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Prevalence of Tinnitus and Hyperacusis in Children and Adolescents: a Systematic Review

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Prevalence of Tinnitus and Hyperacusis in Children and Adolescents: a Systematic Review Open Access Research BMJ Open: first published as 10.1136/bmjopen-2015-010596 on 3 June 2016. Downloaded from Prevalence of tinnitus and hyperacusis in children and adolescents: a systematic review Susanne Nemholt Rosing,1,2,3 Jesper Hvass Schmidt,3,4 Niels Wedderkopp,5,6 David M Baguley7,8 To cite: Rosing SN, ABSTRACT Strengths and limitations of this study Schmidt JH, Wedderkopp N, Objectives: To systematically review studies of the et al. Prevalence of tinnitus epidemiology of tinnitus and hyperacusis in children ▪ and hyperacusis in children Clearly established purpose, as well as a system- and young people, in order to determine the and adolescents: a systematic atic and transparent approach. review. BMJ Open 2016;6: methodological differences implicated in the variability ▪ Comprehensive search strategy. e010596. doi:10.1136/ of prevalence estimates and the influence of population ▪ During the article selection process, language bmjopen-2015-010596 characteristics on childhood tinnitus and hyperacusis. was limited to English, German and Scandinavian Data sources: Articles were retrieved from PubMed, languages. ▸ Prepublication history and EMBASE and Scopus databases and from the relevant ▪ Search and data extraction conducted independ- additional material is reference lists using the methods described in the ently by two authors. available. To view please visit study protocol, which has previously been published. ▪ This study gathered published articles to deter- the journal (http://dx.doi.org/ Reporting Items for Systematic Review (PRISMA) mine the prevalence of tinnitus and/or hyperacu- 10.1136/bmjopen-2015- guidelines were followed. sis across studies. This knowledge is important 010596). Eligibility criteria: Studies addressing childhood in order to know the extent of the problem. prevalence, for example, children and young people aged 5–19 years. Received 20 November 2015 Data selection: 2 reviewers independently assessed Accepted 10 May 2016 1 the studies for eligibility, extracted data and assessed ranging from 7.5% to 60%. Tinnitus is study consistency. Owing to the heterogeneity in the reported to be more common among chil- methodologies among the reported studies, only dren with hearing impairment compared 2 narrative synthesis of the results was carried out. with children with normal hearing. In http://bmjopen.bmj.com/ Results: Having identified 1032 publications, 131 general, studies indicate tinnitus to be rela- articles were selected and 25 articles met the inclusion tively common in childhood, but tinnitus criteria and had sufficient methodological consistency impact seems to be lower in children than to be included. Prevalence estimates of tinnitus range among adults and it is unusual to see adults from 4.7% to 46% in the general paediatric population with tinnitus that has persisted since child- and among children with normal hearing, and from hood.23It is rare for a child to present with 23.5% to 62.2% of population of children with hearing tinnitus spontaneously.4 Some researchers loss. Reported prevalence ranged from 6% to 41.9% fi when children with hearing loss and normal hearing suggest that the prevalence gures in chil- on September 29, 2021 by guest. Protected copyright. were both included. The prevalence of hyperacusis dren are underestimates owing to communi- varied from 3.2% to 17.1%. cation difficulties, but on the other hand, it Conclusions: Data on prevalence vary considerably can be argued that children over-report tin- according to the study design, study population and nitus when questioned in an effort to please the research question posed. The age range of children the questioner.5 A small-scale survey by the studied was varied and a marked degree of variation British Tinnitus Association in the UK has between definitions (tinnitus, hyperacusis) and shown that generally paediatric tinnitus ser- measures (severity, perception, annoyance) was vices were multidisciplinary.6 observed. The lack of consistency among studies There is limited literature looking at the indicates the necessity of examining the epidemiology effects of tinnitus on the health and well- of tinnitus and hyperacusis in children and adolescents being of children.7 On a small population of with a set of standardised criteria. 