Hearing Symptom Tracker

Date

Hearing Quality — Left Ear

How does your left ear feel today overall?

Neutral

5

1 · Very poor10 · Best possible

Static / Baseline Tinnitus

The constant hiss or static — separate from distinct tonal ringing

Present today?

Intensity — compared to your usual baseline

5

1 · Much quieter than usual 10 · Much louder than usual

Ringing Episodes

Distinct tonal ringing — separate from the background static

Any episodes today?

Number of episodes

1

Duration(s)

Pitch

Low

Mid

High

Mixed

Aural Fullness

Plugged, pressured, or full sensation in the left ear

Present today?

Sudden Change

Any noticeable shift — drop or improvement — compared to yesterday

Noticed a change?

Describe what changed and when

Context (optional)

Only note if potentially relevant

Sound exposure today

Sleep last night

Poor

Fair

Good

Great

Other notes

History & Trends