Which Tinnitus Test Is the Best?

Tinnitus is a subjective experience, so any meaningful tinnitus test has to go beyond simply detecting its presence and features. What really matters is assessing how severe the condition is, not just in terms of loudness or emotional distress, but in terms of the neurological forces driving it.

The ideal tinnitus test should explain why the tinnitus feels overwhelming, what the cause is, and how to best treat it. That’s why we created the Tinnitus Severity Assessment™—to measure the loudness, distress, underlying cause, and best treatment approach, all in one test.

In this article, I'll cover how tinnitus testing is currently performed and why a neurology-based tinnitus test was a needed innovation. Topics include:

• How is Tinnitus Diagnosed?
• What is a Tinnitus Hearing Test?
• How a Tinnitus Sound Test Works
• How To Test For Tinnitus Loudness
• How to Test For Tinnitus Severity
• What Is The Best Tinnitus Test (So Far)

How Is Tinnitus Diagnosed?

Do you hear a ringing, buzzing, humming, hissing, or a sound that others don’t hear? You likely have tinnitus. Self-diagnosis is often the first step.

Beyond this, a formal diagnosis involves establishing hearing function, uncover underlying medical issues, and determining severity levels. This process usually starts with an audiologist.

How Do Audiologists Test for Tinnitus?

Getting a tinnitus hearing test by an audiologist is the most important first step in fully diagnosing tinnitus. In-person tinnitus evaluations involve controlled testing in a sound-isolation booth.

Audiologists use a combination of standardized hearing assessments, tinnitus-specific measures, and structured interviews to build a complete clinical picture. The primary tools include the tinnitus audiogram, pitch matching, loudness matching, and tinnitus questionnaires.

The Tinnitus Hearing Test

The cornerstone of any tinnitus workup is a full audiometric evaluation. This test not only checks hearing thresholds across various frequencies but also helps identify conditions that may be causing or worsening tinnitus. This includes:

• Audiogram testing: Measures hearing sensitivity from low to high frequencies in both ears.
• Air and Bone Conduction Testing: Helps distinguish between sensorineural and conductive hearing loss.
• Tympanometry: Assesses eardrum mobility and middle ear pressure and is used to detect Eustachian tube dysfunction.
• Word Recognition Testing: Evaluates how clearly the brain processes speech.

Getting a tinnitus hearing test is essential because it can uncover red flags that point to specific medical causes of tinnitus, many of which are reversible with medical or surgical treatment. For example:

Condition	Summary
Conductive Hearing Loss	Tinnitus may result from middle ear problems like otosclerosis, where the stapes bone becomes fixed. Up to 80% report tinnitus; 70% improve after surgery [1].
Eustachian Tube Dysfunction	Poor pressure regulation in the middle ear can distort sound and increase tinnitus loudness. Often treatable; tympanometry helps with diagnosis.
Acoustic Neuroma (Vestibular Schwannoma)	Asymmetrical hearing loss or poor word recognition may signal a tumor on the auditory nerve. Imaging is needed to rule out this benign but serious cause.

Tinnitus And Hearing Test Considerations

Here are some special considerations regarding tinnitus and hearing tests:

Special Consideration	Summary
Hidden Hearing Loss	Some people have loud tinnitus despite a normal audiogram. This may be due to cochlear synaptopathy—damage at the synapse level, undetectable by standard tests.
The Audiometric Edge Concept	Tinnitus often appears where hearing shifts from normal to impaired on an audiogram. This “edge” may help guide personalized sound therapy decisions.
How Often to Get a Tinnitus Audiogram	Tinnitus patients should retest hearing every 1–2 years to monitor subtle changes and adjust treatment early if needed.

What Is a Tinnitus Sound Test?

When someone mentions a “tinnitus sound test,” they’re usually referring to tinnitus frequency and level matching. This is where a person tries to identify the pitch or frequency of the tinnitus and match its loudness to a sound that is presented to them via headphones. This test is most useful in helping to guide sound-based therapies.

How To Test For Tinnitus Ptich

The core idea is simple: patients listen to various tones or narrow band noise (a combination of multiple tones that are next to each other) and identify the one that most closely resembles their tinnitus. Here are the main methods used:

Method	Description
Method of Adjustment (MOA)	Patients fine-tune a tone using a slider until it matches their tinnitus. Fast, reliable, and commonly preferred.
Two Alternative Forced Choice (2AFC)	Patients compare pairs of tones and select the better match. Uses a staircase algorithm; reliable but slower.
Likeness Rating (LR)	Patients rate how closely each frequency resembles their tinnitus. Time-consuming, but allows spectral mapping.

