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Tinnitus in Childhood
With an incidence rate roughly equal to that of adults, childhood tinnitus presents challenges for the young patient who may not have the ability to name the condition.
While there has been increasing public and professional awareness of the possible impact of troublesome tinnitus in adults, there is less understanding of the problem that tinnitus can be for a child and the child’s family.
Looking at the published information about the incidence of children with tinnitus, a number of problems become apparent. First, there are several studies, but each has considered a different age category as being a child—some 5 to 16 years old, others up to age 19.
Also, each study has used a different definition of tinnitus, so that in one study a transient, trivial tinnitus that comes on from time to time might be a positive finding, whereas another study may be restricted to tinnitus that has a significant impact upon quality of life.
In addition, the language itself can make a difference. Many children will not be familiar with the term tinnitus, giving studies using child-friendly terminology a more robust result.
Nevertheless, a snapshot does emerge. About one-third of young people have tinnitus that they are aware of, and in about one in 12 it has a significant impact, potentially giving rise to problems with sleep and concentration. This is broadly in line with data on adults.
The fact that many of these children have not discussed their tinnitus with their parents is reflected in the small numbers of young people referred for the condition, even in specialist audiology centers.
The causes of tinnitus in children and young people are as varied as in adults. The presence of a hearing loss is a major risk factor for tinnitus, and in particular, an acquired hearing loss seems to carry more risk than being born with a hearing loss—though tinnitus is common among deaf individuals.
Because tinnitus can be an indication of ear disease, all children that complain of it need a detailed otologic and audiologic examination. Other factors that have been identified include noise exposure and secondhand smoke. Children undergoing some types of chemotherapy treatment for cancer are at risk for both tinnitus and inner ear hearing loss.
Following a careful diagnostic evaluation—during which care should be taken to avoid unduly alarming or frightening the child and the child’s family—treatment begins with an explanation of tinnitus, using vocabulary and examples that are age appropriate.
In order to understand the child’s own view of his or her situation, it sometimes helps to have the child draw a self-portrait experiencing tinnitus (see the illustration above), or of the tinnitus itself.
In cases where there is a severe impact from tinnitus, these images can be very moving, and the images help encourage the family to discuss the situation.
If the tinnitus is associated with a hearing loss, hearing aids can be immensely beneficial, even if the loss is mild. The increase in the intensity of external sounds can reduce the perceived intensity of the internal tinnitus sound. In some cases this inhibition persists even when the devices are turned off.
Also important is providing a young person with tactics, such as the use of sound generators, that can reduce the tinnitus in order to strengthen their feeling of control over it. For instance, one of the most common consequences of tinnitus in childhood is poor sleep. The use of bedside sound generators can be very beneficial in blending with the sound of the tinnitus; it, too, offers the child some control. These sounds may also be useful during homework, aiding concentration.
Relaxation therapystrategies can be adapted for use with young people, and these can help reduce agitation associated with tinnitus.
While no one has yet performed a randomized controlled clinical trial of tinnitus management in children and young people, there is emerging evidence that the approaches discussed here as well as similar approaches have potential benefits for children and their families.  
David Baguley, Ph.D., is the director of the Audiology/Hearing Implants Service at Cambridge University Hospitals in the United Kingdom. He is also a fellow of the American Academy of Audiology and a fellow of Wolfson College, University of Cambridge, also in the U.K.

‘Moments of Being So Very Upset’
Two families with children who have tinnitus talk about their experiences coping with it.

By David Baguley, Ph.D.

