UNDERSTAND PEOPLE who are talking?*

15. Your ability to FOLLOW CONVERSATIONS in a group or at meetings?*

RELAXATION: Over the PAST WEEK, how much has your tinnitus interfered with...

16. Your QUIET RESTING ACTIVITIES?*

17. Your ability to RELAX? *

18. Your ability to enjoy "PEACE AND QUIET"?*

QUALITY OF LIFE: Over the PAST WEEK, how much has your tinnitus interfered with...

19. Your enjoyment of SOCIAL ACTIVITIES?*

20. Your ENJOYMENT OF LIFE?*

21. Your RELATIONSHIPS with family, friends and other people?*

22. How often did your tinnitus cause you to have difficulty performing your WORK OR OTHER TASKS, such as home maintenance, school work, or caring for children or others?*

EMOTIONAL: Over the PAST WEEK

23. How ANXIOUS or WORRIED has your tinnitus made you feel?*

24. How BOTHERED or UPSET have you been because of your tinnitus?*

25. How DEPRESSED were you because of your tinnitus?*

THANK YOU for completing the TFI.

Now, review your answers in case you want to make any changes, then press SEND

You will receive a copy of your answers in an email by return