“Items list” for tinnitus case history questionnaires. Items are ordered according to their level of significance: Category “A” (= essential) in bold type.
Family history of tinnitus (parent, sibling, children).
Initial onset. Time?
Initial onset. Mode? Gradual or abrupt?
Initial onset. Associated events? Hearing change, Acoustic trauma, Otitis media,
Head trauma, Whiplash, Dental Treatment, Stress, Other.
Pattern. Steady? Pulsatile? Other?
Site. Right ear? Left ear? Both ears? (symmetrical?) Inside head?
Intermittent or constant?
fluctuant or non-fluctuant?
Loudness. Scale 1-100. At worst & at best?
Quality. Own words / Give a list of choices.
Pure tone or Noise? Uncertain / polyphonic?
Pitch. Very high? High? Medium? Low?
Percentage of awake time aware of tinnitus?
Percentage of awake time annoyed by tinnitus?
Previous tinnitus treatments (no, some, many)?
Natural masking? Music, everyday sounds, other sounds?
Aggravated by loud noise?
Altered by head and neck movement or touching of head or upper limbs
(specification of the respective movements)?
Daytime nap. Worse? Better? No effect?
Effect of nocturnal sleep on daytime tinnitus?
Effect of stress?
Effect of medications? Which?
Hearing aids (No, left ear, right ear, both ears; effect on tinnitus)?
Noise annoyance or intolerance?
Noise induced pain?
Other pain syndromes?
Under treatment for psychiatric problems?