Tinnitus in Children and Adolescents
We often hear about tinnitus in adults and associate it with ageing and hearing loss, but we rarely hear about the children or adolescents who are affected by tinnitus.
Tinnitus is any sound that we hear in our ears or head that is not related to an external source. Many different sounds are reported, including ringing, buzzing and crickets.
Recent studies have shown that tinnitus occurs as frequently in children as it does in adults, but is often not reported. As with adults many children and adolescents who experience tinnitus are untroubled by it. However, for those children for whom tinnitus is worrisome, their concerns should be listened to. Troublesome tinnitus during childhood or adolescence can contribute to sleep difficulties, concentration problems, poor attention, learning difficulties, irritability, emotional distress, anxiety and tiredness. As with tinnitus in adults, tinnitus in children can occur regardless of age or hearing levels and many children with normal hearing experience tinnitus. However, as with adults, tinnitus becomes more common in children who experience hearing difficulties, ear infections or during times of stress, be it emotional, educational or health-related.
In many regards it is not surprising that we hear so little about tinnitus in children. Children may not have the language skills to discuss their tinnitus. Many children describe tinnitus as an action like a ping pong ball, some give it an identity (the zombie), some give it a name of their own or may ask a question such as, “Why are all the voices yelling in my head?” Another complicating factor is that children with tinnitus will often have had it as long as they can remember and may not be aware that others do not hear that same noise. Often tinnitus only becomes apparent when a child becomes older and is able to describe the tinnitus and realises that not everyone shares their experience.
Recent studies have shown that tinnitus occurs as frequently in children as it does in adults but is often not reported.
Not all children with tinnitus are distressed by it; many accept it and continue untroubled. However, for those that are distressed, age-appropriate intervention and family support is highly successful. Children and their families can be assisted to understand the tinnitus and develop very successful coping strategies. Providing factual information, support and reassurance is also very important when there is so little awareness about the condition.
If a child does indicate that they have tinnitus, treatment should involve a holistic approach focusing on the child, their family and their school environment, not just their ears. Treatment should involve both medical assessment by an Ear Nose and Throat Specialist to rule out any underlying medical concerns and audiological management. Audiological management involves testing the child’s hearing, taking a thorough history, exploring when the tinnitus started or changed, when the child notices it, what aspects of their daily lives are affected and whether there is anything in the child’s life that impacts either positively or negatively on the tinnitus. It is also important to understand both the child’s and family’s beliefs and fears about tinnitus since these may be shaped by the media or the experience of others and be inaccurate but still highly influential.
One large difference between the treatment of tinnitus in adults and children focuses on their understanding of tinnitus. All children should be given age-appropriate explanations for their tinnitus. They should be reassured and helped to both externalise the noise and to understand that many other people also hear extra noises. Young children in particular have wonderfully vivid imaginations and an incredible ability to create stories that can be used to help them manage their tinnitus. Often when a young child has tinnitus they will make sense of it on their own by inventing a story. If their story or explanation is that the noise they hear is the result of a monster whispering in their head or zombies that are trying to catch them in their sleep, then their experience of tinnitus can be terrifying. However, when we help a child to use their imagination, imagery and story-telling to create a new story around the tinnitus, we can very effectively and quickly turn their experience from one of terror to one of mastery and victory or even peacefulness. Tinnitus management is most successful when children and adolescents are assisted to develop a sense of control over their tinnitus by developing their own ideas and strategies for managing the difficulties associated with their tinnitus. Other measures also involve using environmental noises and external noise sources for sound enrichment, addressing any hearing issues, assisting with sleep difficulties, obtaining assistance for any concerns regarding anxiety or emotional well-being and developing strategies for the classroom.
Tinnitus in children is very common and the majority of children with tinnitus are not troubled by it. Yet for those children who experience troublesome tinnitus, the impact can be significant. Thankfully effective assistance is available: children and their families can be helped to externalise the tinnitus, develop effective coping strategies and create new stories and images that explain the tinnitus in positive and non-threatening terms. When the distress is removed children can move forward and continue to grow and develop happily.
By Susan Tegg-Quinn
B. Nurs, M Clin Aud, M Aud.
Baguley D., Bartinck G., Kleinnjung T., et al. (2013). Troublesome tinnitus in childhood and adolescence: Data from expert centres. International Journal of Paediatric Otorhinolaryngology, 77 pp 248-251
British Society of Audiology, (2015). “Tinnitus in children Practice Guidelines”
Kentish R., Crocker s., (2006) ‘Scary Monsters and Waterfalls’ , tinnitus narrative therapy with children. In Tinnitus Treatment Clinical Protocols. Ed. Tyler, R. Thieme Medical Publishers.
Kentish R., Crocker S., McKenna L., (2011). Children’s Experience of Tinnitus: A Preliminary Survey of Children Presenting to a Psychology Department. British Journal of Audiology. 34:6, pp335-340