Tinnitus survey

If you are ever affected by tinnitus, we would like to hear from you.

Take part in our survey and help build the UK's largest tinnitus sufferer's database - and help Deafness Research UK's ongoing search for treatments and cures for tinnitus.

Significant survey findings will be published periodically:
 Sufferers blame occupational noise for their tinnitus

Please fill in the form below

If you know someone affected by tinnitus, please let them know about our survey so they can complete it too. It is important to us to get as many views as possible. To email this page to them, click on the 'Email this page to a friend' link in the left column.

Please do not enter data in this field, it is meant to stop spambots, who fill out any field

1	Are you male or female?  male     female
2	What is your age?  18-34    35-49    50-64    65+
3	Which city or town do you live in/near?
4	For how many years have you had tinnitus?
5	How bad is your tinnitus? 1 = doesn't bother me at all : 5 = stops me from living a normal life  1     2     3     4     5
6	Do you have any idea what may have caused your tinnitus? tick all statements which you think could be relevant I worked in a noisy environment I assume it's the result of getting older I have listened to a lot of loud music I noticed it after taking a particular medication  I was in the armed forces It followed an ear or sinus infection It followed a head or neck injury I have no idea Other cause
7	Are there particular situations or things that make your tinnitus symptoms worse? tick all that apply coffee other caffeinated drinks  red wine other alcohol  aspirin other medications  cheese other foods   stressful situations being exposed to loud noise none other
8	What does your tinnitus sound like? tick all that apply buzzing the beat of a pulse ringing voices hissing music / singing whistling humming other
9	Do you have a hearing loss?  yes   no
	If yes, do you wear a hearing aid? I wear a hearing aid in one ear I wear a hearing aid in both ears I don't wear a hearing aid
Only answer questions 10-12 if you wear a hearing aid
10	What affect has wearing a hearing aid had? it's reduced my tinnitus symptoms it's made my tinnitus symptoms worse it's made no difference
11	What type of hearing aid do you wear? analogue    digital
12	Which statement most applies to you? I was prescribed my hearing aid(s) specifically to help my hearing loss I was prescribed my hearing aid(s) specifically to help my tinnitus I was prescribed my hearing aid(s) to help both my hearing loss and tinnitus I don’t know why I was prescribed my hearing aid(s)
13	Any other comments?
	Would you be interested in sharing your experiences of tinnitus? If yes, please fill in the details below:
	Name
	Address
	Phone
	Email
	How would you like to be contacted? by post    by telephone     by email
	Deafness Research UK is committed to providing information about deafness, tinnitus and other hearing problems. If you do not wish to receive further communications from us please tick here:
	Thank you for taking the time to fill in this questionnaire. Click on the 'Send form' button to send it to us.