Tinnitus and Hearing Survey (THS): A Full Guide for Researchers and Clinicians
By ResRef
Published
The Tinnitus and Hearing Survey (THS) is a vital, free, 10-item tool designed to rapidly differentiate between tinnitus and hearing problems in adults.
Introduction
The Tinnitus and Hearing Survey (THS), a concise 10-item instrument, was specifically developed to address a critical clinical need in audiology and otolaryngology. Co-occurring hearing difficulties and tinnitus frequently present a complex diagnostic challenge for professionals because these conditions often manifest simultaneously. Consequently, patients regularly struggle to distinguish which condition causes specific functional impairments, requiring a specialized screening tool to untangle these overlapping subjective experiences. First developed by James A. Henry and his research team in 2015, the tool has since been widely recognized for its capability to rapidly partition patient distress. With over 200 citations in scientific literature, the questionnaire has consistently demonstrated its reliability and validity across diverse clinical populations.
This article delves into the core features, practical applications, and psychometric validation of the survey. Furthermore, it aims to provide researchers and clinicians with actionable insights to optimize diagnostic triage and streamline treatment planning. By exploring its structural breakdown, scoring mechanisms, and global adaptations, healthcare providers can better integrate this instrument into their routine clinical workflows.
Key features of the Tinnitus and Hearing Survey (THS)
Purpose and Use
The primary purpose of the survey is to differentiate between problems associated with tinnitus and hearing difficulties. By utilizing this instrument, healthcare teams can rapidly identify whether complaints stem from sound-tolerance issues, speech-deficit problems, or tinnitus distress. Ultimately, this clear differentiation prevents misallocating clinical resources and leads to highly targeted interventions. Furthermore, the questionnaire provides crucial insights that guide initial clinical discussions, helping patients understand their distinct auditory symptoms.
Target Population
The survey is validated for use with adults aged 18 and older, including:
Young adults (18–24 years)Middle-aged adults (25–44 years)Older adults (45–64 years)Seniors (65+ years)It is specifically engineered for individuals who experience both tinnitus and hearing difficulties simultaneously.
Structure
The survey consists of 10 items, which are divided into three distinct, structured sections. These items load directly onto specific auditory subdomains:
Section A (Tinnitus): 4 items covering tinnitus-specific distress, focusing on functional impacts such as sleep, concentration, and relaxation.Section B (Hearing): 4 items covering communication difficulties, particularly speech recognition in noisy environments and understanding soft voices.Section C (Sound Tolerance): 2 items screening for hyperacusis or heightened sensitivity to loud, everyday environmental sounds.These distinct domains allow for a nuanced understanding of a patient's acoustic profile, facilitating tailored interventions.
Scoring Method
Each item across Sections A and B is rated on a rating scale, ranging from 0 ("not a problem") to 4 ("very big problem"). Consequently, the total score for each independent section can range from 0 to 16. Although Section C was not the primary focus of the initial development investigations, its test–retest reliability was rigorously analyzed and reported by the authors.
Higher scores across the subscales indicate greater reported problems within that specific domain. However, because scores are interpreted dimensionally, no clinical cut-off score is recommended by the developers.
Administration Format
The instrument is designed as a brief 10-item screening survey, making it highly efficient to deploy within clinical environments. However, administering and interpreting this questionnaire requires specialized expertise to ensure clinical accuracy. Healthcare teams can easily administer the questionnaire via multiple modalities, including:
Paper-based formatsDigital (online) platformsIn-person clinical interviewsPhone or video callsBecause it typically takes about 5 minutes to complete, this exceptional brevity makes it highly practical for busy clinical workflows and large-scale research protocols.
Application of the Tinnitus and Hearing Survey (THS)
The survey has broad, multifaceted applications across both clinical practice and academic research domains:
Screening: It serves as an effective, low-burden screening tool to quickly differentiate whether a patient requires targeted tinnitus management, hearing rehabilitation, or sound-tolerance therapy.Treatment Planning: Clinicians can use specific subscale profiles to inform individualized management strategies, determining whether a patient would benefit more from hearing aids, tinnitus retraining therapy (TRT), or sound-enrichment protocols.Research Endpoint: The survey functions as a valuable, lightweight outcome measure in clinical trials and observational studies investigating epidemiological trends or treatment efficacy across diverse auditory phenotypes.Languages and availability
The instrument has been translated and culturally adapted into multiple languages to facilitate international utility, including:
EnglishSpanishBrazilian PortuguesePolishPersianThis global linguistic availability enhances its utility in multicultural clinical settings and facilitates cross-border research collaborations. Additionally, because the tool resides within the public domain, the survey is completely free and globally accessible for immediate clinical and academic use without any licensing barriers.
