Paediatric tinnitus and hyperacusis
Estimates of the
prevalence of tinnitus and hyperacusis in children vary from 4.7% to 46% for
tinnitus and from 3.2% to 17% for hyperacusis (Coelho et al.
2007; Rosing et al. 2016).
For the first time in
the field of audiology, Dr. Aazh’s team compared the correlation between
Uncomfortable Loudness Levels (ULLs) and the effect of hyperacusis on the patient’s
life as measured via the Hyperacusis Questionnaire (HQ) between children and
adults. Their analysis included the data from over 1000 patients and showed a
significant negative relationship between ULLs and HQ in adults (r=-0.4, p<0.0001). In the other words, the lower (worse) the average
ULLs, the greater (worse) the hyperacusis handicap as measured via HQ for
adults. However, there was no statistically significant relationship between ULLs and HQ in children (r=-0.25, p=0.09).
research study published in International Journal of Audiology, Dr. Aazh’s
tinnitus team explored the questions listed below on 62 patients under the age
of 18 (Aazh et al. 2018):
The proportion of children and adolescents seeking
help for tinnitus and/or hyperacusis who meet the ULLmin criterion for hyperacusis.
ULLmin criterion for diagnosing hyperacusis is proposed by Aazh and Moore (2017) and is based on the average ULL
across 0.25, 0.5, 1, 2, 4 and 8 kHz for the ear with the lower average ULL,
which is denoted ULLmin. They suggested that a value of ULLmin equal to or
below 77 dB HL should be taken as indicating the presence of hyperacusis (Aazh & Moore 2017). With this ULLmin criterion, 95%
of adult patients diagnosed as having hyperacusis were found also to meet the
criterion of a cut-off score on the Hyperacusis Questionnaire (HQ) (Khalfa et al. 2002) of 22 or more (Aazh & Moore 2017).
The proportion of children and adolescents who meet
the criterion for severe hyperacusis. Aazh and Moore (2018) proposed that severe hyperacusis
should be diagnosed when a ULL of 30 dB HL or less is measured for at least one
of frequency from 0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz, for at least one ear. Such
extremely lowered ULLs can lead to very severe problems in everyday life. The
average sound level of a whisper or the background noise in a quiet library is
about 30 dB SPL (ASHA 2015).
Hearing status children and adolescents seeking
help for tinnitus and/or hyperacusis.
showed that the mean pure-tone average (PTA) across ears was 13 dB HL (SD =
14.5). Based on the PTA for the worse ear, 80% were
classified as having no hearing loss, 13% had mild hearing loss, 5.6% had
moderate hearing loss, and 1.8% had severe hearing loss.
The mean value of ULLmin
was 64 dB HL (SD = 15, n = 34). Based on the ULLmin values, 85% of the young patients had hyperacusis.
ULL across all young patients and ears was 9.3 dB (SD = 16 dB) lower at 8 than
at 0.25 kHz.
patients were diagnosed with severe hyperacusis as indicated by a ULL of 30 dB
HL or less. A ULL of 30 dB HL or below occurred most often at 8 kHz.
patients with severe hyperacusis, the mean value of ULLmin was 44.4 dB HL (SD =
6.8), while it was 68.4 dB HL (SD = 12) for the remainder of the population.
The difference was significant (p =
0.0004). For the patients with severe hyperacusis, the lowest value of ULLmin
was 37.5 dB HL and the lowest ULL at a single frequency was 15 dB HL, which was
recorded at 6 and 8 kHz for one patient. There were no significant difference
in age and gender distribution between patients with severe hyperacusis and the
remainder of the population (p =
0.098 and p = 0.3, respectively). The
PTA averaged across ears was 11 dB HL (SD = 7 dB) for patients with severe
hyperacusis and 15 dB HL (SD = 17 dB) for the remainder of the population (p = 0.72). The mean audiometric
threshold across ears was 0.7 dB (SD = 13 dB) lower at 8 than at 0.25 kHz for
the patients diagnosed with severe hyperacusis, while it was 3.9 dB (SD = 20
dB) higher for the remainder of the population. However, the difference was not
significant (p = 0.57).
The strong across-frequency variation in ULLs
for many of our young patients might be an indication of adverse reactions only
to specific sounds, which is consistent with the definitions of annoyance and
fear hyperacusis (Tyler et al.
2014) and misophonia (Cavanna &
Seri 2015; Kumar et al. 2017).
Aazh, H., McFerran,
D., & Moore, B. C. J. (2018). Uncomfortable Loudness Levels among children
and adolescents seeking help for tinnitus and/or hyperacusis International Journal of Audiology
Aazh, H., & Moore, B. C. J. (2017). Factors related to
Uncomfortable Loudness Levels for patients seen in a tinnitus and hyperacusis
clinic. International Journal of
Audiology 56, 793-800.
Aazh, H., & Moore, B. C. J. (2018). Prevalence and
characteristics of patients with severe hyperacusis among patients seen in a
tinnitus and hyperacusis clinic Journal of American Academy of Audiology,
ASHA (2015). Noise. Audiology
Information Series, 10802, 1-2.
Cavanna, A. E., & Seri, S. (2015). Misophonia: current
perspectives. Neuropsychiatr Dis Treat,
Coelho, C. B., Sanchez, T. G., & Tyler, R. S. (2007).
Hyperacusis, sound annoyance, and loudness hypersensitivity in children. Prog Brain Res, 166, 169-78.
Khalfa, S., Dubal, S., Veuillet, E., et al. (2002). Psychometric
normalization of a hyperacusis questionnaire. ORL J Otorhinolaryngol Relat Spec, 64, 436-42.
Kumar, S., Tansley-Hancock, O., Sedley, W., et al. (2017). The Brain
Basis for Misophonia. Current Biology,
Rosing, S. N., Schmidt, J. H., Wedderkopp, N., et al. (2016).
Prevalence of tinnitus and hyperacusis in children and adolescents: a
systematic review. BMJ Open, 6, e010596.
Tyler, R. S., Pienkowski, M., Rojas Roncancio, E., et al. (2014). A
review of hyperacusis and future directions: part I. definitions and
manifestations. American Journal of
Audiology, 23, 402-419.