24 children aged 7–17 years, who were Trial registration number: CRD42014013456. referred to a psychological clinic because of For numbered affiliations see 8 end of article. tinnitus, Kentish et al found that insomnia, anxiety and worry, listening and attention Correspondence to INTRODUCTION problems were the main psychological Susanne Nemholt Rosing; The prevalence of tinnitus in children has factors associated with tinnitus symptoms. [email protected] been studied in several articles with reports The group of children with normal hearing Rosing SN, et al. BMJ Open 2016;6:e010596. doi:10.1136/bmjopen-2015-010596 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2015-010596 on 3 June 2016. Downloaded from was more affected by tinnitus and presented higher In the study protocol, it was stated that articles should levels of anxiety than those with impaired hearing. be included in the review if they were original papers Seventy-one per cent of the children had developed from peer-reviewed scientific journals. During the study, coping strategies by the initial assessment to deal with we observed that two conference proceeding articles the tinnitus-like sounds, such as watching or listening to were frequently cited and hence these were included in TV/music/radio, in order to distract from the tinnitus our review, namely Graham11 and Stouffer et al.12 or to read, or to use hearing aids. Slightly more than The aim of the study and the objectives were modified half of the children reported specific concerns about in order to provide methodological consistency and a tinnitus; for example, it can damage or reflect a worsen- clear focus. ing of their hearing. The parents generally shared this Studies were rated on their relevance to the present fear. study objectives, and not, as stated in the study protocol, Baguley et al9 reported that the number of children according to an assessment of study quality. On reflec- seen with a primary symptom of tinnitus represents just tion, the consideration of study quality as described in a small fraction of the total number of patients seen for the protocol was more related to consistency issues asso- tinnitus in four European clinics with an established and ciated with the methodology of the studies. Therefore, it internationally known tinnitus programme. Low referral was decided to use the term methodological consistency may partly reflect a low number of children seeking instead of study quality as described in the protocol.10 A help, or the possibility that there are few services for response to the diversity encountered in the articles children to be referred to.2 identified was to look for common themes. Therefore, Data on hyperacusis among children are sparse.10 the studies were divided into the following population Comparison of prevalence studies in this area is as prob- categories, normal hearing participants and lematic as with tinnitus studies due to the complexity hearing-impaired participants, to achieve a consistent and inadequacy of terminology and definitions.10 way to compare them. The present systematic review was undertaken to deter- mine the extent to which a reliable view of the epidemi- Selection criteria ology of childhood tinnitus and hyperacusis can be held in Articles were screened and selected according to the the presence of these methodological challenges. A reli- research question and PICOS criteria.13 Studies were able estimate would underpin the commissioning, provi- included if they were original articles from peer-reviewed sion and design of clinical services for such patients. scientific journals published in English, German, Swedish, Norwegian or Danish (except for Graham11 and Stouffer et al12 as indicated above). PICOS were: OBJECTIVES population, children and young people aged 5–19 years http://bmjopen.bmj.com/ The following objectives were addressed to: (if the age included in the studies felt outside this ▸ Determine the methodological differences implicated range, the study was included if the prevalence was rated in the variability of prevalence estimates, including separately for different ages); intervention, none; com- those deriving from the tinnitus/hyperacusis question parisons, none; outcomes: (point) prevalence of tinnitus used, approaches to collecting reliable answers and and/or hyperacusis, consequences of tinnitus and/or the characteristics of the tinnitus/hyperacusis hyperacusis; study design, all studies excluding case sensations. series and case studies. ▸ Systematically review the influence of population characteristics (age, gender, hearing ability, comorbid- on September 29, 2021 by guest. Protected copyright. Checklists ity) on childhood tinnitus and hyperacusis. Three checklists were created especially for this review, ▸ Assess the methodological heterogeneity across and were presented in the study protocol. These check- studies and to determine if pooling the studies is lists related to the description of studies, their methodo- feasible. logical consistency (quality checklist in the protocol10) and their results. METHODS Study protocol Searching methods for identification of studies We previously published the study protocol as an open One author (SNR) searched PubMed, EMBASE and access article10
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