Reliability and Validity
The instrument is recognized as a highly reliable and valid instrument for assessing subjective otolaryngological distress. Its psychometric soundness is strongly supported by an excellent Cronbach's alpha ranging between 0.86 and 0.94 for Sections A and B. Moreover, the survey demonstrates strong test-retest reliability, with correlation coefficients (r) ranging from 0.76 to 0.83 over time.
Various international validation studies have further supported its transcultural validity and linguistic stability, showing appropriate alignment with more extensive diagnostic measures.
Validation evidence comes from diverse contexts, including:
The original validation study link.Validation study of the Spanish version Study link.Validation study of the Brazilian Portuguese version study link.Validation study of the Polish version study link.Validation study of the Persian version study link.The Role of Audiologic Evaluation in Progressive Audiologic Tinnitus Management study link.Limitations and Considerations
Despite its notable strengths, the instrument has a few limitations that users must consider:
Self-report measure: As a subjective self-report questionnaire, responses can be influenced by personal interpretation or temporary emotional states.Limited Diagnostic Focus: It does not provide a formal medical diagnosis of underlying auditory pathology, focusing instead entirely on the subjective perception of the patient.Other Versions And Related Questionnaires
While the original 10-item instrument remains widely implemented, researchers have explored specialized modifications for specific clinical contexts. These variations include:
THS-H40: An 11-point modified version of the hearing subscale.THS-T40: An 11-point modified version of the tinnitus subscale.Additionally, clinicians frequently utilize the survey alongside more extensive, comprehensive diagnostic questionnaires, such as:
THI: The Tinnitus Handicap Inventory.TFI: The Tinnitus Functional IndexAdditional Resources
The original validation study link.You can access the questionnaire as a PDF through this link.For inquiries, contact the National Center for Rehabilitative Auditory Research (NCRAR) link.For additional clinician resources, consult the official NCRAR Tinnitus Questionnaires portal link.Frequently Asked Questions (FAQ)
Who can use the THS?Clinicians, researchers, and healthcare providers use the survey for adult patients (aged 18 and older) who experience both tinnitus symptoms and hearing difficulties.
How long does it take to complete the THS?Patients typically take about 5 minutes to complete the survey, which makes it highly feasible for rapid triage in busy clinical and research settings.
How is the THS administered?Healthcare teams can administer the questionnaire via paper-based, digital online platforms, in-person interviews, or phone/video call formats—offering maximum logistical flexibility.
Is there any cost to using the THS?No. The survey is free to use because it is placed in the public domain. It does not require paid licensing or commercial registration.
A Word from ResRef about the Tinnitus and Hearing Survey (THS)
The THS is a brief differential screening tool used in audiology and tinnitus-care settings to help distinguish tinnitus-specific problems from hearing-related difficulties. It has strong validation evidence for its main tinnitus and hearing sections and is useful for guiding clinical discussion about whether tinnitus-specific intervention is appropriate.
References
Henry JA, Griest S, Zaugg TL, Thielman E, Kaelin C, Galvez G, Carlson KF. Tinnitus and hearing survey: a screening tool to differentiate bothersome tinnitus from hearing difficulties. Am J Audiol. 2015 Mar;24(1):66-77. link.Manchaiah, V., Muñoz, M. F., Hatfield, E., Fagelson, M. A., Aronson, E. P., Andersson, G., & Beukes, E. W. (2020). Translation and adaptation of three English tinnitus patient-reported outcome measures to Spanish. International Journal of Audiology, 59(7), 513–518. link.Amanda Rodrigues Scheffer, Maria Fernanda Capoani Garcia Mondelli, Tinnitus and hearing survey: cultural adaptation to Brazilian Portuguese, Brazilian Journal of Otorhinolaryngology, Volume 87, Issue 1, 2021, Pages 28-34, ISSN 1808-8694. link.Raj-Koziak, Danuta, et al. “Tinnitus and Hearing Survey: A Polish Study of Validity and Reliability in a Clinical Population.” Audiology and Neurotology, vol. 22, no. 4-5, 2017, pp. 197–204. link.Alavi Dehkordi SA, Ramezani M, Javanbakht M, Vahedi M. Validity and Reliability of the Persian Version of the Tinnitus and Hearing Survey Questionnaire. Aud Vestib Res. 2025;34(1):9-15. link.Henry JA, Zaugg TL, Myers PJ, Schechter MA. The Role of Audiologic Evaluation in Progressive Audiologic Tinnitus Management. Trends in Amplification. 2008;12(3):170-187. link.