5) Tinnitus in Children Flashcards
Tinnitus in children is often overlooked due to what 3 things?
̶1) Their difficulty in articulating symptoms.
̶2) Children may perceive tinnitus as normal or trivial, leading to underreporting.
̶3) Challenges in assessment and management of tinnitus in children vs. adults
What is the tinnitus prevalence in children with normal hearing?
4.7% to 46%
What is the tinnitus prevalence in children with hearing loss?
23.5% to 62.2%
Why is there a wide prevalence range when it comes to tinnitus in children?
The wide tinnitus prevalence range highlights inconsistency in evidence, due to studies’ diversity in research methods.
What is the prevalence of hyperacusis in children?
3.2% to 17.1%.
̶Reasons for inconsistency in tinnitus prevalence: Studies are diverse in (5):
̶- Research design
̶- Characteristics of the study population (age, auditory disorders, underlying diseases)
̶- Tinnitus definition (permanent and/or intermittent)
̶- Tools (objective or subjective: psychoacoustic assessments, interviews, questionnaires)
̶- Interview with parents or children
Prevalence data in children rely on ____
parental questionnaires
The etiology of tinnitus in children can be ____ or ____
congenital (familial), acquired
What are the 7 etiologies of acquired tinnitus?
1) Middle ear infections
2) Pulsatile middle ear tinnitus
3) Non-pulsative middle ear tinnitus
4) Temporomandibular joint disorder
5) Intracranial tumors
6) Hydrocephalus
7) SNHL for any reason
Explain pulsatile middle ear tinnitus (4)
̶- Venous hums (hearing the normal flow of blood through the jugular veins.)
̶- Transmitted bruits over the carotid artery
̶- Glomus tumors (benign but invasive tumors arising from glomus cells)
- The above 3 are synchronized with the heartbeat
̶- Middle ear myoclonus sound
Explain non-pulsatile middle ear tinnitus
̶- Patulous Eustachian tube involvement (The valve of the Eustachian tube remains abnormally open)
̶- Tympanic membrane perforation
All 3 etiologies of acquired tinnitus are ____
somatosounds
What are somatosounds?
Noises that originate within the body. They are not directly connected to the auditory nervous system
What are the 2 reasons for SNHL when it comes to tinnitus?
̶- Ototoxic drugs
̶- Noise exposure/trauma
Noise exposure/trauma due to…
- Loud recreational activities
- Snowmobiles, water jet skis, gunfire, toys,
fireworks, firecrackers.
̶- Personal music players/headphones
̶- Exposure to intense music (> 80 dBA)
- Snowmobiles, water jet skis, gunfire, toys,
What does tinnitus sound like in children?
Children may use a variety of terms to describe the quality of their tinnitus, such as “ringing,” “buzzing,” “humming,” “wheezing,” “peeping,” “murmuring,” “swishing,” and “whistling.
What are 5 common symptoms reported by children?
̶1) Headache
̶2) Dizziness and vertigo
̶3) Sleep disturbances
̶4) Difficulty with attention and concentration
̶5) Tiredness as a factor precipitating tinnitus
Parental Concerns: Tinnitus is a sign for what 3 things?
̶1) Hearing loss or causing hearing loss.
̶2) Mental health problems
̶3) Brain tumors or other neurological conditions
What are 5 risk factors for tinnitus in children?
1) age
2) sex
3) hearing loss
4) motion sickness
5) hyperacusis
Age - progressive increase of around ____ years.
13 to 14
Sex - unlike adults, a higher prevalence of tinnitus among ____.
girls
What are 3 reasons why tinnitus has a higher prevalence in girls?
̶1) Higher spontaneous otoacoustic emissions in female
̶2) Genetic differences
̶3) Higher tendency of girls to express symptoms.
Hearing loss - Tinnitus incidence is around ____% in slight to mild hearing loss
50
Hearing loss -̶Tinnitus incidence is around ____% in moderate to profound hearing loss.
23.5
Why is tinnitus prevalence lower in those with moderate to profound hearing loss?
- Communication ability to articulate the experience.
- Cannot hear the tinnitus
Motion Sickness - higher frequency in those with ____ and ____.
migraine, vestibular symptoms
What is motion sickness?
Motion sickness refers to a mismatched sensory perception. It happens when the movement you see is different from what your inner ear senses. This can cause dizziness, nausea, and vomiting.
It has been shown that ____ is the highest risk factor for tinnitus in children, but not vice versa
hyperacusis
What are the 2 steps of a tinnitus evaluation
1) history taking
2) examinations and assessments
History taking - ̶ open communication and caution are recommended, because:
- Children are more likely to omit relevant facts.
̶- When questioned, they might aim to please the healthcare provider.
History taking - 3 suggestions:
̶1) Conduct a child-friendly interview.
̶2) Consider cognitive and linguistic ability
̶3) Use open-ended questions
What are 4 components of examinations and assessments for tinnitus?
1) Physical Examinations
2) Laboratory Tests
3) Radiological Assessments
4) Audiologic Assessments
What are 2 components of a physical examination?
1) Head and neck examination (neurological evaluation)
2) Assessment of middle ear for abnormalities:
̶- Patulous Eustachian tube
̶- Myoclonic activity
̶- Carotid artery or jugular veins involvement
̶- Vascular tumors
What are 3 components of laboratory tests?
̶1) Blood count, lipid profile, blood glucose screening, and virology work-up.
̶2) Screen for autoimmune disorders
̶3) Serological tests for congenital neurosyphilis
What are 2 components of radiological assessments?
MRI and CT scan
What are 4 management options for tinnitus?
1) medication
2) surgical intervention
3) counselling
4) relaxation and manual therapies for somatosounds
Management options - medications
̶- Medications and supplements are not recommended.
̶- There is no conclusive evidence for their effectiveness.
Management options - what 5 things might require surgical interventions for tinnitus
- Persistent middle ear effusion
̶- Cholesteatoma
̶- Vascular tumors
̶- Myoclonic activity
̶- Sectioning of tensor tympani and stapedius tendons by tympanostomy.
Management options - counselling for children (5)
- Offer counseling at a child-friendly level and provide coping strategies.
̶- Listen to family concerns and reassuring about the nonthreatening nature of tinnitus.
̶- Involve the entire family in the treatment process.
̶- Consider hearing aids for those with hearing loss.
̶- Collaborate with teachers to monitor the child’s educational progress.
Management options - counselling for youth (5)
̶- General counseling for developing coping strategies.
̶- Relaxation techniques (such as deep breathing exercises, and soft music) to control tension.
̶- Cognitive behavioral therapy (CBT) for those with distress and comorbid symptoms.
̶- Sound therapy using wearable or non-wearable devices.
̶- Conversations about other enjoyable aspects of life to shift focus from tinnitus.
A ____ is required for the evaluation and management of tinnitus
multidisciplinary team
Who should be on the multidisciplinary team?
Otolaryngologists, neurologists, physiotherapists, and dentists.
Management options - Relaxation and Manual Therapies for Somatosounds
- Relaxing Muscle Tension in Jaw and Neck
̶- Deactivating Myofascial Trigger Points (MTP)