Helping young people with tinnitus
Last updated on 17 August 2011
It is a commonly held belief that tinnitus occurs predominantly in adults and older people, and only very rarely in children. Not only is this belief wrong, but it has unfortunate consequences for the levels of help and support available for children and young people with tinnitus.
Although research on the prevalence of tinnitus in children and young people is limited, studies do suggest that tinnitus is as common in children as it is in adults. When questioned, approximately 10% of the child population describe tinnitus sensations, with around 3% being troubled by it. Tinnitus has been found to be more common in children with hearing loss, both sensorineural and conductive. Those with a moderate/severe sensorineural hearing loss have a higher rate of tinnitus than those with a profound loss, and those with an acquired hearing loss are more likely to experience tinnitus than those with a congenital impairment.
What is certainly true is that children rarely report their tinnitus symptoms spontaneously and there are likely to be a number of reasons for this. Firstly, children may be unaware that tinnitus is not a universal experience; young children may lack the linguistic skills to describe their symptoms. Anecdotally, some reveal they are afraid to mention their tinnitus to adults, for fear they will not be believed, or taken seriously. Professionals for their part are often reluctant to ask children about tinnitus for fear of raising awareness and causing worry about it for both child and parent. My clinical experience has taught me that the opposite is true.
Like adults, children and young people try to make sense of their lives. If they experience intrusive tinnitus, and if adults are unwilling to talk to them about tinnitus, then children will come up with their own explanations for what happens to them, but they will do so in the absence of proper information. Young children may really believe that they have “monsters” “bees” or “trains” in their heads – a frightening experience. Unaware that others have the same experience, children and young people can feel very alone. The single most helpful thing for a child or young person with troublesome tinnitus therefore is to talk with someone who is interested, willing to listen, takes them seriously and thinks with them about strategies for coping with it. Tinnitus counselling makes a big difference to children and young people, but only when information is presented at a level the child can understand and in a child friendly way.
The majority of children and young people cope with tinnitus without difficulty, and little help is required other than tinnitus information counselling for parent and child. For some however, it can have a significant impact not only upon their lives but on that of the whole family. Parents can feel at a loss to know how best to help their child and there is a lack of widely available information about tinnitus in children and young people age appropriate for the different age groups.
Tinnitus can be most intrusive in quiet situations, and as with adults, difficulty getting to sleep at night is a common complaint. Here, the use of sound therapy may be helpful, using simple background sounds such as fans, ticking clocks, fish tanks, or quiet background music. Suggesting that a person try not to think about tinnitus is generally not helpful, but mental distractions certainly can. Visual imagery or simple mental tasks such as counting backwards may help to draw attention away from tinnitus. Relaxation techniques can help to reduce tension and stress. There are a number of websites offering useful resources for relaxation techniques such as www.relaxkids.com
Noisy environments can also cause problems. Loud sounds such as school bells may trigger the onset of troublesome tinnitus, and in this respect, the school environment can be particularly challenging. In the classroom, tinnitus can make concentration difficult, competing against the teacher voice for the child’s attention. For those with a hearing loss, speech perception may be diminished when tinnitus is present, meaning that information is missed. Children are often remarkably resourceful at finding ways around this, but they often worry about getting in trouble with the teacher for not paying attention when their tinnitus is distracting. Good liaison with school can make a big difference. Teachers also need information about tinnitus, what it is, and how it affects their particular pupil. An agreed signal between teacher and pupil when tinnitus is most troublesome can help the child regain a sense of control, and alleviate worry about being in trouble when their concentration is reduced. A few minutes break may be all that is needed.
Stressful life circumstances are known to be a risk factor for an increase in tinnitus severity, and this is often the case around the time of public exams. Working under pressure and in a very quiet environment can make tinnitus particularly difficult to ignore. Again, it is important to alert the class teacher and the school’s SENCO (Special educational needs coordinator) to the child’s tinnitus and request that special arrangements are made for exams. For example exams can be sat in a separate room with a fan or some other environmental sound that the child finds helpful as a tinnitus masker. What is important is that strategies for managing tinnitus in school are worked out together - children and young people are generally highly astute at knowing what helps them the most, and adults’ task is to put this in place where possible.
High levels of noise are an everyday feature for children and young people, and an important part of their socialising activities. The school playground, clubs, discos, concerts, and even playing musical instruments can all be challenging environments for the tinnitus sufferer. However, avoiding these completely for fear that it will make their tinnitus worse can be really devastating for some young people. Sound attenuating ear plugs can be helpful as long as they are only worn in very noisy environments. If worn at everyday noise levels, this can increase the sensitivity of the auditory system to sound which can itself aggravate tinnitus.
Tinnitus can be distressing, but in turn, the onset of tinnitus can be related to stressful life circumstances such as parental separation, or difficulties coping academically or socially at school. When tinnitus is associated with emotional distress or educational difficulties, help for this should be sought from appropriate psychological services. Addressing the causes of emotional distress very often leads to a significant improvement in tinnitus.
Tinnitus may leave children feeling helpless to control it in any way, particularly if they have been given unhelpful advice in the past such as that there is no “cure” for tinnitus and the best thing is to go away and learn to live with it. Regaining a sense of hope and control is essential and this arises from the child or young person discovering that there are things that make their tinnitus better and worse. Parents are often the first to notice that their child’s tinnitus seems worse when they are tired, or under pressure from school work or an overactive social life. Simple things that make a difference include ensuring that there is always some level of background environmental sound to avoid quiet situations. For many children and young people tinnitus resolves itself over a period of time. Their lives can continue normally despite the presence of tinnitus. Tinnitus does not mean a lifetime as a “tinnitus sufferer”. Even when tinnitus is not particularly intrusive, nevertheless, children are often greatly reassured and pleased to learn that there are many others of the same age who have tinnitus – they are not alone.
Any child or young person with tinnitus should be referred for a thorough otological and audiological assessment in order to rule out any underlying pathology. Although rare, this can occur. If a previously undiagnosed hearing loss is present, appropriate management of this will very likely have a beneficial effect upon tinnitus perception. At present, there are very few services that offer specialist counselling for children and young people with tinnitus. Nevertheless, help may be available from a range of services including Hearing Therapists, Teachers of the Deaf and Community Paediatric Audiology Services. From whatever source, what children and young people most need is to know that they are neither unique nor alone in having tinnitus, that their difficulties have been listened to and their worries answered and that spontaneous resolution of tinnitus in children is common. Encouraged to develop their own coping strategies, their resourcefulness and creativity can be inspiring.
Rosie Kentish, Consultant Clinical Psychologist, Royal National Throat, Nose and Ear Hospital, London.
This article originally appeared in Quiet, Spring 2010
Tinnitus does not mean a lifetime as a “tinnitus sufferer”.