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European School for Interdisciplinary Tinnitus Research Screening Questionnaire

A 39-question adult screening and tinnitus-profiling form for people with or without tinnitus.

Questions
39
Time
10–15 min
Privacy
Local only
Structured profile—not a diagnostic test.Part A can be completed whether or not you have tinnitus. Part B applies only if you experienced tinnitus during the past year. This is a research profile, not a diagnostic test, and it has no total score. Source and rights.

Section 1

Part A — individual characteristics

A1Age (years)
A2At birth were you described as:
A3What is your height?

Enter centimetres, or feet and inches.

A4What is your weight?

Enter kilograms, or stones and pounds.

A5What is the highest education level you have achieved?
A6What is the average number of alcoholic drinks that you consume per week?

1 drink equals 125 ml wine, 330 ml beer, or 40 ml spirits.

A7Which option best describes your smoking status?
A8How many first-degree relatives do you know to have tinnitus or hearing loss?

List counts for father, mother, brothers, sisters, sons, and daughters.

A9Do you suffer from vertigo (sensation of spinning or tilting)?
A10Have you been diagnosed with any other ear condition?
A11Have you ever undergone any of the following procedures?
A12Over the last week, have external sounds been a problem, being too loud or uncomfortable when they seemed normal to others?
A13Do you currently have any other difficulty with your hearing, such as listening to speech in a noisy situation?
A14Do you use any of the following devices?
A15Do you suffer from any of the following pain syndromes?
A16Do you have any of the following conditions diagnosed by a clinician?
A17Over the past year, have you had tinnitus in your head or in one or both ears that lasts for more than five minutes at a time?

Section 2

Part B — tinnitus characteristics

B1How often do you have tinnitus on average?
B2What best describes your tinnitus during a day?
B3How long ago did your tinnitus appear?

Enter months and/or years, or do not know.

B4Over the past year, how much does your tinnitus worry, annoy, or upset you when it is at its worst?
B5How long ago did your tinnitus start bothering you?

Enter months and/or years, or do not know.

B6Do you hear one or more different tinnitus sounds?
B7How was the start of your tinnitus?
B8List relevant conditions/procedures and whether each happened before, after, or at about the same time as tinnitus onset.
B9Was the initial onset of your tinnitus related to:
B10Were you taking any of these medicines around the time of tinnitus onset?
B11Do you think any conditions are related to your tinnitus onset?

Answer no, or list up to three important conditions.

B12Is the loudness of your tinnitus stable over time or does it fluctuate over a day?
B13What does your tinnitus sound like?
B14Please describe the pitch of your tinnitus
B15Where do you perceive your tinnitus?
B16Is your tinnitus rhythmic?
B17Has a clinician ever heard your tinnitus?
B18Is your tinnitus reduced by:
B19Is your tinnitus increased by:
B20Over the past year, have you seen a healthcare professional about tinnitus?
B21Are you currently receiving any management for tinnitus?
B22Do you think any conditions are related to periods of increased tinnitus?

Answer no, or list up to three important conditions.

Create a private summary

Prepare your response profile

No total or severity band will be added.

Source, rights, and limitations

Freely available with citation. The authors state that the ESIT-SQ is freely available to the research community and request citation when publishing data. TinniTest reproduces the 39 core English questions, without the 17 optional questions or translation changes.

TinniTest.org is independent. Citation and reproduction do not imply author, institution, publisher, VA, or government endorsement.