Prevalence of Tinnitus and Hyperacusis in Children and Adolescents: a Systematic Review

A Cross-Sectional Study of the Prevalence and Factors Associated With Tinnitus and/or Hyperacusis in Children

Nemholt, Susanne1,2,3; Schmidt, Jesper Hvass1,3; Wedderkopp, Niels4,5,6; Baguley, David M7,8,9
Ear and Hearing: July 18, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/AUD.0000000000000759

Objectives: The aim of this study was to determine the prevalence of tinnitus and/or hyperacusis in Danish children aged 10 to 16 years, and to assess associations between tinnitus or hyperacusis and other relevant factors.

Design: A cross-sectional study based on a previously established child cohort. A total of 501 children were enrolled in the project. The study was performed in eight mainstream schools and data were collected during an 8-week period from October 27, 2014 to December 16, 2014.

Results: Using broad tinnitus research questions, the prevalence of any tinnitus was 66.9%; of noise-induced tinnitus (NIT) was 35.7%; and of spontaneous tinnitus (ST) was 53.7%. Bothersome tinnitus was reported by 34.6% of the children with any tinnitus, 23.2% of the whole population. Few children were severely bothered (2.4%, 1.6%, respectively). It was significantly more common for children with NIT to report tinnitus episodes lasting for minutes or longer than for children with ST (p = 0.01). Girls were more likely than boys to be bothered by tinnitus [Odds ratio (OR) = 2.96; 95% confidence interval (CI) 1.34 to 6.51; p = 0.01]. 14.6% of the children reported hyperacusis, and 72.6% of those reporting hyperacusis were bothered by it, 10.6% of the whole population. The odds of having hyperacusis were 4.73 (1.57, 14.21) times higher among those with ST compared with those without ST. Furthermore, hyperacusis was associated with sound avoidance behaviors such as experience of sound-induced pain in the ear (OR = 2.95, 95% CI 1.65 to 5.27; p < 0.001), withdrawal from places or activities (OR = 3.33; 95% CI 1.44 to 7.69; p = 0.01), or concerns about sound could damage the hearing (OR = 1.85, 95% CI 1.06 to 3.31; p = 0.03).

Conclusions: Tinnitus and hyperacusis are common in children but prevalence is dependent on tinnitusdefinitions. Only a few children are severely bothered by tinnitus. In the case of hyperacusis, children may exhibit sound avoidance behavior.

Link: https://journals.lww.com/ear-hearin...tional_Study_of_the_Prevalence_and.98770.aspx

 

Hyperacusis in children: a scoping review
Even if it is not mentioned in the title, it also talks about tinnitus (when tinnitus is a commorbidity of hyperacusis).

Background
Hyperacusis is a chronic condition commonly defined as a lowered tolerance or increased sensitivity to everyday environmental sounds. It has been viewed as a paediatric disorder which can cause significant impairment to a child’s normal functioning. Although clinical guidance highlights the importance of identifying whether the child has intolerance to loud sounds and managing this appropriately, there are currently no assessment or treatment methods that have been designed and tested for use with children with hyperacusis. A review is therefore indicated to consider the profile of children with hyperacusis as a basis for future research into their assessment and treatment.

Method
A scoping review methodology was followed with literature searches conducted in Embase, PsychINFO, PubMed CENTRAL, Scopus, Web of Science and Google Scholar. Research articles were included if they reported on research studies describing children diagnosed with hyperacusis, providing clinical profile information, and/or reporting on an assessment or management method for children with a primary complaint of hyperacusis. Data were charted on Excel and verified by a second researcher. Twenty-one research articles were included.

Results
Children with hyperacusis are typically described in terms of age at presentation, troublesome sounds, physical sensation, behavioural reactions, coping strategies, comorbid conditions and impact on daily life. Methods of assessing the children include semi-structured interviews, questionnaires, neurological assessment, observation and uncomfortable loudness levels. Management methods include psychological therapy, sound therapy, tinnitus retraining therapy, medication and neuro-rehabilitation.

Conclusion
The information we catalogued on various elements of clinical profile, assessment and management can serve as a stepping stone in future research developing questionnaires for clinical measurement of the impact of hyperacusis on children, and the measurement of treatment related change in clinic and in trials. Positive outcomes were noted by the authors following all of the above treatments; future research must compare these and specify the parameters for optimal results.

Full article: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02223-5

 

Prevalence, associated factors, and comorbidities of tinnitus in adolescents

The aim of this study was to investigate the prevalence of tinnitus among adolescents, and the factors known or hypothesized to be associated with tinnitus. Based on random sampling of school types and regions, a nationwide hearing survey of the first-year middle and high school students of South Korea was performed. The subjects underwent an otologic examination followed by pure tone audiometry up to 8 kHz. Questionnaires about the factors associated with hearing and tinnitus were completed by the students and their parents. Among the 1,593 subjects who completed the questionnaire and underwent pure tone audiometry, the prevalence of tinnitus was 46.0% and that of severe tinnitus was 9.1%. Tinnitus was associated with age, female gender, history of ear infection and sinusitis, leisure noise exposure due to karaoke and local-area-network gaming, alcohol consumption, and cigarette smoking. Noticeable hearing loss was not detected but participants with tinnitus complained of difficulty with sound localization, hearing in noise, and verbal working memory and were more susceptible to fatigue. The subjects with tinnitus also suffered more physical and mental health problems than did those without tinnitus. Thus, protection of the ears from noise and appropriate counseling should be considered for adolescents with tinnitus.