All three methods have good reliability, but the “slider bar” method (MOA) is fastest and most intuitive. Keep in mind that it is not absolutely necessary to get it exactly right when doing the pitch matching. As long as the sound you choose (match to) is very close to your tinnitus, it should be ok for sound therapy.

What is a Tinnitus Sound Test used for?

The primary value of tinnitus sound test (pitch matching) is in tailoring sound therapy. Research suggests that customized sound therapy, especially sounds that target the frequency region near the audiometric edge (where hearing begins to drop off) or maximum hearing loss, may be more effective than generic masking sounds.

Some sound therapies are designed based on both the audiogram and the tinnitus frequency to better engage the affected auditory pathways. Our clinical trial on this topic showed that customized sound therapy outperforms white noise in terms of tinnitus reduction [2].

Challenges with Tinnitus Pitch Matching

In real-world testing, patients often struggle to pinpoint a single tone due to the complexity of their tinnitus. Several factors make pitch matching tricky:

Problem With Pitch Matching	Description
Octave confusion	Patients often confuse pitches an octave apart, especially when the tinnitus tone is not clearly defined.
Non-tonal tinnitus	For those with hissing, buzzing, or broadband tinnitus, matching a pure tone is nearly impossible.
Multiple tones	Some patients experience more than one tinnitus sound, and not all are present at once, complicating the test.
Residual inhibition	Tones near the tinnitus frequency can temporarily suppress the sound (residual inhibition), making pitch matching harder by masking the tinnitus too soon.

How To Test Tinnitus Loudness

If you ask most tinnitus sufferers what they want relief from, loudness tops the list. It’s the most immediate, intrusive feature, and understandably, people want it gone.

The problem is that certain loudness tests doesn’t always match the severity of suffering. This disconnect raises serious questions about how we measure tinnitus loudness. Let’s take a closer look.

Objective Loudness Testing For Tinnitus

In tinnitus examinations, “objective” loudness tests try to quantify how loud the tinnitus seems by comparing it to external sounds. Since there’s no way to directly measure phantom sound, this method attempts to anchor it to a known sound in a controlled environment.

However, both primary methods, Loudness Matching and Minimum Masking Level (MML), are still considered psychoacoustic tests. In other words, the outcome of the test hinges on the patient's perception and reporting. They are “psychoacoustic” and therefore not truly “objective”.

Loudness Test	Description
Loudness Matching	Patients adjust a pure tone or narrowband noise until it matches the perceived loudness of their tinnitus. Recorded in dB SL above threshold.
Minimum Masking Level (MML)	Measures the lowest level of external noise needed to completely mask the tinnitus, often using white or narrowband noise.

While these are sometimes used in research settings, they are rarely used in standard clinical care for the reasons explained below.

The Drawbacks Of Objective Tinnitus Loudness Testing

Tinnitus loudness tests aim to provide a semi-objective measurement of how intense the tinnitus sounds to the patient. Unfortunately, they often fall short in capturing the lived experience of tinnitus.

In fact, research has consistently shown that there’s little to no correlation between how loud tinnitus measures in an “objective testing” and how much it actually impacts a person’s life [3]. Here are the main issues with this type of testing:

Problem With Loudness Matching	Description
No correlation with distress	Studies show tinnitus loudness doesn't predict impact—someone with low loudness may be deeply affected, while others with louder scores feel fine.
Fluctuations and time-dependence	Tinnitus loudness fluctuates with factors like sleep, stress, and noise exposure, so a single test may miss how intense it gets during a spike.
Placebo and attentional bias	Being in a soundproof booth can heighten awareness or stress, temporarily altering tinnitus perception and skewing test results.
Lack of real-world relevance	Tinnitus is often worst during real-life stress or noise, but clinic tests in silence can miss how loud or disruptive it truly feels day to day.

The mismatch between “objective” measures of loudness and actual distress is well-documented. In support of this, the UK’s National Institute for Health and Care Excellence (NICE) advises:

• “There is no benefit in performing psychoacoustic measures in addition to standard hearing assessment… The outcome of the tests have little or no impact on routine tinnitus management. The committee noted that psychoacoustic testing is mainly used as a tool in research rather than in clinical practice.” [4] [emphasis added]

This reinforces the idea that objective loudness tests are less clinically relevant. There are better, simpler alternatives, ones that actually help when clinically treating tinnitus.

