The Tinnitus Functional Index (TFI) is a 25-item self-report questionnaire that measures how severe and intrusive tinnitus is and how much it disrupts daily life. Each item is rated from 0 to 10, and the mean is multiplied by 10 to give a total from 0 to 100. It was designed to detect change with treatment.

Why it matters for tinnitus

Tinnitus has no scan or blood test, so trials judge treatments by what people report, as how tinnitus is measured explains. In 2003 the Tinnitus Research Consortium asked for a new outcome measure that would be highly sensitive to treatment effects, cover all major dimensions of tinnitus impact and scale how severe it is. By 2016 the TFI was being translated into at least 14 languages. Results for the Lenire bimodal device and for several sound devices include changes in TFI points.

What the evidence says

  • Development (multi-clinic observational study, 2012). A panel of 17 expert judges reviewed 175 items from nine existing questionnaires and chose those most likely to respond to treatment. Two prototypes, of 43 and 30 items, were tested on 326 and 347 patients, and the 25 best-functioning items became the final version. Every version showed the same eight factors. Internal consistency was high (Cronbach's alpha 0.97) and test–retest reliability was 0.78. The TFI correlated with the Tinnitus Handicap Inventory (THI) at r = 0.86, with a visual analogue scale at 0.75 and with a depression inventory at 0.56. Its effect sizes for detecting improvement at 3 and 6 months were generally larger than those of the THI or the visual analogue scale.
  • Subscales and bands (population survey of veterans, 2024). The eight subscales are intrusive, sense of control, cognitive, sleep, auditory, relaxation, quality of life and emotional, each also scored 0 to 100. The study used these bands: 0–17 not a problem, 18–31 a small problem, 32–53 a moderate problem, 54–72 a big problem, 73–100 a very big problem.
  • Confirmation in a trial (reanalysis of randomised trial data, 2016). In a trial of telephone tinnitus education, the TFI performed well, with a Cohen's d of 1.23. Mean reductions ranged from 13.2 points on the auditory subscale to 26.7 on the relaxation subscale.
  • Meaningful change. The developers set a 13-point reduction as a preliminary criterion. In a 2024 review, members of the development team kept 13 points for individuals, paired with the person's own sense of whether they are doing better. A 2025 anchor-based analysis of a multi-centre randomised trial estimated 9 points after 12 weeks (estimates 7.3 to 9.4, N = 359), and found that higher starting severity and longer follow-up need a larger drop.
  • Against other questionnaires (clinical cohort, 2021). In 210 German-speaking patients treated in a 7-day programme, TFI totals agreed well with the THI and the Tinnitus Questionnaire (intraclass correlations 0.72 to 0.80). Yet its 13-point threshold classed 18.64% as responders, against 38.15% on the THI's threshold. The authors judged the TFI well suited to research.

What this means for you

A TFI score describes how much tinnitus intrudes on your life, not how loud the sound is, and it is not a diagnosis. If a clinic uses it, ask for a baseline score and the same questionnaire at follow-up, because a TFI score cannot be read as a score on another questionnaire. In the 2025 study, a drop of about 9 points matched people rating themselves minimally improved, and those starting out more severe needed more. It does not screen for warning signs: sudden hearing loss needs to be seen the same day, and a pulsing sound with a sudden severe headache needs emergency care; the when to seek care checklist lists the others. The impact self-check uses its own original questions and is not a TFI score.

How it connects