How to Interpret Tinnitus Functional Index Scores: A Proposal for a Grading System Based on a Large Sample of Tinnitus Patients

Abstract

Objectives: The Tinnitus Functional Index (TFI) is considered the gold standard in measuring tinnitus severity. The aim of the study was to establish reference values to improve the interpretability of TFI scores. Design: Results from 1114 patients with tinnitus were retrospectively analyzed. The participants were consecutive patients who attended our tertiary referral Ear, Nose, and Throat Center. The eligibility criteria were: at least 18 years old, persistent tinnitus, completed pure-tone audiometry, and answered all 25 items on the TFI. Hearing status (normal hearing vs. hearing impairment) was established according to the recommendation of the Bureau International d’Audiophonologie. Means (M) and SD on the TFI were the basis for grading tinnitus severity on four levels: low, lower moderate, upper moderate, and high. To gauge individual scores in clinical practice, percentiles are also proposed. Results: All 1114 patients (586 women and 528 men) were Caucasian and aged from 19 to 87 years (M = 50.96; SD = 13.10 years). Tinnitus duration ranged from 0.5 to 50 years (M = 7.17; SD = 7.71 years). There were 258 patients with normal hearing and 856 patients with hearing loss. A score of above 65 points on TFI was established as the cutoff point for diagnosing high tinnitus severity. A regression model associating tinnitus severity with gender, age, tinnitus duration, and hearing loss was statistically significant: F(4,1109) = 8.99; p < 0.001, but the effect was very small (R 2 adj = 0.028) and only gender and age were associated with TFI global score, while tinnitus severity was not related to tinnitus duration or hearing loss. Conclusions: The reference values proposed here support those reported previously by Meikle et al. They are empirically based and can be used as benchmarks in clinical practice and scientific research. They make it possible to assess tinnitus severity, evaluate individual scores, and categorize individuals with tinnitus. This allows researchers to set inclusion or exclusion criteria when assigning patients to specific groups during clinical trials involving tinnitus intervention strategies.

Validation of a Dutch version of the Tinnitus Functional Index in a tertiary referral tinnitus clinic

“…It is noteworthy how the TFI scores were interpreted in the original study of Meikle: mild (scores below 25), moderate (scores between 25 and 50) and severe (scores above 50) problem. As it has been pointed out by Gos et al. (2021) , the averaged TFI score is often close to the severe limit, and with a quite high dispersion.…”

“…It is noteworthy how the TFI scores were interpreted in the original study of Meikle: mild (scores below 25), moderate (scores between 25 and 50) and severe (scores above 50) problem. As it has been pointed out by Gos et al (2021), the averaged TFI score is often close to the severe limit, and with a quite high dispersion. This applies in particular to our data (M ¼ 47.93; SD ¼ 20.41), which raises the question of whether the original cut-off for diagnosing severe tinnitus is too low.…”

“…This applies in particular to our data (M = 47.93; SD = 20.41), which raises the question of whether the original cut-off for diagnosing severe tinnitus is too low. The study of Gos et al. (2021) suggested that this boundary should be set at 65 points, in order to limit the most severe rating to a smaller sample.…”

“…This applies in particular to our data (M ¼ 47.93; SD ¼ 20.41), which raises the question of whether the original cut-off for diagnosing severe tinnitus is too low. The study of Gos et al (2021) suggested that this boundary should be set at 65 points, in order to limit the most severe rating to a smaller sample. In line with Gos et al findings, 37 % of the patients in our study obtained total score to the similarities between the global scores of the THI and the TFI, a potential solution to this problem is to increase the number of categories as in the THI, instead of raising the limit of the group with severe tinnitus.…”

Treated large posterior fossa vestibular schwannoma and meningioma: Hearing outcome and willingness‐to‐accept brain implant for unilateral deafness

“…SSD patients were invited to provide likelihood (never, very unlikely, unlikely, neutral, likely, very likely, and definitely) of willingness‐to‐accept an experimental brain implant that would deliver benefit along two hearing dimensions: (a) spatial hearing (sound detection in the deaf ear hemifield) and (b) speech understanding at four levels of benefit (20%, 40%, 60%, and 80%). The TFI is a validated self‐reported scale for tinnitus severity, where scores between 0 and 18 are low severity; scores between 18 and 42 are lower moderate; scores between 42 and 65 are upper moderate; and scores greater than 65 are high severity 19 . The SSQ12 instrument measures hearing abilities across three subdomains: speech hearing, spatial hearing, and hearing qualities 18 .…”