Source: https://pubmed.ncbi.nlm.nih.gov/32735626/

 

Extended High Frequency Audiogram (EHFA) and Speech In Noise Test (SPIN) are more and more used.

Post-exposure effect of music through personal listening device (PLD) on speech perception in noise test in young adults

Introduction: Tinnitus is often perceived temporarily after noise exposure, usually disappearing within a few hours. However, a significant number of young people perceive permanent tinnitus which is the most frequent symptom following exposure to noise via PLDs.

Objective: To evaluate the effect of music exposure through (PLD) with and without tinnitus on results of EHFA, TEOAEs, ABR and SPIN tests in normal hearing young adults.

Patients and Methods: Sixty normal hearing young adults were included in this study, fifteen as a control group and forty-five PLDs users as study group, the study group were subdivided according to the presence of tinnitus into two subgroups. All subjects were submitted to basic audiological evaluation (pure tone audiometry, speech audiometry and immittancemetry), Extended high frequency audiometry (EHFA), transient evoked otoacoustic emissions (TEOAEs), auditory brainstem response (ABR) and speech perception in noise (SPIN) test.

Results: There were statistically significant differences in extended high frequency audiometry (HFA) at different frequencies among study and control groups. There were statistically significant differences in transient evoked otoacoustic emission test (TEOAEs) response among control and study groups. There were no statistically significant differences in absolute and inter-peak latencies of low and high repetition rate ABR among control and studied groups. There were statistically significant differences in speech perception in noise test (SPIN) among the control and study groups.

Conclusion: : exposure to recreational noise due to excessive PLDs usage cause elevated EHFA thresholds, decreased TEOAEs amplitudes and decreased SPIN scores despite normal conventional PTA thresholds.

 

Tinnitus Is Associated With Extended High-Frequency Hearing Loss and Hidden High-Frequency Damage in Young Patients

OBJECTIVES: To analyze the results of extended high-frequency (EHF) and high-frequency hearing tests in young patients with tinnitus who show normal response in conventional pure-tone audiometry (PTA), and to explore the correlation between tinnitus and hearing loss (HL).

STUDY DESIGN: A case-control study.

SETTING: A Tertiary Eye Ear Nose & Throat Hospital of China.

PARTICIPANTS: Patients with tinnitus, aged 18 to 35 years old, and with normal conventional PTA (125 Hz-8 kHz) were enrolled in the tinnitus group. Volunteers without tinnitus of the same age were enrolled in the control group.

MAIN OUTCOME MEASURES: The incidence of EHF-HL and the hearing thresholds at each frequency, as well as the distribution of maximum HL frequency and edge frequency in all participants were compared.

RESULTS: In total, 28 cases (43 ears) were enrolled in the tinnitus group and 34 cases (68 ears) in the control group. The incidence of EHF-HL, average hearing threshold of each frequency ranging from 4 to 16 kHz, and the maximum hearing threshold were significantly higher in the tinnitus group. The edge frequency in the tinnitus group was lower than that in the control group (10.4 ± 3.1 kHz versus 12.3 ± 2.5 kHz, p = 0.010). The dominant tinnitus pitch in cases whose EHF was impaired was positively correlated with the hearing-level loudness of tinnitus (r = 0.627, p < 0.001).

CONCLUSION: Patients with tinnitus and normal hearing in conventional PTA showed signs of EHF-HL and hidden damage in the high-frequencies more easily. EHF hearing tests and the follow-up of HF hearing tests are recommended to facilitate early detection of hearing impairment for timely intervention.

Source: https://europepmc.org/article/med/33196532

 

Much more information in the full article: see attached file.

Prevalence of tinnitus in a sample of 43,064 children in Warsaw, Poland

Objective:
Tinnitus affects both adults and children. Children rarely complain spontaneously of tinnitus, and their parents are not aware of the condition. The prevalence of tinnitus in children differs considerably between studies, and large studies are needed to reliably estimate how many children experience tinnitus symptoms. The goal of the study was to estimate the prevalence of tinnitus in a large sample of schoolchildren.

Design:
This study was population-based, epidemiological research, conducted in the general, paediatric population of school-age children in Warsaw, Poland. Pure-tone audiometric testing was done, and hearing thresholds were determined from 0.5 to 8 kHz. Both the children and parents answered questions about the presence of tinnitus in the child.

Study sample:
Results from 43,064 children aged 11 to 13 years old, as well as their parents, were collected.

Results:
The study showed that tinnitus affected 3.1% of the children, but it was significantly more frequent (9%) in children with hearing loss. We found that 1.4% of the parents were aware of the presence of tinnitus in their children.

Conclusions:
Children should be routinely asked whether they experience tinnitus and if so, they should be included in the thorough assessment and management of the condition.