We question whether patients with acute tinnitus can be differentiated in their perceived handicap and emotional distress. Dysfunctional mechanisms for coping with stress and illness in patients with acute tinnitus were investigated. Twenty patients (symptoms for less than 1 week) were examined for distress due to tinnitus (TF), degree of depression (BDI), global distress (SCL- 90-R) and coping with stress (SVF). Patients could be differentiated in terms of their psychological distress and annoyance caused by the symptoms. There is a high correlation between the degree of depression, dysfunctional way of coping with stress and emotional distress caused by tinnitus. Dysfunctional stress coping strategies are found more frequently in highly affected patients. Patients with acute tinnitus can be differentiated in terms of their distress and the psychological impairment caused by their symptoms. These results suggest that the immediate reaction to the manifestation of tinnitus might be of prognostic value for the level of emotional distress experienced in chronic tinnitus. The question arises of whether psychological intervention in the acute stage of tinnitus might be beneficial.