occurrence of tinnitus. TINNITUS QUESTIONNAIRE. 1.Are you exposed to the loud noise on your work place? a) YES b) SOMETIMES c) NO (go to the question ...
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TINNITUS QUESTIONNAIRE
1.Are you exposed to the loud noise on your work place? a) YES b) SOMETIMES c) NO (go to the question number 4)
2.How many hours (in average) are you exposed to the loud noise during the work day? a) LESS THAN 1 HOUR b) 2-4 HOURS c) 5-8 HOURS d) MORE THAN 8 HOURS
3. How many time (in average) are you exposed to the loud noise on your work place during the one year? a) LESS THAN A MONTH b) 1-2 MONTHS c) 3-5 MONTHS d) 6-9 MONTHS e) ALL YEAR ROUND (approximately)
4. Do you hear ringing in the ears (tinnitus)? a) YES b) SOMETIMES c) NO (go to the question number 19)
Petric, Domina & Kovačić, Damir. (2017). Connection between noisy environment at work and the occurrence of tinnitus.
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5. What is the quality of your tinnitus (murmur, sound)? a) MURMUR b) HIGH PITCH SOUND c) LOW PITCH SOUND
6. In which ear do you hear tinnitus? a) RIGHT EAR b) LEFT EAR c) BOTH EARS
7. How often do you hear tinnitus in the left ear? a) ALL THE TIME b) SOMETIMES c) RARELY d) NEVER
8. How often do you hear tinnitus in the right ear? a) ALL THE TIME b) SOMETIMES c) RARELY d) NEVER
9. How long have you been suffering from the tinnitus, counting from today? a) 1-7 DAYS b) 1-4 WEEKS c) 1-11 MONTHS d) 1 YEAR Petric, Domina & Kovačić, Damir. (2017). Connection between noisy environment at work and the occurrence of tinnitus.
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e) MORE THAN 1 YEAR
10. Do you feel that tinnitus worsens on your work place? a) YES b) SOMETIMES c) NO
11. Does tinnitus interfere with your everyday work? a) YES b) SOMETIMES c) NO
12. Does tinnitus interfere with your everyday communication with others? a) YES b) SOMETIMES c) NO
13. Do you fell that tinnitus worsens during the stressful events on the work place? a) YES b) SOMETIMES c) NO
14. Do you fell that tinnitus worsens during the stressful events outside the work place? a) YES b) SOMETIMES c) NO
Petric, Domina & Kovačić, Damir. (2017). Connection between noisy environment at work and the occurrence of tinnitus.
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15. Do you feel anxious or depressed because of tinnitus? a) YES b) SOMETIMES c) NO
16. Do you have troubles falling asleep because of tinnitus? a) YES b) SOMETIMES c) NO
17. How loud is your tinnitus (1-I do not hear tinnitus, 4-moderately loud, 7-very loud)? 1
2
3
4
5
6
7
18. How has been tinnitus affected the quality of your life during the last month (1-It has not been affected, 4-moderately, 7-pronouncedly) 1
2
3
4
5
6
7
19. How old are you:
20. Sex:
M
F
21. How long have you been employed on your current yob position? years
months
Petric, Domina & Kovačić, Damir. (2017). Connection between noisy environment at work and the occurrence of tinnitus.
