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Alejandra Arellano Barcenas
University Clinic of Navarra, SpainTitle: What do we know about pediatric tinnitus? Mini review
Abstract
We define tinnitus as the
perception of a sound in the absence of an external source and that is
inaudible to the environment. It is a very frequent symptom in the practice of
otolaryngologists, but how frequent is it in the pediatric population? The prevalence
in children it is difficult to assess and there are few reports on it. It is estimated that between 13% and 47% of
normal hearing children complain of tinnitus and in children with hearing loss,
it is reported that the prevalence of tinnitus reaches 55%. Tinnitus can cause
from minor discomfort in some infants, to difficulties concentration, stress,
fatigue, irritation, sleep disturbances, learning impairment, inattention, and
emotional distress.
They are basically divided into
two large groups:
a) subjective: there is no
external stimulus that produces them, and they are not perceived by others or
by the examining physician, they correspond to approximately 95%, and
b) objectives: they are
perceived by the examiner and correspond to 5% on average.
To date, there are no clinical
guidelines for the treatment of children with tinnitus, likewise, there is a
lack of methodological standards and outcome measures to assess the severity
and impact of tinnitus in the pediatric population and the pathophysiology has
been tried to explain based on the knowledge that exists in the adult
population. Tinnitus is the result of abnormal activity in the auditory pathway
that can occur at any point in it. Since the pathophysiology of this symptom is
so complex, multiple theories have been generated to try to explain it. New
studies reveal the alteration in the compensation systems of the central
auditory pathways as a determining factor in the chronification after an
aggression mainly peripheral, which in many cases occurs in the cochlea.
The pathophysiological theories
to explain it, could be grouped into three levels: cochlear alteration,
aberrant electrical activity in the central nervous system, and cortical
reorganization phenomena. In relation to the cochlear alteration that could
explain the origin of tinnitus, it is considered, on the one hand, that there
could be an alteration between the functioning of the external and internal
hair cells, where the degeneration of the external hair cells would generate a
collapse of the membranes basilar and tectorial, producing a chronic
depolarization of the internal ones, thus generating abnormal activity in the
afferent fibers. And on the other hand, alterations in the metabolic cycle of
glutamate are thought, either due to excess release or a lack of reuptake and
metabolism, which would produce a state of continued depolarization of the
afferent pathway, causing cell edema, release of reactive metabolites of oxygen
with apoptosis.
There is a high association of
tinnitus with hearing loss, which is reported in up to 50% of cases, and is
justified by making a similarity with the reorganization that the somatosensory
cortex undergoes after the amputation of a limb and the perception of the
"limb phantom”, the areas of the auditory cortex that lose their afferent
innervation would undergo reorganization and would perceive anomalous auditory
sensations that would be experienced as tinnitus. Among the main causes of
childhood tinnitus, febrile illnesses, viral infections, otic pathology (acute
and serous otitis media, tympanic perforation, contraction of the ossicular
chain and palate muscles, Eustachian tube dysfunction, etc.), exposure to
acoustic trauma, earwax plugs, head trauma, ototoxicity, etc. have been
reported. For the study, a complete clinical history must be taken, with
special emphasis on the semiology of tinnitus, accompanied by an exhaustive
general physical and otorhinolaryngology examination with performance of tone
audiometry, logo audiometry, impedance-tympanometry, tinnitus measurement, and
if necessary, according to clinical judgment, complement with otoacoustic
emissions, evoked potentials, computed tomography, and nuclear magnetic
resonance. The treatment is related to the etiology and includes sound,
psychological, pharmacological, physical and surgical treatment. It has been
documented that childhood tinnitus, in many cases, is self-limited and has a
better prognosis than in adults, so it is likely that it has a greater chance
of improving with counselling alone or with a combination therapy without
drugs, so it should be prefer conservative management instead of medical or
surgical treatment. As we have documented, there are few studies and monitoring
of tinnitus in children, with a large area of study still to be clarified.
Biography
Alejandra Arellano Barcenas
graduated from the faculty of medicine, UNAM and otorhinolaryngology and head
and neck surgery in CMN SXXI IMSS. She completed international master’s in
nutrition and dietetics with a specialty in eating disorders. She has recertified
by the Council of ENT and CCC, Mexico and the College of Physicians of La
Rioja, Spain. Pediatric otorhinolaryngology attendance, Mayo Clinic, Rochester,
Minnesota, E.U. and at the University Clinic of Navarra, Pamplona, Spain.
Currently, she assigned to the Ciudad de Coria Hospital, Extremadura, Spain,
ENT and CCC specialty. She is COVID critical area doctor, Mexico 2020-2021. She
is professor of ENT at the faculty of medicine, Universidad Anahuac, and
currently at the Anahuac otolaryngology undergraduate program clinical sessions.
Her publications in national and international indexed journals and author of
chapters in books on the specialty. She is the member of the Editorial Board of
Clinical Otorhinolaryngology and Head & Neck Surgery and Otolaryngology
Open Access Journal. Also, she is reviewer for the publication in the journal
Proceedings of Scientific Research Universidad Anahuac and the Cuban Journal of
Otorhinolaryngology and Head and Neck Surgery.
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