Tinnitus Triage COVID-19

COVID-19 and Our Tinnitus Service: Triage Patients with Tinnitus, Hyperacusis and Misophonia Using Telephone Appointment


Instruction on how to use this form.

Patients are actively encouraged to change their appointment type to telephone in order to minimise physical contact during COVID-19 outbreak in the UK and elsewhere in the world. This interview form has been designed in order to facilitate triage of new patients experiencing tinnitus, hyperacusis, and misophonia using telephone appointments. Application of this form will assist the therapist to gather all the essential information needed to explore the relevant medical red flags and the impact of the symptoms on individual’s life and their psychological wellbeing. By clicking on the submit button, you will receive the form securely to the email address you provided. No other copy will be saved anywhere else.

Instructions on how to use this form:

Arrange a suitable time to telephone your patient. See the basic requirement listed below. Add your name or a pseudo name, a code to identify your patient, and the email address that you would like the form to be sent to. For your telephone clinical interview, read the questions to them and complete this form online. Once all questions are answered, click the submit button.

Before ending the call, please make sure to offer the patient an opportunity to ask their questions. You may choose to use some sections from the papers below to offer reassurance and advice:

What are the basic requirements for a telephone clinic?

  • Telephone and PC or Laptop with internet access
  • Identify quiet location in which to contact patient
  • Confirm the patient’s identity in full by asking them to state their full name, DOB, first line of address and postcode
  • Obtain patient agreement to proceed to telephone consultation
  • Ask whether the patient wishes anyone else to join the consultation and, if so, document who was present during the consultation; their name and relationship to the patient.
  • Record your consultation as you would do normally

Triage Patients with Tinnitus, Hyperacusis and Misophonia Using Telephone Appointment

Ear pain?
Ear discharge (otorrhea)?
Balance problem?
Seen ENT?
Hearing difficulties in noise and in quiet?
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

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.

Any relevant medical history?

Use the questions below only if hyperacusis or misophonia are the main complaint. If tinnitus is the main compliant then the questions below can be ignored for this telephone appointment.


  • Hyperacusis is intolerance of certain everyday sounds. The sounds maybe perceived as uncomfortably loud, painful, frightening or annoying.
  • Misophonia is strong emotional reaction to certain sounds related to chewing food, swallowing, tapping, breathing, lip smacking, nose sniffing, and other man made noises.

For each question please choose one number based on how you/your child (for parents) are feeling now.

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):