My role researching mechanisms of tinnitus and optimizing treatments for chronic tinnitus has brought me into contact with many children and young people who have troublesome tinnitus.
Here are two of their stories. (Their names have been changed.)
“Joe” is a 14-year-old boy with troublesome tinnitus in the presence of a mild sensorineural (inner ear) hearing loss in both ears. He had experienced tinnitus for just over a year and was having significant difficulties concentrating, which was affecting his school performance. After being fit with hearing aids, Joe was delighted that the devices were able to inhibit his tinnitus. I spoke with Joe and his father.
What kind of tinnitus did you have?
JOE: It was quite bad tinnitus. It affected my learning and made me feel different from everybody else. When I got the hearing aids it made me feel a lot better. They did really control it very well. I wish I had [gotten help] sooner, so that I got extra learning in.
As Joe’s dad, how did you feel when you knew that Joe had tinnitus?
JOE’S FATHER: It was a horrible feeling of something you couldn’t control. Not many people had too much information on tinnitus. It was something that seemed to occur at any age at any time, and it was frustrating because you couldn’t possibly imagine having a noise in your ears all the time.
What do you think has really helped your son?
I think it is coming to terms with the hearing aids and sticking with them to the extent that it gives them a chance to help, not just the hearing but also the tinnitus. There was always the hope that the tinnitus would be helped by the addition of hearing aids, and I’m very pleased with Joe sticking with it and ultimately doing something about the tinnitus.
What would you say now to the doctors and clinicians who saw your son previously?
I would say that I pushed for referrals to specialists, and I think that’s absolutely critical. The audiologists were brilliant and just the confidence that came from hearing from someone that knew about tinnitus was critical. It calms the situation down, it gives you a direction, and it gives you an enormous amount of hope—especially in a young person—that this won’t last forever and that the hearing aid on the way will potentially help address the situation. Luckily it has!
“Tim” was 7 when he first came to the audiology clinic. He was significantly troubled with his tinnitus, and his parents were very concerned for him. Tim’s self-portrait depicting his tinnitus (see the illustration above) was very moving.
Can you describe the situation when your son first came to us?
TIM’S  MOTHER: He wasn’t sleeping, and he had moments of being so very upset and moments of tantrums where he would get himself into such a state. He would be holding his head quite tightly saying, ‘Stop the noise—it’s really upsetting me, Mum (or Dad)!’ And the tiredness, through lack of sleep during the night, would cause problems during the day, where again it would make him so drowsy that obviously the sound in his head was affecting him more. So it was a vicious circle, I’m afraid.
How much support were you getting with that?
At the time we didn’t have very much support other than the doctors checking to make sure he didn’t have an ear infection or an underlying condition, such as blocked Eustachian tubes. And when they couldn’t find anything, they said, ‘Well, it’s just one of those things, and he’ll have to grow out of it.’ It was a case of us having to constantly try to cope by ourselves until we were actually at our local hospital [because of the tinnitus] and we asked for a referral.
Thankfully a gentleman who knew about your clinic looked him over and realized his ears were very healthy, but he could see the effect it was having on our son. He could see Tim was tired ,and he could see we were tired as well. He passed us over to your clinic, and that’s been fantastic since.
What do you think it was that turned the situation around?
I think it was a case of breaking things down into a more manageable situation where we could concentrate on what was causing him not to sleep. He could hear more in his head if it was a quiet environment, so the use of the bedside sound generator helped. We had already been using the fan or a radio in the background—any extra noise that was helpful.
Also speaking with you made us realize it wasn’t just a one-off thing—it wasn’t just us going crazy; it was something that was manageable. It definitely helped to make us see that it was affecting him more than we actually realized. Even at his young age he expressed himself by drawing a picture (as shown above).
That made us understand how he was feeling and we were able to work from there onward. It made us realize that yes, it really makes him feel frustrated, so if we were able to take that frustration away from him and increase his sleep, the vicious circle would gradually be broken. It also increased his understanding—that he knew that he was in control, which helped all the way around.
And how are things now?
Definitely better. He’s a lot more calm, especially during the day. His schoolwork is so much better than it was, and he has more of an understanding of how to cope with things. We do as well—we can sense when he has not had a good night. He has a routine now where he will have his sound box and fan on, and if he doesn’t, he’ll wake up during the night.
What would you tell parents in your situation?
Not to give up, and you are not alone. Take some notes and keep a sleep diary if you can, including even silly things such as when the child’s appetite isn’t the same. Any little thing can be affected by this particular issue. Then see if you can see a pattern and take this to your general practitioner and ask to be referred to an audiologist. If they are not too sure, then ask again, and keep hounding, basically, and do not give up.
Read as much as you can on the Internet and books, and try and get into contact with some other parents, maybe in an online forum. The more information you have, the more tools you have to actually help your child.
Reading Resources
Although written for adults, the book  “Living With Tinnitus and Hyperacusis” (Sheldon Press, 2010) by Laurence McKenna, Ph.D., and colleagues contains explanations and material that would be of benefit to parents or an older child.  
The reader wanting a summary of the scientific and clinical research material on childhood tinnitus will find it in a chapter in “Tinnitus: A Multidisciplinary Approach” (Second Edition, Wiley-Blackwell, 2013) by David Baguley, Ph.D., and colleagues.
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