Grading the severity of tinnitus: Treatment, symptoms, advice and help

A new grading system that assesses the severity of tinnitus in adults has been proposed by the British Association of Otolaryngologists, Head and Neck Surgeons (BAOL-HNS). Guidelines for the Grading of Tinnitus Severity is the results of a BAOL-HNS working group of six tinnitus experts, chaired by Consultant ENT surgeon Andrew McCombe. The Guidelines attempt to provide a more accurate and uniform approach to the grading of tinnitus severity than the commonly used three-point scale of mild-moderate-severe allows. The Guidelines are designed primarily for use in medico-legal cases where claimants are looking for compensation for their tinnitus, but they may also be useful if clinical practice and in research studies that compare the results of various treatments.

The Guidelines suggest five grades of severity. The numbers in brackets related to scores on the self-report Tinnitus Handicap Inventory (THI) questionnaire¹.

Grade 1 - slight (THI 0-16)

Only heard in quiet environment, very easily masked. No interference with sleep or daily activities. This grading should cover most people who are experiencing but are not troubled by tinnitus.

Grade 2 - mild (THI 18-36)

Easily masked by environmental sound and easily forgotten with activities. May occasionally interfere with sleep but not daily activities.

Grade 3 - moderate (THI 38-56)

May be noticed even in the presence of background or environmental noise although daily activities may still be performed. Less noticeable when concentrating. Not infrequently interferes with sleep and quiet activities.

The majority of people suffering tinnitus should fall into grades 2 and 3.

Grade 4 - severe (THI 56-100)

Almost always heard, rarely if ever masked. Leads to disturbed sleep pattern and can interfere with ability to carry out normal daily activities. Quiet activities adversely affected. Hearing loss is likely to be present. Grading in this group should be uncommon.

Grade 5 - catastrophic (56-100)

All tinnitus symptoms at level of severe or worse. Hearing loss likely to be present. Associated psychological pathology is likely to be found in hospital or GP records. Grading in this group should be extremely rare.

The Guidelines are due to be published in the journal Clinical Otolaryngology, but you can see them at and print them off as 10 A4 pages from www.otonhs.net

¹See Newman C W et al 1996, Development of the tinnitus handicap inventory, Arch Otolaryngol Head Neck Surg 122, pp143-148; Newman C W et al 1998, Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome, J Am Acad Audio l 9, pp153-160.