Research Article

Development and psychometric validation of a new tinnitus questionnaire for clinical use


Background and Aim: Self-administered questionnaires are clinically important to document how tinnitus affects the daily life of patients. In this regard, there is a need to have an alternative questionnaire that covers relevant aspects of tinnitus and related symptoms. The present study aimed to develop and validate a new tinnitus questionnaire known as Tinnitus Handicap Que­stionnaire or Borang Evaluasi Soal selidik Tinitus (BEST) in Malay version.
Methods: The present study had two consecutive phases. In phase 1 of study, BEST que­stionnaire was initially developed in English and underwent forward and backward transla­tion processes. Following relevant amendments, the final version of BEST (Malay version) was ready for subsequent tasks. It consists of 25 items categorized under 3M domain (mind, main and mental). In phase 2, 65 patients with tinnitus were recruited for determining the validity and reliability of BEST.
Results: Content validity index (CVI) of BEST ranged from 0.71-1.00. Endorsement rates of BEST were acceptable (<80%) for the majority of items. BEST was found to have good reliabi­lity as revealed by item-total correlation (0.22-0.84), Cronbach’s alpha (0.62-0.95), split half reliability (0.92) and correlation between domains (r=0.62-0.96). It was correlated with Malay version of Depression Anxiety Stress Scales (BM DASS-21) (p<0.05) but not with tinnitus audiometry (p>0.05) implying good construct validity.
Conclusion: The BEST questionnaire has been proven valid and reliable to be used clinically, particularly among Malay-speaking population. Nevertheless, future studies are welcome to further support the findings obtained from the present study.

1. 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.
2. Nondahl DM, Cruickshanks KJ, Huang GH, Klein BE, Klein R, Nieto FJ, et al. Tinnitus and its risk factors in the Beaver Dam offspring study. Int J Audiol. 2011;50(5):313-20.
3. Tyler RS, Baker LJ. Difficulties experienced by tinnitus sufferers. J Speech Hear Disord. 1983;48(2):150-4.
4. Pridmore S, Walter G, Friedland P. Tinnitus and suicide: recent cases on the public record give cause for reconsideration. Otolaryngol Head Neck Surg. 2012;147(2):193-5.
5. Kuk FK, Tyler RS, Russell D, Jordan H. The psychometric properties of a tinnitus handicap questionnaire. Ear Hear. 1990;11(6):434-45.
6. Wilson PH, Henry J, Bowen M, Haralambous G. Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus. J Speech Hear Res. 1991;34(1):197-201.
7. Newman CW, Jacobson GP, Spitzer JB. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1996;122(2):143-8.
8. Ghulyan-Bédikian V, Paolino M, Giorgetti-D'Esclercs F, Paolino F. Psychometric properties of a French adaptation of the Tinnitus Handicap Inventory. Encephale. 2010;36(5):390-6. French.
9. Jalali MM, Soleimani R, Fallahi M, Aghajanpour M, Elahi M. Psychometric properties of the Persian version of the Tinnitus Handicap Inventory (THI-P). Iran J Otorhinolaryngol. 2015;27(79):83-94.
10. Jun HJ, Yoo IW, Hwang SJ, Hwang SY. Validation of a Korean version of the tinnitus handicap questionnaire. Clin Exp Otorhinolaryngol. 2015;8(3):198-201.
11. Kam ACS, Cheung APP, Chan PYB, Leung EKS, Wong TKC, Van Hasselt CA, et al. Psychometric properties of the Chinese (Cantonese) Tinnitus Handicap Inventory. Clin Otolaryngol. 2009;34(4):309-15.
12. Newman CW, Wharton JA, Jacobson GP. Retest sta¬bility of the tinnitus handicap questionnaire. Ann Otol Rhinol Laryngol. 1995;104(9 Pt 1):718-23.
13. Pan T, Tyler RS, Ji H, Coelho C, Gehringer AK, Gogel SA. Changes in the tinnitus handicap questionnaire after cochlear implantation. Am J Audiol. 2009;18(2):144-51.
14. Newman CW, Sandridge SA. Tinnitus questionnaires. In: Snow JB, editor. Tinnitus: theory and management. Ontario: BC Decker Inc; 2004. p. 237-54.
15. Chang L. A psychometric evaluation of 4-point and 6-point likert-type scales in relation to reliability and validity. Appl Psychol Meas. 1994;18(3):205-15.
16. Preston CC, Colman AM. Optimal number of response categories in rating scales: reliability, validity, discr¬iminating power, and respondent preferences. Acta Psychol (Amst). 2000;104(1):1-15.
17. Vernon JA, Meikle MB. Measurement of tinnitus: an update. In: Kitahara M, editor. Tinnitus: pathophysio¬logy and management. 1st ed. Tokyo: Igaku-Shoin Medical Pub; 1988. p. 36-52.
18. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foun¬dation; 1995.
19. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176-81.
20. Musa R, Fadzil MA, Zain Z. Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). ASEAN Journal of Psychiatry. 2007;8(2):82-9.
21. Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003;42(Pt 2):111-31.
22. Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Str¬ess Scales (DASS) in clinical samples. Behav Res Ther. 1997;35(1):79-89.
23. Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382-6.
24. Matthews TD, Kostelis KT. Designing and conducting research in health and human performance. 1st ed. San Francisco: Jossey-Bass; 2011.
25. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and reco-mmendations. Res Nurs Health. 2006;29(5):489-97.
26. Elson JL, Cadogan M, Apabhai S, Whittaker RG, Phillips A, Trennell MI, et al. Initial development and validation of a mitochondrial disease quality of life scale. Neuromuscul Disord. 2013;23(4):324-9.
27. Bradley C. Handbook of psychology and diabetes: A guide to psychological measurement in diabetes research and practice. Chur, Switzerland: Harwood; 1994.
28. Gorsuch RL. Factor analysis. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum; 1983.
IssueVol 26 No 2 (2017) QRcode
SectionResearch Article(s)
Tinnitus questionnaire psychometric validity reliability

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Zakaria MN, Lau YJ, Wan Husain WS, Aw CL, Nik Othman NA, Salim R, Abdullah B, Zainun Z, Wan Mohamad WN. Development and psychometric validation of a new tinnitus questionnaire for clinical use. Aud Vestib Res. 26(2):71-85.