Introduction
The Tinnitus Functional Index (TFI) is a 25-item self-report questionnaire that measures the severity and negative impact of chronic, intrusive tinnitus. Mary B. Meikle, James A. Henry and a large multi-site team published it in 2012 in Ear and Hearing. It covers eight areas of tinnitus impact, and the article has received at least 1,100 citations.
The team developed the TFI between 2004 and 2008, with funding from the Tinnitus Research Consortium, and Oregon Health & Science University holds its copyright. This guide explains the TFI's subscales, scoring rules, interpretive bands and psychometric evidence.
Key Features of the Tinnitus Functional Index (TFI)
Purpose and Use
The developers designed the TFI for three purposes:
An outcome measure with documented responsiveness to treatment-related changeA measure of individual differences for intake evaluationA reliable and valid measure of multiple domains of tinnitus severityIt suits both clinical and research settings.
Target Population
The TFI is intended for adults with chronic, intrusive tinnitus.
Structure
The TFI contains 25 items in eight factor-based subscales:
Subscale
What it covers
Items
Intrusive
Awareness, loudness and annoyance of tinnitus
3
Sense of Control
Feeling in control, coping and ignoring tinnitus
3
Cognitive
Concentrating, thinking clearly and focusing attention
3
Sleep
Falling and staying asleep, and sleeping deeply
3
Auditory
Hearing clearly and following conversations
3
Relaxation
Resting, relaxing and enjoying peace and quiet
3
Quality of Life
Social activities, enjoyment, relationships and work
4
Emotional
Feeling anxious, bothered or depressed
3
Scoring Method
Respondents rate each item on a 0–10 numeric scale with item-specific verbal anchors, thinking about the past week.
Overall score: sum the item responses, divide by the number of items answered, and multiply by 10, for a score from 0 to 100.Subscale scores: eight scores, one for each factor.Recoded items: items 1 and 25 are recoded.Missing items: a valid overall score, or a subscale with four or more items, needs at least 75% of its items answered; three-item subscales need at least two of three.Higher scores indicate greater tinnitus severity and negative impact.
Interpreting scores: no formal cut-offs exist, but the developers suggest preliminary bands:
TFI score
Suggested meaning
Below about 25
Relatively mild tinnitus, with little or no need for intervention
About 25 to 50
More significant problems; possible or borderline need for professional attention
Above about 50
Severe tinnitus that may warrant more aggressive relief efforts, possibly referral to specialty tinnitus care
A reduction of 13 points is proposed as a preliminary criterion for a meaningful improvement.
Administration Format
The TFI is a self-report questionnaire, so patients complete it themselves using the 0–10 rating scales.
Applications of the Tinnitus Functional Index (TFI)
The TFI supports several uses:
Intake assessment: describing the severity and impact of a patient's tinnitus.Outcome monitoring: tracking treatment-related change, using the 13-point criterion as a preliminary guide.Research: measuring multiple domains of tinnitus impact in clinical studies.Languages and availability
Researchers have translated and validated the TFI in many languages:
German (Germany): validation study; German (Switzerland): validation study; and a comparison of the two German versionsSwedish: cross-cultural adaptation and validationBrazilian Portuguese: translation, adaptation and validationDutch: validation in a tertiary tinnitus clinicJapanese: validation studyChinese: validation of the auditory subscaleKannada: translation and validation for the Indian populationThe final questionnaire carries the notice "Copyright Oregon Health & Science University."
Reliability and Validity
In the original development study, the TFI showed excellent internal consistency (Cronbach's alpha = 0.97) and good test–retest reliability (0.78). In addition, it showed a consistent eight-factor structure.
Validation studies:
The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus (2012): study linkA Swedish cross-cultural adaptation and validation of the TFI (2017): study linkValidation of a Dutch version of the TFI in a tertiary referral tinnitus clinic (2021): study linkLimitations and Considerations
Keep these points in mind:
Development sample: the sample was predominantly male, largely White, and drawn from VA and tertiary clinics.Observational follow-up: responsiveness data came from observational follow-up rather than controlled trials.Preliminary bands: the severity bands and the 13-point change criterion are preliminary, so interpret them cautiously.Other Versions And Related Questionnaires
The development article describes two earlier prototypes that preceded the final 25-item TFI: Prototype 1 (43 items) and Prototype 2 (30 items).
These questionnaires are related:
Tinnitus Handicap Inventory (THI); see the ResRef THI guideVisual Analog Scale (VAS) for tinnitus severityBeck Depression Inventory–Primary Care (BDI-PC)Tinnitus Questionnaire, Tinnitus Handicap Questionnaire and Tinnitus Reaction QuestionnaireTinnitus Severity Index, Tinnitus Severity Scale, Subjective Tinnitus Severity Scale and Tinnitus Severity GradingTinnitus Retraining Therapy Initial InterviewFor brief alternatives, see the ResRef guides to the Skarzynski Tinnitus Scale (STS) and the Fear of Tinnitus Questionnaire (FTQ)Additional Resources
The original article: linkFor inquiries, contact James A. Henry, PhD, National Center for Rehabilitative Auditory Research, VA Medical Center, PO Box 1034, Portland, OR 97207, USA, at james.henry@va.gov.Browse more ENT questionnaires in the ResRef database.Frequently Asked Questions (FAQ)
What does the Tinnitus Functional Index measure?The TFI measures the severity and negative impact of chronic tinnitus across eight areas: intrusiveness, sense of control, cognition, sleep, hearing, relaxation, quality of life and emotions.
