Psychometric properties of the Persian version of the Tinnitus Handicap Inventory (THI-P)

Document Type: Original


1 Department of Otorhinolaryngology, Amiralmomenin Hospital, Guilan University of Medical Sciences, Guilan, Iran.

2 Department of Psychiatry, Shafa Hospital, Guilan University of Medical Sciences, Guilan, Iran.


Tinnitus can have a significant effect on an individual’s quality of life, and is very difficult quantify. One of the most popular questionnaires used in this area is the Tinnitus Handicap Inventory (THI). The aim of this study was to determine the reliability and validity of a Persian translation of the Tinnitus Handicap Inventory (THI-P).
Materials and Methods:
This prospective clinical study was performed in the Otolaryngology Department of Guilan University of Medical Sciences, Iran. A total of 102 patients aged 23–80 years with tinnitus completed the (THI-P). The patients were instructed to complete the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Audiometry was performed. Eight-five patients were asked to complete the THI-P for a second time 7–10 days after the initial interview. We assessed test–retest reliability and internal reliability of the THI-P. Validity was assessed by analyzing the THI-P of patients according to their age, tinnitus duration and psychological distress (BDI and STAI). A factor analysis was computed to verify if three subscales (functional, emotional, and catastrophic) represented three distinct variables.
Test–retest correlation coefficient scores were highly significant. The THI-P and its subscales showed good internal consistency reliability (α = 0.80 to 0.96). High-to-moderate correlations were observed between THI-P and psychological distress and tinnitus symptom ratings.
A confirmatory factor analysis failed to validate the three subscales of THI, and high inter-correlations found between the subscales question whether they represent three distinct factors.
The results suggest that the THI-P is a reliable and valid tool which can be used in a clinical setting to quantify the impact of tinnitus on the quality of life of Iranian patients.


Main Subjects

1. Jastreboff PJ, Hazell JW. Treatment of tinnitus based on a neurophysiological model. In: Vernon JA, editor. Tinnitus: treatment and relief. Boston, MA: Allyn and Bacon; 1998. p. 201–17.

2. Moller AR. Tinnitus: presence and future. Prog Brain Res. 2007; 166:3–16.

3. Henry JA, Dennis KC, Schechter MA. General review of tinnitus: prevalence, mechanisms, effects, and management. J Speech Lang Hear Res. 2005; 48(5):1204–35.

4. Hoffman HJ, Reed GW. Epidemiology of tinnitus. In: Snow JB, editor. Tinnitus: theory and manage- ment. Lewiston, NY: BC Decker; 2004. p. 16-41.

5. Westin V, Hayes SC, Andersson G. Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact. Behav Res Ther. 2008; 46(12):1259–65.

6. Davis A, Refaie AE. Epidemiology of tinnitus. In: Tyler RS, editor. Tinnitus handbook. Sandiego, CA: Singular; 2000. p. 1–24.

7. Newman CW, Jacobson GP, Spitzer JB. Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg. 1996; 122(2): 143–8.

8. Newman CW, Jacobson GP. Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome. J Am Acad Audiol 1998; 9: 379–80.

9.  Mirz F, Zachariae B, Anderson SE, Nielsen AG, Johansen LV, Bjerring P, et al. Treatment of tinnitus with low-intensity laser. Ugeskr Laeger 2000; 162(25): 3607–10.

10. Henry JL, Wilson PH. The psychological management of tinnitus: comparison of a combined cognitive educational program, education alone and a waiting-list control. Int Tinnitus J 1996; 2:9–20.

11. Westerberg BD, Roberson JB Jr, Stach BA. A double-blind placebo-controlled trial of baclofen in the treatment of tinnitus. Am J Otol 1996;17(6): 896–903.

12. Aksoy S, Firat Y, Alpar R. The Tinnitus Handicap Inventory: A Study of Validity and Reliability. Int Tinnitus J. 2007;13(2):94–98.

13. Zachariae R, Mirz F, Johansen LV, Andersen SE, Bjerring P, Pedersen CB. Reliability and validity of a Danish adaptation of the tinnitus handicap inventory. Scand Audiol 2000; 29(1): 37–43.

