Tinnitus Handicap Inventory (THI) Calculator
The Tinnitus Handicap Inventory (THI) is a 25-item validated self-assessment questionnaire that measures the impact of tinnitus on daily life. It evaluates functional, emotional, and catastrophic dimensions of tinnitus severity.
About
The Tinnitus Handicap Inventory was developed by Newman, Jacobson, and Spitzer in 1996 and published in Ear and Hearing. It was designed to provide a standardized, psychometrically robust measure of the perceived handicap caused by tinnitus. The questionnaire comprises 25 items divided into three subscales: functional (11 items, 0-44) assessing the impact of tinnitus on daily activities including work, social interactions, sleep, and concentration; emotional (11 items, 0-44) capturing psychological distress including anxiety, depression, anger, frustration, and irritability; and catastrophic (3 items, 0-12) evaluating feelings of desperation and perceived inability to cope with tinnitus. Each item has three response options: "Yes" (4 points), "Sometimes" (2 points), or "No" (0 points). The total score ranges from 0 to 100, with higher scores indicating greater perceived disability. The THI classifies tinnitus severity into 5 grades: Grade 1 Slight (0-16), Grade 2 Mild (18-36), Grade 3 Moderate (38-56), Grade 4 Severe (58-76), and Grade 5 Catastrophic (78-100). The THI has excellent psychometric properties with high internal consistency (Cronbach's alpha 0.93-0.94) and test-retest reliability (r=0.92).
Formula
THI Total = Functional (0-44) + Emotional (0-44) + Catastrophic (0-12). Score: 0-100.
Each of the 25 items is scored: Yes = 4, Sometimes = 2, No = 0. Functional subscale (11 items, range 0-44, items 1,2,4,7,10,12,14,17,19,22,23): assesses impact on work, social activities, sleep, reading, concentration, and household responsibilities. Emotional subscale (11 items, range 0-44, items 3,5,6,8,11,13,15,16,18,20,21): evaluates emotional reactions including anxiety, depression, anger, frustration, and relationship difficulties. Catastrophic subscale (3 items, range 0-12, items 24,25,26): measures more severe reactions including feeling of desperation, inability to escape tinnitus, and perception of having a terrible disease. Grade classification: Slight (0-16) — tinnitus only in quiet. Mild (18-36) — easily masked, occasional sleep interference. Moderate (38-56) — noticeable in background noise, affects sleep and concentration. Severe (58-76) — audible most of the time, significant psychosocial impact. Catastrophic (78-100) — audible always, severe disruption of all activities.
Score Interpretation
The THI is one of the most widely used tinnitus-specific outcome measures in clinical practice and research. Tinnitus affects approximately 10-15% of the adult population, with 1-2% experiencing severe impairment. The THI plays several crucial roles: (1) Baseline assessment to quantify the severity of tinnitus handicap at initial presentation. (2) Monitoring treatment response to interventions including tinnitus retraining therapy (TRT), cognitive behavioral therapy (CBT), sound therapy, hearing aids, and pharmacological treatments. The MCID for THI is approximately 20-25 points, meaning improvement of this magnitude is clinically meaningful. (3) Identifying which domain (functional, emotional, catastrophic) is most affected, enabling targeted intervention. (4) Assessing disability for medicolegal purposes. (5) Screening for patients requiring further investigation, as severe or catastrophic grades may warrant MRI to exclude vestibular schwannoma. The THI correlates moderately with tinnitus loudness matching, but more strongly with measures of psychological distress and quality of life, underscoring the importance of assessing handicap rather than just auditory characteristics of tinnitus.
Grade 1 — Slight (0-16) — 0–16
Tinnitus perceived only in quiet environments. No impact on daily life or sleep.
Management: Reassurance. Avoid silence (use background sound or white noise). Follow up if worsening.
Grade 2 — Mild (18-36) — 18–36
Tinnitus easily masked by ambient noise. May occasionally interfere with sleep.
Management: Audiological evaluation. Sound therapy. Sleep hygiene counseling. Consider hearing aid if hearing loss.
Grade 3 — Moderate (38-56) — 38–56
Tinnitus noticeable even in background noise. Interferes with sleep and concentration.
Management: Comprehensive audiological evaluation. Tinnitus retraining therapy (TRT). Cognitive behavioral therapy (CBT). Sound therapy. Hearing aid trial if hearing loss.
Grade 4 — Severe (58-76) — 58–76
Tinnitus audible most of the time. Significant interference with sleep, concentration, and daily activities.
Management: ENT and audiology referral. Tinnitus retraining therapy (TRT). Cognitive behavioral therapy (CBT). Consider pharmacological options for associated anxiety/depression. MRI internal auditory meatus to exclude vestibular schwannoma.
Grade 5 — Catastrophic (78-100) — 78–100
Tinnitus audible at all times. Severe disruption of all daily activities. Emotional and psychological impact.
Management: Urgent ENT and audiology evaluation. Multidisciplinary approach. Tinnitus retraining therapy. Cognitive behavioral therapy. Pharmacotherapy for anxiety/depression/insomnia. Consider MRI to rule out retrocochlear pathology.
Reference Ranges
| Population | Normal Range | Notes |
|---|---|---|
| Adults with tinnitus | 0-100 | 0-16: Slight. 18-36: Mild. 38-56: Moderate. 58-76: Severe. 78-100: Catastrophic. |
Dr. Mahmoud El-Sayed
Dr. Mahmoud El-Sayed is a consultant otorhinolaryngologist with over 15 years of experience in clinical ENT practice.
View medical review board & editorial policy →Example Calculation
A 62-year-old male with bilateral tinnitus for 3 years submits his THI responses. Functional subscale: 26/44 (tinnitus interferes with concentration at work, social events, and falling asleep). Emotional subscale: 24/44 (feeling anxious about tinnitus, frustration, occasional irritability with family). Catastrophic subscale: 8/12 (feeling that tinnitus will get worse and is a terrible disease). Total THI = 58/100. Interpretation: Grade 4 — Severe tinnitus. Recommendation: ENT and audiology referral. Tinnitus retraining therapy, cognitive behavioral therapy, sound therapy. Consider MRI internal auditory meatus to rule out vestibular schwannoma.
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Common Mistakes
Assuming THI score correlates directly with tinnitus loudness
THI measures the perceived handicap caused by tinnitus, which correlates only moderately with loudness matching. Two patients with identical tinnitus loudness may have very different THI scores based on their psychological response, coping mechanisms, and context. Emotional distress and catastrophizing are often more important determinants of THI score than auditory characteristics.