How is the TFI scored?Items are rated 0 to 10 for the past week. Sum the answered items, divide by the number answered and multiply by 10, giving a 0–100 score. Higher scores mean more severe tinnitus.
What do TFI scores mean?Preliminary bands suggest below about 25 is relatively mild, about 25 to 50 may need professional attention, and above about 50 is severe. These bands are not formal cut-offs.
What change in TFI score is meaningful?The developers propose a reduction of 13 points as a preliminary criterion for meaningful improvement, based on observational follow-up rather than controlled trials.
A Word from ResRef About the Tinnitus Functional Index (TFI)
The TFI is a self-report tool for assessing the severity and negative impact of chronic tinnitus, with documented responsiveness to treatment-related change, and it suits both intake assessment and outcome monitoring in clinical and research settings. In the original development study it showed excellent internal consistency (alpha 0.97), good test–retest reliability (0.78), and a consistent eight-factor structure. The development sample was predominantly male, largely White, and drawn from VA and tertiary clinics, and follow-up was observational rather than from controlled trials, so the suggested severity bands and the 13-point change criterion are preliminary and should be interpreted cautiously.
References
Meikle, M. B., Henry, J. A., Griest, S. E., Stewart, B. J., Abrams, H. B., McArdle, R., Myers, P. J., Newman, C. W., Sandridge, S., Turk, D. C., Folmer, R. L., Frederick, E. J., House, J. W., Jacobson, G. P., Kinney, S. E., Martin, W. H., Nagler, S. M., Reich, G. E., Searchfield, G.. Vernon, J. A. (2012). The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear and Hearing, 33(2), 153–76. https://doi.org/10.1097/AUD.0b013e31822f67c0Brüggemann, P., Szczepek, A. J., Kleinjung, T., Ojo, M., & Mazurek, B. (2017). [Validation of the German Version of Tinnitus Functional Index (TFI)]. Laryngo- Rhino- Otologie, 96(9), 615–619. https://doi.org/10.1055/s-0042-122342Hoff, M., & Kähäri, K. (2017). A Swedish cross-cultural adaptation and validation of the Tinnitus Functional Index. International Journal of Audiology, 56(4), 277–285. https://doi.org/10.1080/14992027.2016.1265154Peter, N., Kleinjung, T., Jeker, R., Meyer, M., Klaghofer, R., & Weidt, S. (2017). Tinnitus functional index: validation of the German version for Switzerland. Health and Quality of Life Outcomes, 15(1), 94. https://doi.org/10.1186/s12955-017-0669-xPeter, N., Kleinjung, T., Lippuner, R., Boecking, B., Brueggemann, P., & Mazurek, B. (2022). [German-language versions of the Tinnitus Functional Index: Comparison of the two validated German-language versions of the Tinnitus Functional Index for Switzerland and Germany]. HNO, 70(3), 187–192. https://doi.org/10.1007/s00106-021-01099-wRosa MRDD, Doi, M. Y., Branco-Barreiro, F. C. A., Simonetti, P., Oiticica, J., & Marchiori, L. L. M. (2022). Translation, Cultural Adaptation and Validation to Brazilian Portuguese of the Tinnitus Functional Index Questionnaire. International Archives of Otorhinolaryngology, 26(3), e304–e309. https://doi.org/10.1055/s-0041-1730347Santacruz, J. L., Arnold, R., Tuinstra, J., Stewart, R. E., & van Dijk, P. (2021). Validation of a Dutch version of the Tinnitus Functional Index in a tertiary referral tinnitus clinic. Heliyon, 7(8), e07733. https://doi.org/10.1016/j.heliyon.2021.e07733Suzuki, N., Oishi, N., & Ogawa, K. (2019). Validation of the Japanese version of the tinnitus functional index (TFI). International Journal of Audiology, 58(3), 167–173. https://doi.org/10.1080/14992027.2018.1534279Xiang, T., Zheng, Y., & Lu, T. (2020). [Validation of the Chinese version of the auditory subscale of the tinnitus functional index]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi = Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 34(7), 603–605;609. https://doi.org/10.13201/j.issn.2096-7993.2020.07.006Vasudevan, H., Palaniswamy, H. P., & Kanagokar, V. (2025). Translation and validation of the Tinnitus Functional Index (TFI) into Kannada: a tool for clinical and research use in the Indian population. Disability and Rehabilitation, 47(6), 1561–1566. https://doi.org/10.1080/09638288.2024.2375434