Alternatives to Objective Tinnitus Loudness Tests

There are simple, practical ways to measure tinnitus loudness that better reflect real-world experience. While not perfect, these tools are often more aligned with what patients actually feel—and far more useful in everyday clinical settings.

Visual Analog Scale (VAS) Loudness Tests

The VAS is a simple yet powerful tool: patients rate how loud their tinnitus feels by marking a point on a scale (typically 0–10 scales and the like). While less “objective” than booth testing, this method has shown much stronger correlation with tinnitus-related distress compared to audiology-based loudness matching.

Visual analog scale (VAS) testing also has several key advantages:

• It’s fast, easy to administer, and doesn’t require special equipment.
• It can be repeated frequently to monitor changes over time or response to treatment.
• It’s sensitive to perceived changes, even if absolute loudness remains constant.

Because it reflects the patient’s real-world experience more accurately, the VAS is often preferred in both clinical and research settings.

Ecological Momentary Assessment (EMA) Loudness Tests

Ecological Momentary Assessment (EMA) uses apps or wearables to collect real-time data on tinnitus as it’s happening. By prompting users to rate loudness and distress throughout the day, EMA captures how symptoms fluctuate with environment, mood, and triggers—offering a more accurate view of tinnitus in daily life [5].

That said, the EMA approach is not without limitations. For instance, frequent self-monitoring can heighten awareness and reinforce attention to the sound, potentially amplifying the perception of tinnitus itself.

End-of-day VAS Assessments

Recent research shows that nightly journaling using a visual analog scale (VAS) may be a good compromise. Studies comparing daily end-of-day diary ratings with more complex momentary assessments found that they track extremely closely [6].

This study suggests that quick, consistent evening check-ins over time with a VAS tool can reflect the true lived experience of loudness better than any one-time clinical test or EMA testing.

How Do You Measure Tinnitus Severity?

Tinnitus severity goes far beyond just how loud the sound feels. When it’s severe, it can trigger emotional distress, take over attention, disrupt sleep, and interfere with thinking—signs that the brain’s sensory filtering is off. This level of impact points to a deeper brain network disorder, not something basic loudness tests can capture.

So how do we actually measure severity? Right now, the most reliable and consistent way is through questionnaire-based tinnitus severity scales. These are sometimes referred to as “psychometric tests for tinnitus“– not just a “do I have tinnitus quiz”, but a tinnitus quiz that reflects the psychosocial impact of the tinnitus.

The Tinnitus Handicap Inventory (THI)

The Tinnitus Handicap Inventory (THI) is one of the most widely used tools for assessing tinnitus severity. It’s a 25-item questionnaire that asks patients to a series of statements about how tinnitus affects their life.

The THI was originally designed to capture the impact of tinnitus across three subscales:

Subscale	Description
Functional	Mental, physical, and social limitations in day-to-day life.
Emotional	Frustration, anger, depression, and anxiety resulting from tinnitus.
Catastrophic	Severe psychological reactions such as despair, panic, and fear of having a terrible disease.

Because of its heavy emphasis on distress, it’s sometimes referred to as an emotional tinnitus test in lay language.

Inherent Problems With The THI

New research has raised serious concerns about the structure of the THI. For instance, a recent study showed that the THI does not reliably separate these subscales [7]. Instead, all items tend to reflect a single underlying factor: emotional distress. In other words, the THI appears to be a one dimensional measure.

The THI also fails to fully capture the functional burden of severe tinnitus, such as impaired focus, sleep disruption, or social impact. In essence, the THI tells us how emotionally distressed someone feels about their tinnitus—but NOT how severely the condition is affecting their brain and behavior beyond emotional impact.

Research Problems With The THI

While the THI may accurately reflect emotional distress from tinnitus, it's a relatively poor tool for measuring the effectiveness of a clinical intervention. For instance, it can't capture functional improvements or changes in brain reactivity, which limits its usefulness in evaluating intervention outcomes.

Further, the way the THI is used in clinical trials is also problematic. It often exaggerates the impact of an intervention by labeling small score changes as meaningful. This is because of how the minimal clinically important difference (MCID) is defined—the way researchers determine if an intervention made a meaningful impact [8].

