Objective:The purpose of this study was to investigate difficulties associated with tinnitus in a large sample of patients using an open-ended problem questionnaire.Design:Four hundred seventy-three unselected patients referred to the Tinnitus Clinic of the Welsh Hearing Institute (1986 through 1991) completed the Tinnitus Problem Questionnaire(Tyler & Baker, 1983). Before clinical assessment, patients were invited to list problems that they associated with their tinnitus in order of importance in an open-ended questionnaire. Their responses were coded into 45 categories. The responses of 39 patients who only described their tinnitus were excluded leaving unselected responses from 436 patients, 224 women and 212 men, whose average age was 57.1 yr. The questionnaire elicited an average 3.78 responses per patient (range 1 to 12).Results:The 30 most common difficulties attributed to tinnitus are described. There was broad agreement between the problems reported in this clinic-based study and those reported by a self-help group sample(Tyler& Baker, 1983).Conclusions:Analysis of these responses into groups based on psychological (30.1%), hearing (23.5%), health (20.7%), sleep (14.6%), and situational (11.1%) difficulties highlights the need for recognition of the global consequences of tinnitus to many patients and for a broadly based tinnitus management model.