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CC BY 4.0 questionnaire

FiveQ Tinnitus Impact Questionnaire

Five quick ratings of sleep, concentration, relaxation, daily activities, and hearing over the last week.

Questions
5
Time
2 min
Privacy
Local only
Educational questionnaire—not a diagnosis.Over the last week, choose a number from 1 (no impact) to 10 (intense impact) for each statement. Source and rights.

Section 1

Impact over the last week

01Over the last week, my Tinnitus has prevented me from sleeping.
No impactIntense impact
02Over the last week, my Tinnitus has impacted on my ability to concentrate.
No impactIntense impact
03Over the last week, my Tinnitus has affected my ability to relax.
No impactIntense impact
04Over the last week, my Tinnitus has affected on my ability to perform day to day activities
No impactIntense impact
05Over the last week, my Tinnitus has impacted on my ability to hear.
No impactIntense impact

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Calculate the FiveQ result

Only the scoring rules described by the cited source are applied.

Source, rights, and limitations

CC BY 4.0. The validation article and questionnaire are published under Creative Commons Attribution 4.0. TinniTest reproduces the English wording with attribution.

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