THI versus TFI
Many audiologists default to the Tinnitus Handicap Inventory because that's what they were trained on. THI is a valid instrument, but the Oto program and the published evidence both use the TFI. Treat THI as a historical reference and make the TFI your standard going forward.
Using the sub-scales in conversation
Whichever sub-scales come back highest at baseline give you a starting point for which parts of the Oto program to highlight first — sleep-elevated patients usually benefit from the sleep-hygiene content, emotional-elevated patients from the CBT-based emotional regulation work, intrusive-elevated patients from attention re-direction.
Explaining the TFI to the patient — the onion metaphor
"Tinnitus is like an onion — there are many layers to it. Sleep, emotion, concentration, relationships. The TFI is how we peel back those layers one by one, so we can understand exactly where your tinnitus is affecting you most and focus your care there." Naming the eight subscales (Intrusive, Sleep, Cognitive, Auditory, Relaxation, Quality of Life, Emotional, Sense of Control) makes the questionnaire feel like a clinical tool, not a form.
Don't re-administer at the 4- or 8-week reviews — pull from the portal
Re-test bias is real. The app prompts the patient to complete the TFI on its own cadence; read the result from the portal at the follow-up. Re-administering chairside obscures the trajectory.
At the 4-week review, watch subscale shifts — not the global score
A flat global TFI at 4 weeks is normal. Early movement shows up in the subscales that were highest at baseline. The 12-week reading is where the global score change matters for MCID.
Some patients push back on filling out a twenty-five-item form at intake
Frame it as the clinical anchor for their care: "This is how we'll know the Oto program is working for you across the next twelve weeks. It takes about five minutes — let's do it together." Sitting with them while they fill it out usually gets past it.