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15. Please describe the PITCH of your tinnitus:

very high frequency

high frequency

medium frequency

low frequency

16.

hat percent of your total awake time, over the last month, have you been aware of your tinnitus ? For example, 100% would indicate that you were aware of your tinnitus all the time, and 25% would indicate that you were aware of your tinnitus ¼ of the time

% (Please write in a single number between 1 and 100.)

17. What percent of your total awake time, over the last month, have you been annoyed, distressed, or irritated of your tinnitus ?

% (Please write in a single number between 1 and 100.)

18. How many different treatments have you undergone because of your tinnitus ?

none

one

several

many

19. Is your tinnitus reduced by music or by certain types of environmental sounds such as the noise of a waterfall or the noise of running water when you are standing in the shower ?

YES

NO

I don t know

20. Does the presence of loud noise make your tinnitus worse?

YES

NO

I don t know

21. Does any head and neck movement (e.g. moving the jaw forward or clenching the teeth), or having your arms/hands or head touched, affect your tinnitus ?

YES

NO

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