“Fewer questions where possible, all the questions where necessary”

Our study on a shortened version of the Tinnitus Handicap Inventory (THI) has been published in the *International Journal of Audiology*.

One Monday morning, a patient begins filling out the digital medical history form in preparation for her appointment with the ENT specialist. She has been hearing a soft, high-pitched ringing sound for months. It starts off smoothly, but at one point she thinks:“This is quite a lot. So many questions about how much the ringing in my ear bothers me.”
That’s exactly what we wanted to address—without compromising on safety or clinical usability.

We are proud that our research on this topic has now been published in theInternational Journal of Audiology: an adaptive, short version of the Tinnitus Handicap Inventory (THI-12/8/5) that asks exactly as much as is necessary. No more.

The problem

Tinnitus is distressing, but the burden of symptoms varies from patient to patient. ENT specialists often measure the burden of tinnitus using the THI, a 25-item questionnaire with a total score ranging from 0 to 100. If you do not differentiate based on symptom burden, everyone receives the same comprehensive THI questionnaire—often unnecessarily. Over-surveying reduces patients’ willingness to complete questionnaires again during a follow-up assessment or subsequent intake.

The simple idea: Make the THI adaptive

Using a genetic algorithm, we developed a three-step approach for the THI:

• Step 1: 12 items.If the predicted total THI score is ≤16 (mild), the questionnaire ends.
• Step 2: 8 additional items.At 18–36 (mild), we add a short set and then stop.
• Step 3: (remaining 5 additional items). If the score is above 36, ConsultAssistent automatically retrieves all remaining items from the THI.

This is how THI-12/8/5 comes about: fewer questions where possible, complete transparency where necessary.

What our research shows

The publication highlights four points that are important in clinical practice:

1. Low projection error:standard deviation ≈ 2.1 THI points; maximum deviation ≈ 8.5.

1. High category agreementregarding the thresholds (mild/moderate/severe/catastrophic), with sensitivity and specificity ≥90%.
2. Profit depends on case mix:
   1. Dutch holdout: average 19.8/25 items (≈21% less).
   2. Light (step 1): 12/25 items (≈52% less).
   3. Tertiary population (heavier patients): less reduction — safety remains assured because more patients complete all 25 items.
3. Algorithmic shortlisting has broader applications:the principle (genetic algorithm-driven selection) is effective and simple and could potentially be applied to other questionnaires as well.

Important: we use and report the total THI score for triage; we do not interpret subscales. The adaptive design does not replace the THI-25: a projection >36 always results in the full questionnaire being administered.

How this works in practice

• THI ≤16 (mild)→ 12 items; explanation/reassurance, routine audiological care, self-management.
• THI 18–36 (mild)→ 20 items; stepwise care (e.g., hearing interventions, brief CBT-based self-help) and reassessment after 6–12 weeks (e.g., MCID ≈7 points).
• THI >36→ automatic THI-25; consider multidisciplinary audiological and/or psychological support.

Why it's important to shorten now

Digital care pathways are part of everyday practice. Patients prepare at home; teams want to use that information in a targeted way. An adaptive questionnaire that evolves in response to the severity of symptoms fits seamlessly into this process. Asking too many questions reduces response rates and adoption; tailoring the questionnaire to the patient’s needs increases its usability.

Standard in our digital ENT medical history

THI-12/8/5 is built into ConsultAssistent and integrated with various EHRs (including HiX, Nexus, and Emma). Implementation primarily involves configuration: fixed thresholds, clear reporting, and an AI summary as a pre-consultation report, based on the entire digital medical history.

As far as we're concerned: the new standard

Not every patient needs to answer every question to receive good care. And no patient should be allowed to provide insufficient information when there is more going on. With THI-12/8/5, we do this in our digital medical history form for ENT—and we use data to show that it’s possible.

Want to read more or learn more?

– Readthe article in the *International Journal of Audiology* here:
– Are you interested in the full article? Contact us for an e-print of the full article. Emailresearch@consultassistent.nl or
– Would you like to see how this works in the digital ENT medical history and how it fits into your care pathway?Contact us for a demo

Performance depends on the case mix; in tertiary populations, the reduction is smaller. Above 36, the THI-25 is administered in full. The short form is intended for triage and reports the total score.