International Journal of Audiology 2004; 43:600–604
Rapid assessment of tinnitus-related
psychological distress using the Mini-TQ
Evaluación rápida del estrés psicológico relacionado
con el acúfeno mediante el uso de Mini-TQ
*Department of Clinical Psychology,
University of Mainz, Mainz,
Roseneck Centre of Behavioural
Medicine, Prien, Germany
Tinnitus Questionnaire (TQ)
The aim of this study was to develop an abridged version
of the Tinnitus Questionnaire (TQ) to be used as a quick
tool for the assessment of tinnitus-related psychological
distress. Data from 351 inpatients and 122 outpatients
with chronic tinnitus were used to analyse item statistics
and psychometric properties. Twelve items with an opti-
mal combination of high item–total correlations, reliabil-
ity and sensitivity in assessing changes were selected for
the Mini-TQ. Correlation with the full TQ was 0.90,
and test–retest reliability was 0.89. Validity was con-
ﬁrmed by associations with general psychological symp-
tom patterns. Treatment effects indicated by the Mini-TQ
were slightly greater than those indicated by the full TQ.
The Mini-TQ is recommended as a psychometrically
approved and solid tool for rapid and economical assess-
ment of subjective tinnitus distress.
El objetivo de este estudio fue desarrollar una versión
corta del Cuestionario del Acúfeno (TQ) para usarlo
como una herramienta rápida de evaluación del estrés
psicológico relacionado con el acúfeno. Se utilizaron los
datos de 351 pacientes internados y 122 pacientes exter-
nos con acúfeno crónico para analizar la estadística de
cada pregunta y sus propiedades psicométricas. Se selec-
cionaron para el Mini-TQ, 12 preguntas que tenían una
óptima combinación de elevada correlación, conﬁabili-
dad y sensibilidad para evaluar cambios. La correlación
con el TQ completo fue > 0.90 y la conﬁabilidad de com-
probación de la prueba fue del 0.89. Se validó la prueba
conﬁrmando la asociación con patrones de síntomas psi-
cológicos. Los efectos del tratamiento indicados por el
Mini-TQ fueron ligeramente mayores que aquellos indi-
cados por el TQ completo. Se recomienda el Mini-TQ
como una herramienta psicométrica sólida, aprobada
para realizar una evaluación rápida y económica del
estrés producido por el acúfeno subjetivo.
University of Mainz, Department of Clinical Psychology,
Staudingerweg 9, D-55099 Mainz, Germany
September 11, 2003
January 9, 2004
There is strong evidence from the literature of the past 20 years
that the clinical picture of tinnitus is not strictly limited to oto-
logical considerations (Scott & Lindberg, 2000; Erlandsson &
Holgers, 2001). Patients may develop psychological complaints
of varying severity, especially when medical treatments fail and
the tinnitus has become chronic. Psychological complications
include annoyance resulting from the permanent awareness of
the noise, concentration problems, depression, anxiety and irri-
tability, sleep disturbances, and intense worrying. It is widely
recognized that reliable and valid instruments are needed to
describe these different facets and the degree of tinnitus-related
distress (McCombe et al, 2001).
In addition to clinical examinations, questionnaires are used
commonly for the examination of subjective complaints associ-
ated with tinnitus (Hallam et al, 1988; Erlandsson et al, 1992).
Patients respond to a set of questions or statements that are pre-
sented in a structured and standardized form. Well-developed
scales are easy to administer, yield reliable data, and allow a
valid interpretation of the patient’s current status. There are
strict psychometric criteria according to which the scientiﬁc and
clinical value of existing instruments can be judged (Anastasi &
Urbina, 1997). Different questionnaires are available that have
been speciﬁcally designed for the assessment of tinnitus-related
psychological complaints and symptoms. Table 1 shows the
scales that have been developed according to scientiﬁc standards
and are used in international research.
Although the instruments shown in Table 1 were developed in
different countries by independent working groups, they seem to
measure a very similar pattern of complaints and handicaps.
Baguley et al (2000) administered the Tinnitus Questionnaire
(TQ) and Tinnitus Handicap Inventory to the same sample of
patients, and found that the convergent validity of both instru-
ments was high, with total as well as subscale scores being signif-
icantly correlated. However, the value of subscales seems to be
limited, because there is no general agreement about how many
of them are needed and how they should be labelled. From our
perspective, it seems remarkable that most authors in this ﬁeld
report only global indices of distress and no subscale results.