For example, a drop from 96 to 90 may be reported as clinical improvement because the MCID is set at 6—even though the patient likely feels no real difference. This can create the illusion of effectiveness where there’s little actual benefit.

The Tinnitus Functional Index (TFI)

The Tinnitus Functional Index (TFI) was designed to address many of the limitations of the THI. While the THI focuses heavily on emotional distress, the TFI goes beyond suffering to assess the functional impact of tinnitus.

How the TFI Works

The TFI is a 25-item self-report questionnaire that evaluates tinnitus severity across eight functional domains:

Functional Domain	Description
Intrusiveness	How often tinnitus demands attention or dominates awareness.
Sense of Control	Whether the person feels they can manage or control the sound.
Cognitive Interference	Impact on focus, clarity, and mental efficiency.
Sleep Disturbance	How tinnitus interferes with sleep onset, duration, and quality.
Auditory Clarity	How hearing difficulties are attributed to tinnitus.
Relaxation Ability	The extent to which tinnitus prevents relaxation.
Quality of Life	Disruptions in relationships, social life, and day-to-day engagement.
Emotional Distress	Anxiety, frustration, and emotional strain caused by tinnitus.

Scoring and Interpretation

Each item is rated from 0 (no impact) to 10 (extreme impact), and the domain scores are averaged to yield a total score from 0 to 100.

The TFI was originally scaled using language like “not a problem” to “a very big problem,” reflecting the patient’s perceived burden. The ranges can be reasonably translated into categories of tinnitus severity like so:

TFI Score	Original Label	Severity Translation
0–17	Not a problem	Minimal – No significant tinnitus impact
18–31	Small problem	Mild tinnitus — minimal interference
32–53	Moderate problem	Moderate tinnitus — affecting functional domains
54–72	Big problem	Severe tinnitus — persistent and disruptive
73–100	Very big problem	Very severe tinnitus — constant and debilitating

For patients, the TFI offers a structured way to communicate their experience beyond just saying “it’s loud” or “it’s awful.” For clinicians, it offers a data-driven tool for customizing care and documenting outcomes. And for researchers, it provides a standardized, validated measure that reflects the real-world burden of tinnitus.

In short, the TFI isn’t just an emotional distress scale like the THI. It’s a much better estimate of the functional impact of tinnitus, and therefore, of tinnitus severity.

The Modified Tinnitus Functional Index™ (mTFI)

Our research team recently developed the Modified Tinnitus Functional Index™ (mTFI) to be a streamlined, user-friendly version of the original TFI test. It preserves the core functionality, but simplifies the process to make it easier to complete regularly.

Important Change in the mTFI: A Better Appraisal Of The Tinnitus Sound

One major update in the mTFI was the removal of the “Auditory Clarity” domain. We estimated that it was less relevant for tracking severity.

In its place, we now score tinnitus loudness and intrusiveness separately. This reflects real-world differences and gives a clearer view of how tinnitus operates in the brain.

• Loudness measures the raw intensity of the signal, likely tied to overactive sensory pathways, poor thalamic filtering, and limbic system activation.
• Intrusiveness tracks how often tinnitus enters conscious awareness. It’s a measure of attention and salience—the brain’s inability to ignore the sound.

By breaking out these two features of tinnitus, we can weigh the test more heavily toward the actual tinnitus percept and in doing so, get more insight into the thalamic-limbic (brain centers) vs. attention-salience components of tinnitus severity.

mTFI: A More Tinnitus-Specific Test

This change addresses a key concern from the tinnitus community: that most questionnaires don’t focus enough on the tinnitus sound itself. While the original TFI had only 16% tinnitus-specific questions, the mTFI has 25%. This gives the mTFI the highest focus on tinnitus-specific symptoms of any major questionnaire.

