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Please Read Each Question Below Carefully. To Answer A Question, Select One Of The Numbers That Are Listed In The Dropdown For That Question.

I. OVER THE PAST WEEK

1. On a scale of 0% "Never aware" to 100% "Always aware", what percentage of your time awake were you consciously aware of your tinnitus?

2. On a scale of 0-10, how strong or loud was your tinnitus? 0 being "Not at all strong or loud" and 10 being "Extremely strong or loud".

3. On a scale of 0% "None of the time" to 100% "All of the time", what percentage of your time awake were you annoyed by your tinnitus?

SC. OVER THE PAST WEEK

4. Did you feel IN CONTROL in regard to your tinnitus? On a scale of 0 "Very much in control" to 10 "Never in control".

5. How easy was it for you to COPE with your tinnitus? On a scale of 0 "Very easy to cope" to 10 "Impossible to cope".

6. How easy was it for you to IGNORE your tinnitus? On a scale of 0 "Very easy to ignore" to 10 "Impossible to ignore".

C. Over The PAST WEEK, How Much Did Your Tinnitus Interfere With...

7. Your ability to CONCENTRATE? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

8. Your ability to THINK CLEARLY? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

9. Your ability to FOCUS ATTENTION on other things besides your tinnitus? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

SL. Over The PAST WEEK...

10. How often did your tinnitus make it difficult to FALL ASLEEP or STAY ASLEEP? On a scale of 0 "Never had difficulty" to "Always had difficulty".

11. How often did your tinnitus cause you difficulty in getting AS MUCH SLEEP as you needed? On a scale of 0 "Never had difficulty" to "Always had difficulty".

12. How much of the time did your tinnitus keep you from SLEEPING as DEEPLY or as PEACEFULLY as you would have liked? On a scale of 0 "None of the time" to "All of the time".

A. Over The PAST WEEK, How Much Has Your Tinnitus Interfered With...

13. Your ability to HEAR CLEARLY? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

14. Your ability to UNDERSTAND PEOPLE who are talking? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

15. Your ability to FOLLOW CONVERSATIONS in a group or at meetings? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

R. Over The PAST WEEK, How Much Has Your Tinnitus Interfered With...

16. Your QUIET RESTING ACTIVITIES? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

17. Your ability to RELAX? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

18. Your ability to enjoy PEACE AND QUIET? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

Q. Over The PAST WEEK, How Much Has Your Tinnitus Interfered With...

19. Your enjoyment of SOCIAL ACTIVITIES? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

20. Your ENJOYMENT OF LIFE? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

21. Your RELATIONSHIPS with family, friends and other people? On a scale of 0 "Did not interfere" to 10 "Completely interfered".

22. 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? On a scale of 0 "Never had difficulty" to 10 "Always had difficulty".

E. Over The PAST WEEK...

23. How ANXIOUS or WORRIED has your tinnitus made you feel? On a scale of 0 "Not at all anxious or worried" to "Extremely anxious or worried".

24. How BOTHERED or UPSET have you been because of your tinnitus? On a scale of 0 "Not at all bothered or upset" to "Extremely bothered or upset".

25. How DEPRESSED were you because of your tinnitus? On a scale of 0 "Not at all depressed" to "Extremely depressed".