An unresolved problem with some questionnaires is the rela-
tively large number of items needed to determine a global dis-
tress measure. This is a disadvantage when the time available for
investigation is limited and other instruments need to be com-
pleted as well. For example, 40 of the 52 items of the TQ are
needed for computation of the total score (Hiller & Goebel,
1992). Therefore, after many years of working with the TQ, we
felt an increasing need for a quicker and more compact measure
Rapid assessment of tinnitus-related
psychological distress using the Mini-TQ
of overall tinnitus distress. Furthermore, we observed that
some items were of little value because they seemed to be char-
acteristic only for subgroups of patients or had low relevance for
usual clinical decisions.
In the present study, we attempted to develop an abridged
version of the TQ, with the primary goal of maintaining its
excellent psychometric qualities. This article describes this new
instrument, called the Mini-TQ, and provides data on reliability,
validity, sensitivity to change, and comparison with the full TQ.
Sample and procedure
To analyse scale characteristics, we used a large sample of 351 tin-
nitus patients treated at the Roseneck Centre for Behavioural
Medicine in Prien, Germany. This hospital is a research-oriented
unit afﬁliated to the Medical Faculty of the University of Munich.
It provides tertiary care services and forms part of the German
mental healthcare system. It includes a department that special-
izes in the treatment of chronic tinnitus according to the princi-
ples of cognitive behavioural therapy (CBT). The demographic
characteristics of the sample were as follows: 31.8% female, 68.2%
male, and mean age 47.4 years (SD9.8) (range 17–74 years). All
patients had chronic tinnitus (6 months), in most cases present
for 5–20 years. Major aetiological factors were history of sudden
hearing loss (about 40%), acoustical trauma or longstanding
noise exposure (about 40%), and Menière’s disease (about 10%).
Abnormal audiograms were found for about 70% of patients,
although hearing aids were indicated for only 20–25%.
The TQ was completed within 3 days of admission. As men-
tioned, this 52-item scale is a well-established instrument for the
assessment of the broad spectrum of tinnitus-related psychologi-
cal complaints. Areas of complaint include emotional and cog-
nitive distress, intrusiveness, auditory perceptual difﬁculties,
sleep disturbances, and associated somatic complaints. The total
TQ score indicates the general level of psychological and psy-
chosomatic distress. The TQ has been shown to be reliable and
valid in several previous studies (e.g. Hallam et al, 1988; Hiller
& Goebel, 1992; Hiller et al, 1994; Baguley et al, 2000).
Questions are answered as either true, partly true, or not true.
The total score was computed according to the coding criteria
published in our previous work (Hiller & Goebel, 1992). Post-
treatment TQ data were available for 220 patients in the above
Second sample for cross-validation
A second sample of 122 outpatients was used for cross-
validation of the results obtained from the main sample. These
patients were treated at the Psychological Institute of the
University of Mainz as part of a treatment programme evaluat-
ing CBT for chronic tinnitus patients (Haerkötter & Hiller, 1999;
Hiller & Haerkötter, unpublished data). All patients completed
the TQ before and after the treatments, which lasted for 4–10
weeks. Of the patients, 43.4% were female, and 56.6% male; the
mean age of the entire sample was 49.8 years (SD 13.7) (range
20–78 years). As in the ﬁrst sample, all patients reported having
tinnitus for more than 6 months (28% for more than 5 years).
Medical diagnoses and hearing status were largely similar to
those for the inpatient sample.
As general psychopathology is frequently found in chronic tinni-
tus patients, we employed the Hopkins Symptom Checklist
SCL-90R (Derogatis, 1983) as an external criterion to evaluate
the validity of the Mini-TQ.
We used Pearson correlations to analyse the associations
between items and total scores, full TQ and Mini-TQ, and
tinnitus-related and general psychological complaints, and to
measure test–retest reliability. Reliability on item level will be
expressed by kappa (), a chance-corrected measure of agree-
ment between categorical variables. To evaluate the magnitude
of treatment effects, we calculated sample effect sizes (ESs)
according to the d statistic proposed by Cohen (1988).
