Assessment Interview

Triage Patients with Tinnitus, Hyperacusis and Misophonia: Suitable for Face-to-Face or Telehealth appointments

What is your main complaint?
Definition: Tinnitus is the perception of sound(s) without any actual sound source (Ringing, buzzing, continuous, pulsing, etc).
Definition: Hyperacusis is intolerance of certain everyday sounds. The sounds maybe perceived as uncomfortably loud, painful, frightening or annoying.
Definition: Misophonia is strong emotional reaction (e.g., anger, disgust, etc.) to certain sounds related to chewing food, swallowing, tapping, breathing, lip smacking, nose sniffing, and other man made noises.
Ear pain?
Ear discharge (otorrhea)?
Balance problem?
Seen ENT?
Further comments about ENT disorders, and the tests, treatments, and procedures taken?
How is your hearing?
Do you have history of loud noise exposure?
(e.g., working with heavy machinery, gunfire and explosions, music industry, etc.)
Any relevant medical history?
How would you describe your mood today?
Onset of tinnitus? When did it start and any known reason that might have caused it?
What does tinnitus sound like? Ringing, buzzing, continuous, pulsing, etc
Where tinnitus is perceived? Right ear, Left ear, head, external to them
If you dream have you ever perceived tinnitus in your dreams?

Family history of Autistic Spectrum disorders?
While you were growing up during the first 18 years of life, did your parent(s) have depression or mental illness?
Family history of tinnitus, sensitivity to noise, or hearing impairment?
Details of any stress producing events that might have contributed or predisposed you to your main compliant? (e.g., traumatic events, life stress, changes in job, school, life circumstances, accidents, hospitalisation, severe illness and death in the family/friends, etc.)
Details of misophonia or hyperacusis (if relevant)? Duration, trigger sounds, emotional and behavioural reactions, activities affected.

Now please rank your tinnitus, on a scale of 0 to 10, with regard to severity, annoyance, and effect on your life. Please do not include hearing difficulties when you answer these questions.

Screening for Anxiety and Depression-Tinnitus/Hyperacusis/Misophonia (SAD-T) or SAD-T (Parent)

Over the last 2 weeks, how often have you **your child for parents***been bothered by any of the following problems?
Feeling nervous, anxious or on edge
Not being able to stop or control worrying
Little interest or pleasure in doing things
Feeling down, depressed or hopeless
Total Score: 00
  • Scores of 4 or more indicate possible symptoms of anxiety and/or depression.
  • Patients with score of 6 or more are at higher risk of developing suicidal and/or self-harm ideas.
History of mental health illness:
Seen mental health services:
Suicidal ideations (Only ask if needed based on your clinical judgment of patient’s mood or when SAD-T questionnaire score is 6 or more):
Add details of their current and past mental health illness, current and past mental health treatments, and if you had to take urgent percussions on suicidal and self-harm ideations?
Any further comments?