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

Media Contact: Susanne Nemholt Rosing | Email: srosing@health.sdu.dk | June 3rd, 2016

Copyright © 2016 by the BMJ Publishing Group Ltd. All rights reserved.

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Abstract

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 pediatric 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 standardize criteria.

Trial registration number

CRD42014013456.

Strengths and limitations of this study

  • Clearly established purpose, as well as a systematic and transparent approach.
  • Comprehensive search strategy.
  • During the article selection process, language was limited to English, German and Scandinavian languages.
  • Search and data extraction conducted independently by two authors.
  • This study gathered published articles to determine the prevalence of tinnitus and/or hyperacusis across studies. This knowledge is important in order to know the extent of the problem.
  • Introduction

    The prevalence of tinnitus in children has been studied in several articles with reports ranging from 7.5% to 60%.1 Tinnitus is reported to be more common among children with hearing impairment compared with children with normal hearing.2 In general, studies indicate tinnitus to be relatively common in childhood, but tinnitus impact seems to be lower in children than among adults and it is unusual to see adults with tinnitus that has persisted since childhood.2 ,3 It is rare for a child to present with tinnitus spontaneously.4 Some researchers suggest that the prevalence figures in children are underestimates owing to communication difficulties, but on the other hand, it can be argued that children over-report tinnitus when questioned in an effort to please the questioner.5 A small-scale survey by the British Tinnitus Association in the UK has shown that generally pediatric tinnitus services were multidisciplinary.6

    There is limited literature looking at the effects of tinnitus on the health and well-being of children.7 On a small population of 24 children aged 7–17 years, who were referred to a psychological clinic because of tinnitus, Kentish et al8 found that insomnia, anxiety and worry, listening and attention problems were the main psychological factors associated with tinnitus symptoms. The group of children with normal hearing was more affected by tinnitus and presented higher levels of anxiety than those with impaired hearing. Seventy-one per cent of the children had developed coping strategies by the initial assessment to deal with the tinnitus-like sounds, such as watching or listening to TV/music/radio, in order to distract from the tinnitus or to read, or to use hearing aids. Slightly more than half of the children reported specific concerns about tinnitus; for example, it can damage or reflect a worsening of their hearing. The parents generally shared this fear.

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