What is a normal THI score?

There is no single normal score. Scores from 0 to 16 are graded slight, which usually means tinnitus is only noticed in quiet places and is easily ignored. Whatever your score, it reflects how much tinnitus is affecting you at the time, and it is worth talking through with an audiologist or GP.

How is the Tinnitus Handicap Inventory scored?

There are 25 questions. Each Yes scores 4, each Sometimes scores 2 and each No scores 0, giving a total out of 100. The questions also form three part-scores: functional, emotional and catastrophic. The total is then placed in one of five grades, from slight to catastrophic.

Does a high THI score mean my tinnitus is getting worse?

Not necessarily. The THI measures how much tinnitus is affecting your life, not how loud it is or what is happening in your ears. Stress, poor sleep or a hard week can raise the score. It is not a diagnosis, so if your score is high or has changed, speak to an audiologist or your GP.

What is the Tinnitus Handicap Inventory (THI) and what does my score mean?

You have just come out of a hearing appointment. Somewhere between the beeps in the booth and the chat at the end, the audiologist mentioned the THI and a number. Maybe it was 24. Maybe it was 62. Maybe they said "moderate" and moved on before you could ask what that meant.

The Tinnitus Handicap Inventory is one of the most widely used tinnitus questionnaires. It is short and simple, and it is easy to misread. Here is what it is, where it came from, how the score is worked out, and what your number does and does not say about you.

What the THI is, in plain words

The THI is a list of 25 questions about how tinnitus affects your daily life. It does not measure how loud the sound is or what pitch it is. It asks how much the tinnitus gets in the way: of sleep, concentration, mood, relationships and your sense of being able to cope.

It was published in 1996 by Craig Newman, Gary Jacobson and Jaclyn Spitzer, in a paper called Development of the Tinnitus Handicap Inventory. Their aim was a questionnaire that was quick to fill in, easy to score, and useful to clinicians who wanted to understand the impact of tinnitus on a person, not just describe the noise. It has since been translated into many languages and is used in clinics and research around the world.

The word "handicap" is a little old-fashioned now. It does not mean you are being labelled. In this context it simply means how much the tinnitus is holding you back day to day.

How the THI is scored

Each of the 25 questions is answered with one of three options:

Yes scores 4 points.
Sometimes scores 2 points.
No scores 0 points.

The points are added up to give a total between 0 and 100. A higher score means the tinnitus is having a bigger effect on your life. Because every answer is worth 0, 2 or 4, totals are always even numbers.

The three part-scores

In the original paper, the questions fall into three groups, which can be scored separately:

Functional (11 questions): how tinnitus affects things like concentrating, reading, sleeping, hearing people and getting on with work or home life.
Emotional (9 questions): feelings such as frustration, irritability, anxiety or low mood linked to the tinnitus.
Catastrophic (5 questions): the heaviest feelings, such as feeling desperate, feeling you cannot escape it, or feeling you can no longer cope.

The part-scores can be more helpful than the total. Two people can both score 40, one mostly from sleep and concentration, the other mostly from worry. Those are quite different conversations to have with an audiologist.

What the grades mean

The original 1996 paper gave a total score. The five grades most clinics now use came later, from a British working group led by McCombe and colleagues, published in 2001 as guidelines for grading tinnitus severity. Roughly, they look like this:

Slight (0 to 16): tinnitus is usually only noticed in quiet surroundings and is easily ignored.
Mild (18 to 36): easily masked by everyday sound and easily forgotten when you are busy.
Moderate (38 to 56): noticed even with background noise, though daily activities can still go ahead.
Severe (58 to 76): almost always heard, often disturbs sleep and can get in the way of daily life.
Catastrophic (78 to 100): always heard, disturbs sleep and makes many daily activities hard.

These descriptions are a guide, not a verdict. Plenty of people do not fit their band neatly, and the score sits next to everything else your audiologist learns about you.

Your THI score is a snapshot of how much tinnitus is weighing on you right now. It is not a diagnosis, and it is not a measure of how damaged your ears are.

What your score can and cannot tell you

It helps to be clear about what the THI is for.

It is not a diagnosis. It does not tell you what is causing your tinnitus, and it does not test your hearing.
It reflects how you feel at the time. A bad week, poor sleep or a stressful patch can push answers up. A calmer spell can bring them down.
It is a starting point for a conversation. NICE guidance on tinnitus talks about using questionnaires to understand how much tinnitus is affecting someone, alongside a proper assessment. That is the role the THI plays.
Small changes are not always meaningful. A few points up or down between one go and the next may just be normal variation. Your audiologist can help you judge whether a change matters.

Whatever your number, it is worth talking through with an audiologist or your GP. Tinnitus UK points out that many people find the impact of tinnitus becomes easier to live with over time, and that support is available. If your score was high, that is a reason to ask for help, not a reason to lose hope.

If the catastrophic questions hit home

If you answered "Yes" to questions about feeling desperate or unable to cope, please tell someone. Speak to your GP. If you are struggling right now, Samaritans can be reached free in the UK on 116 123, day or night.

When to see a doctor

A questionnaire cannot pick up the patterns that need medical attention. The NHS says to:

See a GP if you have tinnitus regularly or constantly, if it is getting worse, or if it is bothering you, for example by affecting your sleep or concentration or making you feel anxious or depressed.
Ask for an urgent GP appointment if your tinnitus beats in time with your pulse.
Go to A&E or call 999 if you have tinnitus after a head injury, or tinnitus with sudden hearing loss, weakness in the muscles of your face, or a spinning sensation (vertigo).

Do not wait for a score to tell you it is serious.

How TinnitusMe helps with this

TinnitusMe is a tinnitus app, available on iPhone and Android. It is not a medical device, and it does not diagnose, treat or relieve tinnitus.

The THI, in Profile

In Profile you will find the tinnitus questionnaire: the Tinnitus Handicap Inventory by Newman, Jacobson and Spitzer. It is 25 questions, each answered No, Sometimes or Yes, and takes about four minutes.

When you finish, you see your score out of 100, your grade (slight, mild, moderate, severe or catastrophic) and your three part-scores: functional, emotional and catastrophic.

Your past scores

Each time you take it, the score is kept, so you can look back at your history. You choose when. The app never reminds you or asks you to retake it. If you have an appointment coming up, you can show your audiologist how your scores have changed.

The rest of the app, briefly

Day to day, there is one thing to do: log it when it gets louder. Open the Log tab, tap Log Spike, and skip any step you like. The rest is collected for you, such as weather, the noise level around you, and sleep from your watch or fitness app if you connect one. Over time, What Happened shows what tends to go with your louder days compared with your quieter ones.

Find out more at tinnitusme.com.