To select items for the abridged questionnaire, we determined (1)
to what degree each item was associated with the overall
tinnitus-related distress (item–total correlations), (2) how often
each item was endorsed by tinnitus patients (item frequencies),
and (3) how dependably the contents were reported ( values
obtained in the test–retest study). We did not consider items of
the subscales ‘auditory perceptual difﬁculties’ and ‘somatic com-
plaints’. Based on these considerations, the 12 items shown in
Table 2 were chosen to constitute the Mini-TQ. Item–total cor-
relations and coefﬁcients were generally good to high. Seven
items were taken from the intrusiveness and emotional distress
subscales (1, 2, 5, 6, 7, 9, 12), three from the cognitive distress
subscale (3, 10, 11) and one from the sleep disturbance subscale
(8). Item 4 had not previously been considered in TQ subscaling,
because the area of negative effects on social relationships is not
well represented in the item pool of the TQ. However, as this
item was found to have good psychometric properties and repre-
sents an important aspect of tinnitus-related distress, it was
decided to include it in the abridged questionnaire.
Table 1. Questionnaires to assess tinnitus-related distress
No. of No. of
Instrument items dimensions Authors
TQ Tinnitus Questionnaire 52 5 or 6 Hallam (1996); Hiller & Goebel (1992)
TRQ Tinnitus Reaction Questionnaire 26 4 Wilson et al (1991)
THQ Tinnitus Handicap Questionnaire 27 3 Kuk et al (1990)
THI Tinnitus Handicap Inventory 25 1–3 Newman et al (1996, 1998)
STSS Subjective Tinnitus Severity Scale 16 5 Halford & Anderson (1991)
International Journal of Audiology, Volume 43 Number 10
Congruence between full TQ and Mini-TQ
Table 3 shows Pearson correlations between the Mini-TQ on one
hand, and the subscales and global score of the full TQ on the
other. Values 0.90 indicate extraordinarily high congruence of
the new 12-item version and the original TQ global score. It can
be seen that while our item selection resulted in good overlap
with the TQ subscales E, C and I, the correlations with the sub-
scales A and Sl are clearly lower.
Psychometric properties of the Mini-TQ
Table 4 shows high test–retest reliability and internal consistency
for the Mini-TQ, despite the small number of items. This result
is plausible, because a group of relatively homogeneous items
with good reliabilities on item level had been selected. It is
known that tinnitus-related complaints correlate moderately
with general psychological symptoms, which represents an
important aspect of validity. Table 5 displays the intercorrela-
tions of the abridged and full TQ with the subscales and scores
of the SCL-90R. It can be seen that the values are very similar.
Sensitivity of measures for the assessment of change
An important characteristic of a measure is its sensitivity for the
assessment of changes over time, e.g. when the course of a disor-
der or treatment effects are being evaluated. To analyse the
applicability of the Mini-TQ as an instrument for repeated mea-
surement, we compared treatment effects obtained for the same
samples with the full TQ and with the Mini-TQ. The inpatients
Table 2. Characteristics of the Mini-TQ items
Item–total Item frequency Test–retest
1. I am aware of the noises from the
moment I get up to the moment I sleep 0.56 60/27 0.49
2. Because of the noises I worry that there is
something seriously wrong with my body 0.39 33/32 0.57
3. If the noises continue my life will not be worth living 0.66 15/41 0.78
4. I am more irritable with my family
and friends because of the noises 0.58 40/39 0.54
5. I worry that the noises might damage my physical health 0.54 40/32 0.57
6. I ﬁnd it harder to relax because of the noises 0.57 71/23 0.55
7. My noises are often so bad that I cannot ignore them 0.64 75/16 0.53
8. It takes me longer to get to sleep because of the noises 0.59 56/24 0.62
9. I am more liable to feel low because of the noises 0.65 55/31 0.62
10. I often think about whether the noises will ever go away 0.57 59/26 0.49
11. I am a victim of my noises 0.71 27/38 0.61
12. The noises have affected my concentration 0.66 61/31 0.63
Pearson correlation between item and full TQ global score according to Hiller & Goebel (1992), based on n 351.
