Demographic data, referral patterns and interventions used for children and adolescents with tinnitus and hyperacusis in Denmark.

OBJECTIVES: To investigate whether children and adolescents with tinnitus and/or hyperacusis are seen in Ear-Nose-Throat (ENT) clinics and to report the clinical data, treatment and referral patterns of these children. To describe the population of children and adolescents with tinnitus and/or hyperacusis found in Educational- Psychological Advisory services (EPAs) and Centres for special Education for Adults (CEAs) and to identify the referral patterns and interventions used for the children in each of these settings. METHODS: A prospective study within 15 ENT clinics was conducted from June 2014 to February 2015. All children with a primary complaint of tinnitus and/or hyperacusis was reported. No changes in daily practice regarding diagnostics, treatment or referral were made. A retrospective case review was undertaken during a five-year period from 01/01/2009 to 31/12/2013 in each Danish municipality and region. RESULTS: In the prospective ENT study, 12 children were identified and in the retrospective CEA/EPA study 69 children were identified. The 12 children seen by ENT (8 females and 4 male) had an age range from 5.7 to 14 years. The majority of the 69 children seen by CEA/EPA (n = 50, 72.5%) had been diagnosed with tinnitus as a primary complaint. Hyperacusis was the primary complaint in 9 cases (12.8%), and both tinnitus and hyperacusis were reported in 11 cases (15.7%). The findings of this study indicate that a majority of children with tinnitus and/or hyperacusis are seen in settings designed for adult audiological rehabilitation. Counselling, including explanations and discussion of coping strategies was the most commonly reported intervention. Intervention methods corresponding with guidelines for tinnitus management in adults were used in 11 cases (15.9%). CONCLUSION: Overall only a small number of children with tinnitus and/or hyperacusis were identified in this systems, suggesting that either the children are seen at general practitioner level or not being referred at all. It may also be the case that the incidence of troublesome tinnitus in childhood is lower than the epidemiological data proposes. Referral pathways indicate a general uncertainty about which services provide acquire sufficient intervention. This study indicates that clinicians working at tinnitus services for adults (CEAs) collectively have the skills to help older children, and that a service development focus should be on the younger children as this point.

Prevalence of tinnitus and hyperacusis in children and adolescents: a systematic review.

OBJECTIVES: To systematically review studies of the epidemiology of tinnitus and hyperacusis in children and young people, in order to determine the methodological differences implicated in the variability of prevalence estimates and the influence of population characteristics on childhood tinnitus and hyperacusis. DATA SOURCES: Articles were retrieved from PubMed, EMBASE and Scopus databases and from the relevant reference lists using the methods described in the study protocol, which has previously been published. Reporting Items for Systematic Review (PRISMA) guidelines were followed. ELIGIBILITY CRITERIA: Studies addressing childhood prevalence, for example, children and young people aged 5-19 years. DATA SELECTION: 2 reviewers independently assessed the studies for eligibility, extracted data and assessed study consistency. Owing to the heterogeneity in the methodologies among the reported studies, only narrative synthesis of the results was carried out. RESULTS: Having identified 1032 publications, 131 articles were selected and 25 articles met the inclusion criteria and had sufficient methodological consistency to be included. Prevalence estimates of tinnitus range from 4.7% to 46% in the general paediatric population and among children with normal hearing, and from 23.5% to 62.2% of population of children with hearing loss. Reported prevalence ranged from 6% to 41.9% when children with hearing loss and normal hearing were both included. The prevalence of hyperacusis varied from 3.2% to 17.1%. CONCLUSIONS: Data on prevalence vary considerably according to the study design, study population and the research question posed. The age range of children studied was varied and a marked degree of variation between definitions (tinnitus, hyperacusis) and measures (severity, perception, annoyance) was observed. The lack of consistency among studies indicates the necessity of examining the epidemiology of tinnitus and hyperacusis in children and adolescents with a set of standardised criteria. TRIAL REGISTRATION NUMBER: CRD42014013456.