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
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
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
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.