Percentage of patients answering ‘true’/answering ‘partly true’, based on n 351.
Kappa (), based on n 60, from the study of Hiller et al (1994).
Table 3. Pearson correlations between TQ and Mini-TQ
ECE1CI A Sl So TQ
(inpatients) 0.93 0.84 0.93 0.80 0.51 0.65 0.48 0.93
(outpatients) 0.90 0.81 0.91 0.80 0.59 0.52 0.53 0.91
Based on n 351 (inpatients) and n 122 (outpatients).
Subscales of the TQ: E, Emotional distress; C, Cognitive distress; EC,
Emotional and cognitive distress; I, Intrusiveness; A, Auditory perceptual difﬁcul-
ties; Sl, Sleep distrubances; So, Somatic complaints.
Table 4. Reliability and internal consistency of the Mini-TQ
n 60 0.89
Cronbachs’ n 349 0.87
Cronbachs’ n 112 0.90
Table 5. Association with general psychopathology
SCL-90R scales Mini-TQ Full TQ
Somatization 0.30 0.32
Obsessive-compulsive 0.38 0.37
Interpersonal sensitivity 0.29 0.26
Depression 0.42 0.38
Anxiety 0.34 0.31
Hostility 0.27 0.26
Phobic anxiety 0.26 0.28
Paranoid ideation 0.29 0.28
Psychoticism 0.30 0.30
General symptomatic index (GSI) 0.40 0.39
Positive symptom total (PST) 0.37 0.36
Positive symptom distress index (PSDI) 0.41 0.38
Pearson correlations; based on n324.
Rapid assessment of tinnitus-related
psychological distress using the Mini-TQ
of the Roseneck Centre had been treated for 4–10 weeks with an
intense programme according to the principles of behavioural
medicine, including individual and group CBT, relaxation train-
ing, medical consultation, and physical and body-related thera-
pies (Goebel & Hiller, 1996). The outpatients at the University
of Mainz were treated according to a newly developed CBT pro-
gramme consisting of either 10 weekly sessions for severely dis-
tressed patients or four sessions for patients with only moderate
symptoms (Haerkötter & Hiller, 1999).
Table 6 summarizes the comparison between the full and
abridged TQ for decompensated inpatients with initial TQ
scores above 40 and for two outpatient subgroups with either
high (40) or moderate (40) levels of distress. Both measures
were able to identify signiﬁcant improvements in all groups
(p 0.01). However, statistical signiﬁcance does not guarantee
that the Mini-TQ is equally powerful in detecting differences
before and after treatment. We therefore calculated Cohen’s d
as an ES denoting a standardized difference between two means.
The results in Table 6 show that the Mini-TQ is equally, if not
slightly more, powerful than the full TQ for the measurement of
improvements during treatment.
The Mini-TQ was also able to differentiate more generally
between inpatients and outpatients. The entire inpatient group
improved from 15.8 (SD 5.7) to 13.0 (SD6.0), and the out-
patient group from 12.4 (SD5.3) to 8.7 (SD 5.8). The group
main effect for these data was signiﬁcant in a repeated-measures
analysis of variance (df1, F 44.9, p 0.01).
Standardization and norms
The distribution of the Mini-TQ scores must be known if individ-
ual test results are to be interpreted properly. We therefore com-
puted cumulative percentages separately for our samples of
inpatients and outpatients (Table 7). The mean values (SDs)
were 15.4 (5.7) for inpatients and 12.6 (5.3) for outpatients.
Interpretation can depend on many variables, such as clinical set-
ting (e.g. private ENT practitioners, otological inpatient units,
tertiary care facilities for distressed tinnitus sufferers) or purpose
of investigation (e.g. treatment decision). However, our recommen-
dation is to consider patients scoring 1–7 as being compensated
(no clinically relevant distress due to the tinnitus), those scoring
8–12 as moderately distressed, those scoring 13–18 as severely dis-
tressed, and those scoring 19–24 as most severely distressed.