Category	THI	TFI	mTFI
Tinnitus-Specific	0% (!!!)	16%	25%
Auditory Perception	4%	12%	0%
Emotion/Psychology	68%	36%	25%
Health Impact	8%	24%	25%
Lifestyle Impact	20%	12%	25%

mTFI Scoring

The mTFI keeps eight total domains, but sums up each domain in one question. This makes it easy to complete in under two minutes while still giving a nuanced view of how tinnitus is impacting daily life and brain function. You can compare your mTFI score with the TFI score by multiplying it by 2.5.

mTFI Score	Tinnitus Severity Level
0–13	Mild
14–20	Moderate
21–40	Severe

Strengths of the mTFI

The mTFI brings several unique strengths that make it especially useful for ongoing tinnitus care:

Feature	Description
Tinnitus-Specific Focus	Dedicates 25% of questions to the tinnitus sound itself—more than any other major questionnaire—addressing a long-standing gap in tinnitus assessments.
Expanded Insight	Captures both loudness and intrusiveness—two distinct aspects that often reflect different brain systems (auditory vs. salience/attention networks).
Quick & Repeatable	Short enough to complete daily, making it ideal for routine tracking—like a mood or pain diary, but designed specifically for tinnitus.
Pattern Recognition Over Time	Reveals symptom patterns, triggers, and treatment responses—providing actionable insights to help guide and adjust care strategies early.
Patient-Centric Design	Easy to understand, fast to complete, and empowers patients to take an active role in tracking progress and managing their condition.

The Tinnitus Severity Assessment™: A Next-Gen Tinnitus Test

For decades, the focus of tinnitus severity assessments has been on loudness and distress—how intense the sound feels or how much it bothers you.

But this missed the deeper question: why is it happening, and what’s keeping it stuck? That blind spot overlooked central sensitization, a key driver of tinnitus severity.

The Tinnitus Severity Assessment™ was designed to correct this. It combines two tests that work together to capture the full picture:

• Modified Tinnitus Functional Index™ (mTFI)
• Brain Sensitization Profile™ (BSP)

The mTFI measures the impact of tinnitus and the BSP measures the sensory reactivity driving it. Together, they uncover both the burden of symptoms and the underlying brain dynamics—crucial for selecting the right treatment strategy.

Just to give you a glimpse of how powerful this is: a BSP score of 11 or higher is linked to a 4× greater odds of having severe tinnitus. When the score is 23 or higher, that risk jumps to nearly 6.5× greater odds. It’s now becoming clear that brain sensitization is one of the strongest drivers of tinnitus severity we’ve ever measured.

Tinnitus Evaluation With The Brain Sensitization Profile™

The Brain Sensitization Profile™ (BSP) is designed to measure something most doctors overlook: nervous system hypersensitivity and reactivity. The root condition, called central sensitization, makes the brain more likely to overreact to sensory information, such as sound, pain, motion, light, and other sensory inputs.

When the brain enters a state of central sensitization—often linked to neuroinflammation and an imbalance between excitatory and inhibitory signaling—it loses its ability to regulate auditory input properly. This leads to amplification and instability of the tinnitus signal, two key hallmarks of increased tinnitus severity.

The Brain Sensitization Profile™ evaluates for this by looking at four domains of nervous system reactivity — with the first two focused specifically on tinnitus.

Domain	Summary
Tinnitus Instability	Evaluates for changes in pitch, loudness, or sudden spikes—signals instability in how the brain regulates auditory input; most heavily weighted in scoring.
Sound Sensitivity	Measures overreaction to everyday sounds (hyperacusis) or sound-triggered spikes (reactive tinnitus); reflects auditory system hyperreactivity and central gain; more heavily weighted in scoring.
Somatic Sensitivity	Captures physical symptoms like jaw tension or headaches; suggests broader central sensitization beyond the auditory system.
Sensory Sensitivity	Looks at sensitivity to light, motion, weather, or smells; indicates global sensory reactivity often tied to migraine-like patterns.

BSP Weighting and Scoring

Each symptom you report contributes to your overall BSP score, with tinnitus- and sound-related symptoms contributing more heavily. Here is how the BSP test is weighted:

Subdomain	Items	Points	Max Score
Tinnitus Instability	3	4 pts	12
Sound Sensitivity	3	3 pts	9
Somatic Sensitivity	7	1 pt	7
Sensory Sensitivity	7	1 pt	7
Total			35 points max

This weighted approach helps identify not just the presence of sensitization, but how directly it may be influencing your tinnitus symptoms. The result is a more accurate, brain-centered picture of what's keeping your tinnitus active and how to target it.

Here is how the BSP test is scored:

Score Range	Classification	What It Means
0-3	Minimal or No Sensitization	Little to no evidence of heightened sensory reactivity. Your nervous system appears stable.
4-10	Likely Sensitization	Some isolated signs are present, suggesting a pattern of increased central sensitization.
11-22	Definite Sensitization	Your nervous system shows a measurable level of reactivity and sensitization that may amplify tinnitus.
23-35	Significant Sensitization	Widespread brain sensitization is profoundly contributing to symptom intensity and instability.

