OBJECTIVES To assess the patient-reported ability to concentrate of people with tinnitus in an international context, the 30-item APSA originally developed in German had to be translated into 5 languages. A rigorous methodology was employed to ensure conceptual equivalence and cross-cultural relevance of the translations. METHODS To facilitate the translation process, the original German version was first translated into US English and then into the 5 target languages following the internationally accepted process: 1) forward translation; 2) back translation; 3) clinician review; 4) cognitive debriefing on 5 patients with tinnitus; and 5) international harmonization. Each step was conducted in close collaboration with the developer. RESULTS two challenges were inherent in this process: (1) For reasons of timing, the translations into languages other than English started prior to finalizing the US version. This interpretation of the US English text as a non-final interpretation of the German original required a constant update of the list of concepts (the document defining the meaning of each item and accepted alternative formulations for translations) as well as a constant modification of the US English translation and consequently the other language versions. (2) The “two wave” translation process revealed issues in the German original requiring the integration of updates at all levels as well as the reformulation of 2 items in the German version. CONCLUSIONS The translation of the APSA was performed following a rigorous methodology to facilitate international comparison and pooling of data. The project demonstrates the difficulty of using non-English measures in an international context. It also reveals the essential role the “list of concepts” plays in the translation process and suggests the advantage of integrating international input into the design of measures when these are used in an international context.