The Tinnitus Handicap Inventory (THI) is a 25-item self-report questionnaire that measures how much tinnitus interferes with daily life. Each item is answered yes, sometimes or no and scores 0, 2 or 4 points, giving a total from 0 to 100, where higher totals mean greater handicap. It rates impact, not loudness.

Why it matters for tinnitus

Tinnitus has no blood test or scan, so clinics and trials rely on what people report, as how tinnitus is measured explains. The THI is the questionnaire they report most often. A 2016 systematic review of 228 treatment studies published from 2006 to 2015 found 24 different patient-reported tools, predominantly the THI, at 15% of studies. Many treatment results, including those of the Cochrane review of CBT for tinnitus, are expressed in THI points.

What the evidence says

  • Development (standardisation study, 1996). A 45-item version was tested on 84 patients, then a 25-item version on 66, with the items grouped into functional, emotional and catastrophic subscales. The items ask how tinnitus affects everyday functioning and emotions, and include catastrophic reactions such as feeling no longer able to cope. Internal consistency was high (Cronbach's alpha 0.93), with no significant age or gender effects. Scores correlated significantly with ratings of annoyance, sleep disruption, depression and concentration, and only weakly with judgements of tinnitus pitch and loudness.
  • Repeatability (small retest study, 1998). In 29 adults retested a mean of 20 days apart, test–retest reliability was high, but one person's score had to move 20 points or more to count as a statistically significant change.
  • Severity grades (working-group guideline, 2001). A British working group proposed five grades: slight, mild, moderate, severe and catastrophic, adding that the top two should, by epidemiological definition, be very rare. The THI bands used in a 2025 study are 0–16 very mild, 18–36 mild, 38–56 moderate, 58–76 severe and 78–100 catastrophic. Among the 364 treatment-seeking people in that study, 31% scored severe or catastrophic.
  • Meaningful change (anchor-based studies and a systematic review). A 2011 study of 210 patients in the Tinnitus Research Initiative database put the smallest relevant drop at 6 or 7 points, depending on the method, and the 2020 Cochrane review of CBT (28 randomised trials) used 7 points to interpret its results. A 2025 multi-centre trial analysis estimated 11 points after 12 weeks (estimates 7.8 to 12), and found that higher starting severity and longer follow-up need a larger drop. People who said their tinnitus had not changed still improved by a mean of 8.7 points.
  • Across languages (database study, 2012). In 1,318 patients from several countries, the THI kept high internal consistency in every language and correlated at around 0.8 with other tinnitus questionnaires. It was not originally designed to measure change, but it responds to treatment.

What this means for you

A THI score describes how much tinnitus is affecting your life. It does not measure how loud the sound is, and it is not a diagnosis; it is a starting point for a conversation with a clinician. If you are tracking change, use the same questionnaire each time, because a THI score cannot be read as a score on another questionnaire, and treat small movements with caution: a drop under 6 points is below every published THI estimate. A questionnaire 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 THI score.

How it connects

  • Tinnitus questionnaires compared sets the THI beside the TFI, TQ, Mini-TQ and others, including why their responder rates disagree.
  • The Tinnitus Functional Index, its main alternative, was built later specifically to detect change with treatment.
  • How tinnitus is measured explains why 7, 11 and 13 points are all quoted as thresholds.
  • Reading a tinnitus study shows how to judge a THI change against a control group.