Tinnitus, the perception of sound without an external source, is often thought of as an adult health issue, but it is common among children. This phantom sound can manifest as ringing, buzzing, hissing, or roaring and is generated by irregular activity within the brain’s auditory pathways. Research suggests that between 12% and 36% of children may experience tinnitus, with approximately 15% having a chronic form. Many children do not spontaneously report symptoms because they lack the vocabulary to describe the sensation or assume the noise is something everyone hears. Recognizing the causes of pediatric tinnitus is important for parents and clinicians, as addressing the underlying issue can often lead to resolution or effective management.
Primary Physical and Environmental Causes
One of the most frequent causes of tinnitus in children is noise exposure, which can cause temporary or permanent damage to the delicate hair cells within the inner ear. Loud noises from sources such as high-volume headphones, musical instruments, or acute exposures like fireworks or concerts can trigger the condition. This damage leads to the brain overcompensating for the loss of input, resulting in the perception of the phantom sound.
Physical obstructions in the ear canal are common triggers for transient tinnitus. An excessive buildup of earwax (cerumen impaction) can press against the eardrum and alter sound transmission, resulting in a temporary perception of ringing or humming. Once the obstruction is removed, the tinnitus resolves immediately.
Middle ear issues, particularly acute and chronic infections like otitis media, frequently lead to tinnitus due to fluid accumulation behind the eardrum. This fluid creates pressure changes and temporary conductive hearing loss, which the brain interprets as sound. Barotrauma, physical damage to the ear from sudden pressure changes (such as those experienced during air travel or deep-sea diving), can also be a direct cause.
Underlying Medical Conditions and Ototoxic Medications
Tinnitus is closely associated with underlying hearing loss, particularly sensorineural hearing loss (SNHL), which involves damage to the inner ear or the auditory nerve. In children with SNHL, the prevalence of tinnitus is significantly higher than in the general pediatric population. The perceived sound often corresponds to the frequency range where the child has experienced hearing decline.
Less common medical conditions may also be linked to the symptom. Temporomandibular joint (TMJ) disorders, involving the hinge joint that connects the jaw to the skull, can cause tinnitus due to the anatomical proximity of the jaw muscles to the middle ear structures. Though rare in children, conditions such as Meniere’s disease, which affects the inner ear and causes episodes of vertigo, hearing loss, and tinnitus, must be considered in specific cases.
A review of a child’s medication history is necessary when investigating tinnitus, as various drugs are ototoxic, meaning they can damage the inner ear. Certain antibiotics, notably aminoglycosides like gentamicin, are ototoxic, especially when administered intravenously. High doses of non-steroidal anti-inflammatory drugs (NSAIDs) and chemotherapy agents, such as cisplatin, can induce temporary or permanent tinnitus.
Identifying Tinnitus in Young Children
The subjective nature of tinnitus makes diagnosis difficult, especially in children who may not be able to articulate what they are experiencing. Parents should watch for behavioral signs that indirectly signal the presence of a persistent internal sound. These signs can include increased irritability, difficulty concentrating on schoolwork, or a new sensitivity to loud noises.
The child might complain about sounds that no one else can hear, or ask “What is that noise?” in quiet environments, particularly at bedtime. A comprehensive audiological evaluation is the standard diagnostic approach, including pure tone testing to assess hearing thresholds and tympanometry to check middle ear function. Pediatric audiologists use specialized communication techniques and age-appropriate prompts to help younger patients describe the sounds they perceive.
Management and Coping Strategies
When the cause of tinnitus cannot be fully resolved, such as in cases associated with permanent SNHL, the focus shifts to management and habituation. Tinnitus retraining therapy (TRT) concepts are adapted for children, focusing on counseling to demystify the sound and reduce fear and anxiety. This educational component helps the child categorize the tinnitus as a neutral, non-threatening signal.
Sound enrichment is a cornerstone of management, aimed at reducing the contrast between the internal sound and the environment. Using low-level background noise, such as a white noise machine, nature sounds, or soft music, can mask the tinnitus, making it less noticeable, particularly when the environment is quiet. This technique is beneficial at night to improve sleep quality, which is frequently disrupted by the perceived sound.
Since stress and anxiety can intensify tinnitus perception, incorporating stress reduction techniques is helpful. Simple relaxation exercises, mindfulness practices, and ensuring a regular sleep schedule can help regulate the nervous system. Parental and professional reassurance is important, helping the child understand that while the sound may persist, their brain can learn to filter it out over time.