A Profound Discovery Regarding Tinnitus Severity

In a dataset of 960 patients, new analysis uncovered a powerful predictor of tinnitus severity that standard tests miss entirely: the brain sensitization picked up by the BSP.

Two key findings:

• BSP Score ≥11
  Individuals with a BSP score of 11 or higher had 4× greater odds of scoring in the severe tinnitus range (mTFI ≥ 20). [OR: 3.98 | 95% CI: 2.78–5.70 | p < 0.0000000001]
• BSP Score ≥23
  Individuals with a brain sensitization score of 23 or higher had 6.5× greater odds of scoring in the severe tinnitus range (mTFI ≥ 20). [OR: 6.53 | 95% CI: 3.01–14.19 | p = 0.0000021]

These results suggest that central nervous system sensitization isn't just a background factor — it may be the strongest, most overlooked driver of tinnitus severity we have ever considered.

Brain Sensitivity Mediates Tinnitus Loudness

Another striking insight from this dataset is that brain sensitization strongly predicts tinnitus loudness. This challenges the reductionist view that loudness is driven solely by the auditory brainstem or psychological factors like anxiety. Instead, the data points to a third, more compelling explanation; that central sensitization is a mediating factor in determining tinnitus loudness.

• BSP Score ≥11
  Individuals with a brain sensitization score of 11 or higher had 2.34× greater odds of reporting tinnitus loudness in the highest range (4–5 on the mTFI). [OR: 2.34 | 95% CI: 1.75–3.14 | p < 0.0000000102].

A Personal Note To Tinnitus Sufferers

* For many, this is the first time they  see how all of their symptoms are connected. It’s one of the most rewarding parts of working in tinnitus care — being able to tell someone, “Yes, we actually have an explanation for what you’re going through.”

I would invite you to take the test, analyze your results, and if your score is high and you'd like help, schedule a call with us to discuss your case with one of our team members. 

How to Interpret Your Total TSA Score

Your combined mTFI and BSP make up the total Tinnitus Severity Assessment™ score. It reflects both what you’re experiencing and how deeply your brain may be involved in amplifying those symptoms.

Score Range	Severity Level	What It Means
0–10	Mild	Tinnitus is present but manageable. Your system is still flexible, and symptoms may resolve with early support. There is little to no signs of brain sensitization.
11–31	Moderate	Tinnitus is interfering with daily life, and brain sensitization may be emerging. This is a key window for intervention and an opportunity to stay ahead of the problem. You still may be an excellent candidate for treatment.
32 and above	Severe	Tinnitus is deeply affecting your quality of life, and brain reactivity is likely reinforcing the cycle. A structured treatment plan is recommended that uses medical interventions that target brain sensitivity.

Tinnitus severity isn’t just about how loud the sound is, it’s about how wide the brain network disturbance has become. The TSA is the first tool designed to measure both the impact of tinnitus and the neurologic sensitivity that drives it.

Here is an important point. You may have scored in the Severe range on your mTFI score (ie 21 or above), but still scored Moderate on the TSA total score. What's going on?

All this means is that your tinnitus is bothersome, but you may not yet have features of sensitization. You still may benefit from treatment, so please give us a call if you would like to discuss this further. 

New Horizons in Tinnitus Testing (2025 Update)

Tinnitus testing is evolving fast and researchers are closing in on new ways to test for tinnitus severity. Here’s a look at three promising areas of research:

EEG Tinnitus Tests

Electroencephalography (EEG), and more specifically quantitative EEG (different from the test you can get at a neurologist), is now being used to identify tinnitus-specific brain patterns.

A 2025 study used brainwave “microstates” and deep learning to distinguish tinnitus patients from controls with over 90% accuracy [9]. Another found that those with bothersome tinnitus showed increased activity in auditory and emotional centers and reduced signals in the orbitofrontal cortex, which regulates emotion [10].

Interestingly, these brain electrical activity patterns mirror the dysfunctions measured by our TSA test—especially disruptions in the brain’s ability to filter and regulate sensory input. The EEG reflects imbalances in excitation and inhibition and sensory gating, which the TSA is designed to capture at a symptom level.

