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9.

here do you perceive your tinnitus

right ear

left ear

both ears, worse in left

both ears, worse in right

both ears, equally

inside the head

elsewhere

10. How does your tinnitus manifest itself over time?

intermittent

constant

11. Does the LOUDNESS of the tinnitus vary from day to day?

YES NO

12. Describe the LOUDNESS of your tinnitus using a scale from 1-100.

(1 = VERY FAINT; 100 = VERY LOUD)

( 1 – 100 )

13. Please describe in your own words what your tinnitus usually sounds like:

_________________________________________________________________

The following list gives examples of some possible sensations, feel free to use other terms as well: hissing, ringing, pulsing, buzzing, clicking, cracking, tonal (like a dial tone or other kinds of tones), humming, popping, roaring, rushing, typewriter, whistling, whooshing.

14. Does your tinnitus more sound like a tone or more like noise:

tone noise crickets

other

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