The Tinnitus Functional Index (TFI) is a self-report questionnaire that assesses the severity of an individual’s tinnitus and its impact on their daily life.

“Tinnitus” is the medical term for the perception of sound in the absence of any external noise. Most people describe tinnitus as “ringing in the ears.” However, tinnitus can manifest in different ways for different people.

Tinnitus is common, affecting approximately 10% of adults in the United States. Around 5 million people in the United States experience chronic and bothersome tinnitus, and around 2 million people find the condition debilitating.

If tinnitus affects your day-to-day life, the TFI can help doctors better understand the range of your symptoms and how they affect you.

The Tinnitus Functional Index (TFI) is a self-report questionnaire that doctors may use to assess the severity of your tinnitus and the extent to which the condition affects your daily functioning. Doctors may also use the TFI to monitor your response to tinnitus treatments.

This 25-item questionnaire assesses the severity of your tinnitus over the previous week. The questions are grouped into eight subscales, or “factors.”

The eight factors that the TFI assesses are:

  • Intrusiveness: “How strong or loud was your tinnitus?”
  • Sense of control: “How easy was it for you to ignore your tinnitus?”
  • Cognition: “How much did your tinnitus interfere with your ability to concentrate?”
  • Sleep: “How often did your tinnitus make it difficult to fall asleep or stay asleep?”
  • Auditory: “How much has your tinnitus interfered with your ability to hear clearly?”
  • Relaxation: “How much has your tinnitus interfered with your ability to relax?”
  • Quality of life: “How much has tinnitus interfered with your enjoyment of social activities?”
  • Emotional distress: “How anxious or worried has your tinnitus made you feel?”

When filling in the questionnaire, you rate your response to each question on a scale of 0 to 10. Scores of “0” represent the least impact on your functioning, while scores of “10” represent the greatest impact.

After you have completed the TFI, your primary care professional will add all of your individual scores and divide the overall score by the number of answers you provided. They will then multiply this new score by 10 to give a TFI score of between 0 and 100.

The closer your TFI score is to 100, the more severe your tinnitus and the greater its impact on your daily functioning.

If you have tinnitus, doctors may use other methods besides the TFI to help determine the severity of the condition.

An audiologist may conduct hearing tests to help diagnose and determine the extent of hearing loss or tinnitus. Examples of such tests include:

  • Speech recognition test: assesses how well you can hear and repeat certain words
  • Pure tone audiogram: measures the lowest volume at which you start to hear different sound frequencies
  • Tympanogram: assesses the ability of your middle ear structures to transmit and amplify sound
  • Acoustic reflex testing: measures the contraction of your middle ear muscles in response to loud sounds
  • Otoacoustic emission testing: measures the movement of individual hair cells within your inner ear

Doctors may also administer questionnaires similar to the TFI to assess your tinnitus burden, which is the extent to which tinnitus affects your functioning. Examples include:

  • The Tinnitus Handicap Inventory (THI): identifies the difficulties you may experience as a result of your tinnitus and evaluates the severity of these difficulties
  • The Tinnitus Reaction Questionnaire (TRQ): assesses the psychological distress your tinnitus causes you
  • The Tinnitus Primary Functions Questionnaire (TPFQ): developed for use in the clinic as well as clinical trials and focuses on the four key areas that tinnitus can affect:
    • thoughts and emotions
    • hearing
    • sleep
    • concentration
  • The Tinnitus Handicap Questionnaire (THQ): developed for use in clinical trials and addresses the impact of tinnitus on multiple factors that contribute to your overall quality of life

The National Institute on Deafness and Other Communication Disorders (NIDOCD) recommends that you visit your primary care doctor if you experience symptoms of tinnitus. Your doctor will examine the inside of your ear to check for earwax or fluid that may be blocking your ear canal and causing symptoms. They will also ask about your medical history, as certain medical conditions and medications can cause or contribute to tinnitus.

If necessary, the doctor may refer you to a specialist, such as an otolaryngologist (ENT doctor) or an audiologist.

ENT doctors specialize in diagnosing and treating conditions of the ear, nose, and throat. An ENT doctor will conduct a physical examination of your head, neck, and ears. They may also order imaging tests to determine whether your tinnitus is due to an underlying medical condition or a structural issue in any of these areas.

Audiologists specialize in identifying and treating hearing and balance issues. An audiologist will conduct hearing tests to assess your hearing as well as the pitch and intensity of your tinnitus.

If your treatment team is able to identify the cause of your tinnitus, they will provide treatments to address the cause and eliminate or reduce the symptoms. If they are unable to identify the cause, they will recommend treatments to help lessen the impact of your tinnitus.

“Tinnitus” is the medical term for the perception of sound in the absence of any external noise. Most people describe tinnitus as “ringing in the ears,” but the condition may manifest as other sounds, such as whooshing, hissing, or clicking. It may be acute or chronic and may range from mild to severe.

The Tinnitus Functional Index (TFI) is a 25-item self-report questionnaire that doctors and audiologists may use to assess the severity of your tinnitus and the extent to which it affects your daily functioning.

The questionnaire assesses how tinnitus affects your hearing, sleep, and emotions, among other factors. The higher your score on the TFI, the greater the severity and impact of your tinnitus.

If you are experiencing tinnitus symptoms, you can see your primary care physician for an initial examination. Your doctor can then refer you to an otolaryngologist or audiologist, if necessary. These specialist doctors will carry out their own tests and examinations to help identify the cause of your tinnitus and provide appropriate treatments.