Sound Relief Hearing Center

Serving the Denver Metro Area

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Hyperacusis
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Tinnitus
Hyperacusis
Hearing
About
Locations
Book Now

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Tinnitus Impact Survey

How bad is my tinnitus? How much is it impacting my life?

By taking our in-depth Tinnitus Impact Survey, we can determine the severity of your tinnitus.

Within minutes, we will also send your results via e-mail along with our recommendations for you to find the relief you deserve.

If at any point you have questions or concerns, please give us a call.

Step 1 of 9

11%

Please read each question below carefully.

Over the past week...
What percentage of your time awake were you consciously AWARE OF your tinnitus?*
0% Never - 100% Always
- 0%
- 10%
- 20%
- 30%
- 40%
- 50%
- 60%
- 70%
- 80%
- 90%
- 100%
How STRONG or LOUD was your tinnitus?*
(0) Not at all - (10) Extremely
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
What percentage of your time awake were you ANNOYED by your tinnitus?*
0% Never - 100% Always
- 0%
- 10%
- 20%
- 30%
- 40%
- 50%
- 60%
- 70%
- 80%
- 90%
- 100%

Over the past week...
Did you feel IN CONTROL in regard to your tinnitus?*
(0) Very much in control - (10) Never in control
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How easy was it for you to COPE with your tinnitus?*
(0) Very easy - (10) Impossible
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How easy was it for you to IGNORE your tinnitus?*
(0) Very easy - (10) Impossible
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week, how much did your tinnitus interfere with...
Your ability to CONCENTRATE?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to THINK CLEARLY?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to FOCUS ATTENTION on other things besides your tinnitus?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week...
How often did your tinnitus make it difficult to FALL ASLEEP or STAY ASLEEP?*
(0) Never - (10) Always
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How often did your tinnitus cause you difficulty in getting AS MUCH SLEEP as you needed?*
(0) Never - (10) Always
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How much of the time did your tinnitus keep you from SLEEPING as DEEPLY or as PEACEFULLY as you would have liked?*
(0) Never - (10) Always
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week, how much has your tinnitus interfered with...
Your ability to HEAR CLEARLY?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to UNDERSTAND PEOPLE who are talking?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to FOLLOW CONVERSATIONS in a group or at meetings?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week, how much has your tinnitus interfered with...
Your QUIET RESTING ACTIVITIES?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to RELAX?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to enjoy "PEACE AND QUIET"?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week, how much has your tinnitus interfered with...
Your enjoyment of SOCIAL ACTIVITIES?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ENJOYMENT OF LIFE?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your RELATIONSHIPS with family, friends, and other people?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How often did your tinnitus cause you to have difficulty performing your WORK or OTHER TASKS, such as home maintenance, school work, or caring for children or others?*
(0) Never - (10) Always
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week...
How ANXIOUS or WORRIED has your tinnitus made you feel?*
(0) Not at all - (10) Extremely
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How BOTHERED or UPSET have you been because of your tinnitus?*
(0) Not at all - (10) Extremely
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How DEPRESSED were you because of your tinnitus?*
(0) Not at all - (10) Extremely depressed
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Within minutes, we will also send your results via e-mail along with our recommendations for you to find the relief you deserve.
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