Tinnitus

What is tinnitus (ringing in ears)?

Tinnitus is a condition where a child hears a buzzing or ringing that is coming from inside his ear. The noise can be either continuous or sporadic, in one or both ears, and high or low pitch. For some children, the noise can be a roaring, humming, hissing, or clicking sound instead of the typical ringing.

Children with tinnitus may have damage to the inner ear that causes the brain’s sound-processing system to malfunction, causing the ringing or buzzing sound of tinnitus.

Most children with tinnitus have normal hearing, but the most severe cases can cause hearing impairments.

Tinnitus is about as common in children as it is in adults. About one-third of children suffer from it at some point, but the condition often goes unnoticed. In many cases, the child is too young to describe what they’re hearing, has come to think of it as normal, or is not troubled by the experience enough to mention it.

In one in 12 children with tinnitus, the condition causes enough distress that it interferes with sleep and concentration in school. In severe cases, kids can become extremely stressed or depressed.

Causes

The brain’s sound-processing system produces the noises associated with tinnitus. It does so in response to various causes, including damage to the inner ear and hearing impairments. The causes of tinnitus include:

  • Cumulative noise exposure from listening to loud music on earphones or ear buds
  • Wax build-up in the ear canal
  • Ear or sinus infections
  • Misaligned jaw joints
  • Neck or head trauma, such as a concussion
  • Second-hand smoke exposure
  • Chemotherapy, certain antibiotics, aspirin or other medications that can damage the inner ear
  • Ear injuries, such as from poking an object too far into the ear
  • Acquired hearing loss
  • Congenital hearing loss
  • Abnormal growth of the middle ear bones
  • Slow-growing tumors on auditory, vestibular or facial nerves
  • Ménière's disease

Signs and symptoms

Depending on your child’s age and ability to express himself, as well as the severity of his tinnitus, symptoms may vary. Common symptoms of tinnitus in children include:

  • Reports of ringing, buzzing, clicking, whistling, humming, hissing, or roaring sound
  • Sensitivity to noise
  • Poor attention and restlessness in a very young child
  • Tantrums, irritability, and your child holding his head or ears
  • Severe fatigue
  • Anxiety or depression

Testing and diagnosis

If your child doesn’t have a middle ear infection, often signaled by discharge from the ear or pain following a cold, then the primary care provider will likely refer your child to an otolaryngologist (ear, nose, and throat specialist), to have his tinnitus evaluated. The specialist may conduct various tests including:

  • Physical exam and thorough medical history
  • Questions regarding your child’s behavior and symptoms
  • Hearing tests, including otologic and audiologic exams
  • Lab (blood) tests
  • CT scan or MRI

Treatment

There is no specific treatment to cure tinnitus. Fortunately, most children outgrow tinnitus.

In cases where the tinnitus is caused by an underlying condition, your child’s otolaryngologist will address that problem.

  • If medication caused the tinnitus, the specialist will recommend a change or discontinuation of medication. In most medication-induced cases, the tinnitus resolves over time.
  • If noise exposure caused the tinnitus, your child’s primary care provider will recommend stopping the use of earphones to listen to music and encourage wearing ear plugs at concerts. In these cases, the tinnitus generally goes away once the inner ear has had time to heal.
  • When the tinnitus is caused by hearing loss, hearing aids can greatly improve symptoms. Hearing more environmental sounds helps to filter out the tinnitus and make it less noticeable.

Whatever the cause of your child’s tinnitus—and especially when the cause isn’t clear-cut — the goal is management of the condition through various therapies. These therapies can help to relieve stress and fatigue, which have been known to exacerbate tinnitus, and to retrain the brain’s response. Some therapies a specialist might recommend for a child include:

  • Proper and explanation of his condition. Putting a name to his condition helps to reassure your child that he’ll likely outgrow it and that other kids experience the same thing. Having this understanding will greatly reduce his stress.
  • Healthy eating, exercise, and a regular sleep schedule. Improving your child’s general well-being can help to decrease stress and fatigue known to aggravate tinnitus. It will also improve his mood, making him better able to cope.
  • Education about the use of sound therapy, or a sound machine to provide background noise. Using a fan or white-noise machine can blend with the sound of the tinnitus and make it less noticeable. It helps your child to feel in control of his condition, helps his nervous system adapt to the tinnitus, and improves your child’s ability to concentrate. A sound machine can be especially helpful at night, when many tinnitus sufferers have trouble falling asleep because quiet heightens the tinnitus noises. Some children find soft background music to be more helpful than a white-noise machine.
  • Special hearing aids programmed to filter out tinnitus. Even if your child doesn’t have hearing loss, special hearing aids can be used to amplify environmental sounds and to turn down the tinnitus noises; your child’s brain will then focus on the environmental sounds instead of the tinnitus.

Outlook

Most children outgrow tinnitus, even without therapy. Children who use stress management techniques, sound therapy, and hearing aids when appropriate report a great improvement in their symptoms. A specialist’s care can help to produce the most successful outcomes, especially in lessening the day-to-day impact of tinnitus.

Follow-up care

Your child’s primary care provider will recommend the individualized therapy regimen that’s right for your child. If your child has an underlying medical problem causing tinnitus, the specific treatment will be initiated.

Why choose CHOP?

Tinnitus is a distressing and often complicated condition that requires accurate diagnosis and appropriate care to improve and eliminate symptoms. It’s crucial to find the specialist who will explore all the options for management of tinnitus, treatment of its underlying cause, and support for your child as they cope this their condition. At CHOP, the otolaryngology team is expertly trained in the diagnosis and treatment of tinnitus and will work with your child, family and other sub-specialists at CHOP as needed to ensure the condition and your child’s quality of life is improved as soon as possible.