An evaluation of paediatric tinnitus services in UK National Health Service audiology departments

Abstract

Background: Whilst evidence indicates many children experience troublesome tinnitus, specialist services for children are far less established than those available for adults. To date, there is limited understanding of how paediatric tinnitus is managed in the UK, and to what extent current practice reflects what is recommended. This service evaluation aimed to 1) profile how tinnitus in children is managed in UK clinical practice, and assess to what extent care provided by services reflects advice included in the British Society of Audiology (BSA) Tinnitus in Children Practice Guidance, 2) collate clinician opinions on how services may be optimised, and 3) identify common problems experienced by children who present with bothersome tinnitus in clinic. Methods: As part of a larger survey, eight questions regarding services for paediatric tinnitus were distributed to UK NHS audiology services via email and social media. Representatives from eighty-seven services responded between July and September 2017. Results: Fifty-three percent of respondents reported that their department provided a paediatric tinnitus service. Among these services, there was widespread use of most BSA recommended assessments and treatments. Less widely used practices were the assessment of mental health (42%), and the use of psychological treatment approaches; cognitive behavioural therapy (CBT) (28%), mindfulness (28%), and narrative therapy (14%). There was varied use of measurement tools to assess tinnitus in children, and a minority of respondents reported using adult tinnitus questionnaires with children. Frequently reported tinnitus-related problems presented by children were sleep difficulties, concentration difficulties at school, situation-specific concentration difficulties, and emotional distress. Conclusions: Approaches used to manage children with troublesome tinnitus in UK NHS services are largely consistent and reflective of the current practice guidance. However, findings from this study indicate specialist staff training, access to child-specific tools, and the treatment and referral of children with tinnitus-related psychological problems represent key areas in need of optimisation.

Reflections on How Tinnitus Impacts the Lives of Children and Adolescents

“…Participants indicated that tinnitus might affect children's Emotional Wellbeing, their Academic Performances and Social/Relational aspects of their lives and cause Auditory/Cognitive Processing interference. These findings concurred with and extended the findings of a scoping review reporting tinnitus-related problems experienced by children and how they impact upon physical health, emotional health, cognitive health, hearing and listening abilities, a sense of being different or isolated, and quality of life (Smith et al, 2020). The participants in the present study grouped the statements in a manner that highlighted similar areas of impact; however, the content of the statements often provided insight into why tinnitus may have the impact described.…”

“…However, such measures may not adequately address the issues and concerns experienced by children. In a recent scoping review of the clinical management of tinnitus during childhood, Smith et al (2020) found that the Tinnitus Handicap Inventory, Tinnitus Functional Index and Mini-Tinnitus Questionnaire were the most commonly used in clinical practice in the UK as measures of tinnitus for children. PRMs have also been used in research settings to study the impact of tinnitus during childhood (Y. H. Kim et al, 2012;J.…”

Reducing the Impact of Tinnitus on Children and Adolescents’ Lives: A Mixed-Methods Concept Mapping Study

“…Tinnitus with varying degrees of associated distress has been identified as occurring during childhood, and multidisciplinary attempts to manage and ameliorate it have been identified as occurring within clinical settings in an ad hoc manner [ 10 ]. Smith et al [ 10 ] in their scoping review of clinical services for children with tinnitus identified these to include medical interventions for underlying ear, nose, and throat conditions, hearing aids to address associated hearing loss, masking devices for sound enrichment, hearing protection, counselling in the form of reassurance and/or tinnitus education, narrative therapy, and psychological assistance. In a research environment, Tinnitus Retraining Therapy (TRT) with sound enrichment through hearing aids and/or noise generators [ 7 , 11 , 12 ], counselling [ 12 , 13 ], and amplification for the suppression of tinnitus in children with hearing loss [ 3 ] have been reported.…”

“…These differences may arise from (1) methodological differences between studies in regard to the way they elicit and measure information about tinnitus, (2) low numbers of children presenting in clinical facilities seeking assistance for their tinnitus, (3) low awareness levels of paediatric tinnitus amongst general practitioners, and (4) difficulties experienced by children in communicating their experience of tinnitus [1,8,9]. Tinnitus with varying degrees of associated distress has been identified as occurring during childhood, and multidisciplinary attempts to manage and ameliorate it have been identified as occurring within clinical settings in an ad hoc manner [10]. Smith et al [10] in their scoping review of clinical services for children with tinnitus identified these to include medical interventions for underlying ear, nose, and throat conditions, hearing aids to address associated hearing loss, masking devices for sound enrichment, hearing protection, counselling in the form of reassurance and/or tinnitus education, narrative therapy, and psychological assistance.…”

Provider Documentation of Tinnitus in Childhood Cancer Survivors

“…19,20 However, interventions, such as fitting for hearing aids, can offer symptomatic relief for children and adolescents with tinnitus. 21 Recognizing the potential disruptive impact of tinnitus and the importance of early intervention, the most recent Children's Oncology Group (COG) clinical practice guidelines recommend annual surveillance for tinnitus in CCS with any treatment-related risk factor. 22 Intentional screening of pediatric CCS is particularly important because children and adolescents are less likely to spontaneously report tinnitus to medical providers but can reliably describe tinnitus when directly questioned.…”