CHRONIC TINNITUS IN CHILDREN AND ADOLESCE NTS

Background: The problem of tinnitus in adults is reviewed systematical ly in nearly all standard otolaryngology reference works, whereas text books and monographs that focus on pediatric otorhinolaryngology or au diology and hearing in children and adolescents provide only little in formation concerning the epidemiology, etiology and therapy of tinnitu s. The purpose of this study was to evaluate the psychosomatic aspects of chronic tinnitus in this younger age group. A rational diagnostic approach is discussed as to which diagnostic measures are necessary in the pediatric group for deciding which therapeutic option to chose. T he therapeutic outcome of tinnitus counselling in non-severe cases and of parenteral lidocaine infusions in cases of a troublesome tinnitus is presented. Patients and methods: From January 1992 to December 1995 , 31 children and adolescents in the age range from 6 to 17 years were treated far a chronic tinnitus without a measurable hearing loss. In 20 cases the tinnitus was bilateral; in 11 cases it was unilateral, wi thout side preference. In 24 patients the case history gave no hint of a major annoyance by the tinnitus or significant psychological compon ents. In these cases tinnitus counselling was carried out. In 7 cases - 3 girls and 4 boys in the age range from 10 to 17 years - the kind a nd grade of symptom satisfied the ICD-10 criteria of a depressive epis ode. These patients were hospitalized for 10 days and a lidocaine infu sion therapy (2 mg/kg Xylocain Cor in 500 ml HAES 6%) was performed as treatment for the somatic component of the disorder. Data were analyz ed catamnestically using the patients' files. Results: In all cases no rmal hearing threshold and speech intelligibility were ascertained by pure-tone and speech audiometry. Auditory evoked brainstem potentials gave no further information. The measurement of transient evoked otoac oustic emissions gave no consistent results in either of the two group s. Tinnitus measurement and audiometric masking could only be carried out in patients older than 10 years and showed non-reproducible result s. In all cases with no major symptoms tinnitus disappeared. During a follow-up of 12-44 months, 4 cases treated with lidocaine achieved com plete remission; in 3 cases the tinnitus eased off to such an extent t hat it was no longer regarded as annoying, In one girl of the lidocain e group a somatisation disorder developed independently of the tinnitu s and was treated by psychotherapy. No side-effects of the lidocaine o ccurred. Conclusions: All aspects of chronic tinnitus in children and adolescents can be covered best when regarding this symptom as a psych osomatic disorder. The diagnostic approach in this age group has to in clude a detailed case history embracing both organic and psychological and social aspects. It should also include pure-tone and speech audio metry. Only in cases with an uncertain hearing threshold auditory evok ed brainstem potentials have to be measured. Otoacoustic emissions giv e no further information about the development and therapeutic outcome of the tinnitus. In this age group tinnitus measurement and masking i s of no diagnostic value. In patients with no signs of a hearing loss and no other organic symptoms there is no need for further diagnostic measures such as imaging or serological investigations. In cases with severe annoyance,tinnitus counselling is sufficient therapy, In cases with severe symptoms,lidocaine infusion therapy may be a therapeutic o ption for the somatic component of the disorder. In adolescents with c hronic tinnitus psychotherapy will be necessary only in rare cases. Th e overall prognosis of this disorder is good.