Functional Brain Imaging

Functional MRI (fMRI) has shown striking differences between people with mild and severe tinnitus. Those in the severe category displayed stronger activation across networks tied to sound processing, emotional reactivity, and attention.

Importantly, it’s not just one brain region—it’s a whole system reacting in unison, pointing to tinnitus severity as a brain-wide issue rather than a local hearing problem [11].

These whole-brain patterns strongly validate the TSA framework. fMRI confirms that the more intense and distressing the tinnitus, the more it engages emotion-regulation circuits, echoing the TSA’s measurement of limbic (emotional part of the brain) overdrive and sensory gating failure.

Multimodal Recordings

Some of the most promising studies are combining EEG, eye tracking, and facial expression analysis to measure tinnitus severity in real time [12]. When exposed to sharp sound bursts, people with tinnitus show exaggerated pupil dilation and subtle facial muscle shifts—physiological markers that predicted distress levels with over 90% accuracy in some trials.

What’s powerful about this multimodal approach is how well it supports the TSA’s core premise: that tinnitus becomes severe not just due to loudness, but due to the brain’s heightened state of reactivity. These studies detect that emotional and sensory overload live, using compact tools that could soon enable at-home monitoring of tinnitus-related brain activity.

Future Directions

The future of tinnitus testing looks smarter, more precise, and less reliant on guesswork. From brain scans to pupil tracking to protein analysis, researchers are finally building tools that can show how severe your tinnitus is.

The question is whether these advanced tools will replace traditional tinnitus questionnaires—or simply confirm that well-designed questionnaires are already picking up the same brain-based patterns. Given their low cost, ease of use, and ability to scale online, questionnaires like the Tinnitus Severity Assessment™ are likely to remain the standard for screening and tracking, even as biomarker technologies evolve.

Tinnitus Severity Testing: From Symptoms to Mechanism

Tinnitus assessment has gone through several important phases—each advancing our ability to measure the condition, each building on each other.

Approach	Summary
Loudness Testing	Intuitive but unreliable—doesn’t reflect distress or how the brain processes tinnitus.
Distress Measures	Captures emotional burden, but influenced by non-auditory factors; offers an incomplete view.
Functional Impact Tools	Evaluates how tinnitus affects life (e.g., sleep, focus), but only measures downstream effects.
Sensory Reactivity	Focuses on brain sensitization; links symptoms to underlying mechanisms and guides treatment.
Combined Approach	Combines loudness, distress, functional impact, and reactivity for a complete view of tinnitus severity.

The Tinnitus Severity Assessment™ adds to this progression by adding the dimension of sensory reactivity and then combining tinnitus-specific impact, functional impact, and neural reactivity together to deliver a more complete and clinically actionable picture.

This marks a shift from simply describing symptoms to understanding the underlying brain mechanisms—paving the way for more targeted, effective treatment.

Tinnitus Testing FAQs

Tinnitus Test References

[1]           H. Skarżyński, E. Gos, B. Dziendziel, D. Raj-Koziak, E. A. Włodarczyk, and P. H. Skarżyński, “Clinically important change in tinnitus sensation after stapedotomy,” Health Qual. Life Outcomes, vol. 16, p. 208, Nov. 2018, doi: 10.1186/s12955-018-1037-1.

[2]           K. Goshtasbi, K. Tawk, P. Khosravi, M. Abouzari, and H. R. Djalilian, “Smartphone-Based Cognitive Behavioral Therapy and Customized Sound Therapy for Tinnitus: A Randomized Controlled Trial,” Ann. Otol. Rhinol. Laryngol., vol. 134, no. 2, pp. 125–133, Feb. 2025, doi: 10.1177/00034894241297594.

[3]           P. Brüggemann, A. J. Szczepek, M. Rose, L. McKenna, H. Olze, and B. Mazurek, “Impact of Multiple Factors on the Degree of Tinnitus Distress,” Front. Hum. Neurosci., vol. 10, Jun. 2016, doi: 10.3389/fnhum.2016.00341.

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[5]           M. Engelke, S. Müller, B. Langguth, R. Pryss, and W. Schlee, “Tinnitus Measured in Everyday Life: A Literature Review of Ecological Momentary Assessment Studies,” J. Assoc. Res. Otolaryngol. JARO, Jun. 2025, doi: 10.1007/s10162-025-00995-0.

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