This study was motivated by the desire to optimize the psycho-
metric assessment of tinnitus-related distress. We knew from our
long experience with the TQ that subscales are only rarely
analysed, and researchers as well as clinicians seem to be pri-
marily interested in a measure of overall distress. Although the
TQ is one of the best accepted questionnaires in the ﬁeld of tin-
nitus research, its weaknesses are the large number of items (52)
and the fact that not all items are used to compute the total
score. Furthermore, there is an increasing need for short instru-
ments, because multiple scales are usually employed in research
Table 7. Norms for the Mini-TQ
Scores Inpatients Outpatients
(n 5351) (n 5122)
10 21 34
11 26 43
12 31 48
13 35 55
14 41 62
15 46 67
16 52 78
17 58 81
18 66 85
19 71 89
20 76 93
21 84 94
22 91 95
23 96 98
24 100 100
Table 6. Use of the TQ and Mini-TQ to measure treatment effects
treatment treatment Signiﬁcance Pre–Post
Subgroup Measure Mean (SD) Mean (SD) t-value ES
Inpatients TQ 40 Full TQ 59.7 (10.6) 50.3 (16.1) 8.99* 0.70
Mini TQ 18.4 (3.6) 15.2 (5.1) 8.92* 0.75
Outpatients TQ 40 Full TQ 54.7 (9.4) 41.7 (17.0) 6.85* 0.98
Mini-TQ 17.2 (3.3) 13.0 (5.6) 5.98* 0.94
TQ 40 Full TQ 24.9 (8.0) 16.6 (9.5) 8.01* 0.95
Mini TQ 9.0 (3.4) 5.5 (3.5) 7.73* 1.03
Based on n 156 (inpatients 40), n 54 (outpatients40) and n 68 (outpatients40). ES, effect size.
International Journal of Audiology, Volume 43 Number 10
projects, and the patients’ willingness to accept large question-
naire batteries is limited.
The results of the present study are encouraging. The 12
items of the new Mini-TQ were selected according to strictly
deﬁned psychometric criteria. We considered items only if they
were highly correlated with the general score and had proven to
be reliable. Another major criterion was their sensitivity for indi-
cating changes of symptomatology, because evaluating treat-
ment outcome represents a major application. Our analyses
conﬁrmed that the Mini-TQ consists of a very homogeneous set
of items, with excellent values of reliability and internal consis-
tency. Furthermore, intercorrelations with measures of general
psychopathology were practically identical to those obtained
with the full TQ. We were also able to demonstrate that the new
measure was equally, or probably even slightly more, powerful in
the detection of improvements during inpatient and outpatient
treatments. In a last step, we provided norms for inpatients and
outpatients that may facilitate the interpretation of individual
scores for other users. However, as these were not patients usu-
ally seen in private ENT practices or audiological clinics, the
usefulness and validity of the Mini-TQ remains to be evaluated
in these settings.
To summarize, the development of the Mini-TQ represents a
further step towards the compact, quick and economical assess-
ment of subjective tinnitus distress. There are no recognizable
psychometric disadvantages as compared to the full TQ. We
therefore suggest that the full version should only be used if
there are special questions concerning the subscales, e.g. if there
is an interest in studying auditory perceptual difﬁculties or sleep
disturbances apart from general distress (Baguley et al, 2000).
The Mini-TQ is suitable for research and may help in the com-
parison of ﬁndings between countries. It can also be used in
everyday clinical practice, because the 12 selected items reﬂect
most central and characteristic aspects of tinnitus distress.
Although there are no general limitations, the scale is probably
more valuable for chronic tinnitus, since psychological distress
in acute patients may be temporary and of lower prognostic
Appendix: the Mini-TQ
The purpose of this questionnaire is to ﬁnd out whether the
noises in your ears/head have had any effect on your mood,
habits or attitudes. Please tick the answer that applies to you for
1. I am aware of the noises from the moment I get up to the
moment I sleep
2. Because of the noises I worry that there is something seri-
ously wrong with my body
3. If the noises continue my life will not be worth living
4. I am more irritable with my family and friends because of
5. I worry that the noises might damage my physical health
6. I ﬁnd it harder to relax because of the noises
7. My noises are often so bad that I cannot ignore them
8. It takes me longer to get to sleep because of the noises
9. I am more liable to feel low because of the noises
10. I often think about whether the noises will ever go away
11. I am a victim of my noises
12. The noises have affected my concentration
(Note: the response alternatives for each item are True, Partly
True, and Not True)
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