14. Baguley D, Norman M. Tinnitus handicap inventory. J Am Acad Audiol 2001; 12(7): 379–80.

15. Kim JH, Lee SY, Kim CH, Lim SL, Shin JN, Chung WH, et al. Reliability and validity of a Korean adaptation of the tinnitus handicap inventory. Korean J Otolaryngol-Head Neck Surg 2002; 45(4):328–34.

16. Schmidt LP, Teixeira VN, Dall’Igna C, Dallagnol D, Smith MM. Brazilian Portuguese language version of the “Tinnitus Handicap Inventory”: validity and reproducibility. Braz J Otorhinolaryngol 2006; 72(6):808–10.

17. Monzani D, Genovese E, Marrara A, Gherpelli C, Pingani L, Forghieri M, et al. Validity of the Italian adaptation of the Tinnitus Handicap Inventory: focus on quality of life and psychological distress in tinnitus-sufferers. Acta Otorhinolaryngol Ital 2008; 28(3):126–34.

18. Lim JJ, Lu PK, Koh DS, Eng SP. Impact of tinnitus as measured by the Tinnitus Handicap Inventory among tinnitus sufferers in Singapore. Singapore Med J 2010; 51(7):551–7.

19. Meng Z, Zheng Y, Liu S, Wang K, Kong X, Tao Y, et al. Reliability and validity of the chinese (mandarin) Tinnitus Handicap Inventory. Clin Exp Otorhinolaryngol 2012;5(1):10–6.

20. Kam AC, Cheung AP, Chan PY, Leung EK, Wong TK, van Hasselt CA, et al. Psychometric properties of the Chinese (Cantonese) Tin­nitus Handicap Inventory. Clin Otolaryngol 2009; 34(4): 309–15.

21. Shinden S, Ogawa K, Inoue Y, Tazo M, Asano K. Tinnitus annoyance and difficulty in activities of daily life evaluated by the Tinnitus Handicap Inventory. Audiol Japan 2002;45(6):685–91.

22. Tobias CA, Llanes EG, Chiong C. Validity of a filipino translation of the Tinnitus Handicap Inventory. Int Tinnitus J 2012; 17(1):64–9.

23. Mahmoudian S, Shahmiri E, Rouzbahani M, Jafari Z, Keyhani MR, Rahimi F, et al. Persian language  version of the “Tinnitus Handicap Inventory”: translation, standardization, validity and reliability. International Tinnitus Journal 2011;16(2): 93-103.

24. Vernon JA, Meikle MB: Measurement of tinnitus:an update. In: Kitahara M, editor. tinnitus, Pathophysiology and Management. Tokyo, Igaku-Shoin Ltd, 1988, p. 36–52.

25. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4(6):561–71.

26. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory–Second edition: BDI-II-PERSIAN. Depress Anxiety 2005;21(4):185–92.

27. Lespérance F, Frasure-Smith N, Talajic M, Cameron O. Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med 1996; 58(2):99–112.

28. Spielberger CD, Gorsuch RL, Luschene RE. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press 1970.

29. Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. J Midwifery Womens Health 2005; 50(4):e36–e40.

30. Dadsetan P, Mansour M. Mental illness. Tehran: Roshd Press; 1998 [in Persian].

31. Nunnally JC, Bernstein I: Psychometric Theory (McGraw-Hill Series in Psychology). New York: McGraw-Hill Higher Education 1993, p. 736.

32. Westen D, Rosenthal R. Quantifying construct validity: Two simple measures. Journal of Personality and Social Psychology. 2003; 84(3): 608–18.

33. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of va­lidity in measuring physical and mental health constructs. Med Care 1993; 31(3):247–63.

34. Costantini M, Musso M, Viterbori P, Bonci F, Del Mastro L, Garrone O, et al. Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale. Support Care Cancer 1999; 7(3):121–7.

35. Baguley DM, Andersson G. Factor analysis of the Tinnitus Handicap gInventory. Am J Audiol 2003; 12(1):31–4.

36. Kuk FK, Tyler RS, Russell D, Jordan H. The psychometric properties of a tinnitus handicap questionnaire. Ear Hear 1990; 11(6):434–45.

37. Zeman F, Koller M, Langguth B, Landgrebe M. Which tinnitus-related aspects are relevant for quality of life and depression: results from a large international multicentre sample? Health Qual Life Outcomes 2014 Jan 14;12:7.