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The higher mean THQ scores for the Australian sample probably reflects the fact that the sample was selected explicitly on the basis of the experience of tinnitusrelated distress. The US sample consisted of tinnitus patients who attended otolaryngology, veterans, and university clinics but were not assessed independently as being distressed by their tinnitus. The Australian sample consisted of tinnitus sufferers drawn from an outpatient veterans hospital and media advertisement and were selected for inclusion in the present study on the basis of their demonstration of a significant level of distress associated with tinnitus (i.e., score > 17 on TRQ). Both studies reported similar findings with regard to internal consistency, though the range for itemtotal correlations was slightly lower in the Australian study. Low and nonsignificant correlations were found between the THQ and both loudness match and MML measures, supporting other research that has shown little relationship between audiological and psychological measures [13,14]. Overall, these results indicate that the factors that affect psychological effects of tinnitus are independent of its psychoacoustic qualities, consistent with the cognitive theory of emotional distress [15]. Moderate correlations between the THQ and measures of depressive symptomatology are reported by the US and Australian studies, further supporting the association between tinnitus-related difficulties and depressive symptomatology [16,17]. Investigation of the factor structure of the THQ revealed three factors that were interpreted as (1) emotional, social and, physical effects of tinnitus; (2) effects on hearing acuity and communication; and (3) the individual's appraisal of tinnitus. These factors are similar to the three factors reported in the original investigation by Kuk et al. [2], although containing some slight differences in the items that loaded on the various factors. Despite these differences, the three factors in our study accounted for a similar amount of the variance as seen in the three factors in the original investigation.
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