- Research article
- Open Access
An evaluation of paediatric tinnitus services in UK National Health Service audiology departments
BMC Health Services Research volume 20, Article number: 214 (2020)
Whilst evidence indicates many children experience troublesome tinnitus, specialist services for children are far less established than those available for adults. To date, there is limited understanding of how paediatric tinnitus is managed in the UK, and to what extent current practice reflects what is recommended. This service evaluation aimed to 1) profile how tinnitus in children is managed in UK clinical practice, and assess to what extent care provided by services reflects advice included in the British Society of Audiology (BSA) Tinnitus in Children Practice Guidance, 2) collate clinician opinions on how services may be optimised, and 3) identify common problems experienced by children who present with bothersome tinnitus in clinic.
As part of a larger survey, eight questions regarding services for paediatric tinnitus were distributed to UK NHS audiology services via email and social media. Representatives from eighty-seven services responded between July and September 2017.
Fifty-three percent of respondents reported that their department provided a paediatric tinnitus service. Among these services, there was widespread use of most BSA recommended assessments and treatments. Less widely used practices were the assessment of mental health (42%), and the use of psychological treatment approaches; cognitive behavioural therapy (CBT) (28%), mindfulness (28%), and narrative therapy (14%). There was varied use of measurement tools to assess tinnitus in children, and a minority of respondents reported using adult tinnitus questionnaires with children. Frequently reported tinnitus-related problems presented by children were sleep difficulties, concentration difficulties at school, situation-specific concentration difficulties, and emotional distress.
Approaches used to manage children with troublesome tinnitus in UK NHS services are largely consistent and reflective of the current practice guidance. However, findings from this study indicate specialist staff training, access to child-specific tools, and the treatment and referral of children with tinnitus-related psychological problems represent key areas in need of optimisation.
Tinnitus is the perception of sound in the ears or head without any external source. For some, this symptom can be troublesome, causing problems in many different areas of life, such as with sleep, psychological health, or cognitive performance [1, 2]. Those with troublesome tinnitus may benefit from referral to specialist health services for assessment and treatment support . Prevalence data suggest that similar proportions of adults and children experience troublesome tinnitus; Davis  reported 2.8% of adults to have tinnitus that was “moderately annoying or worse”, and similarly, Humphriss et al.  reported 3.1% of children to experience “clinically significant” tinnitus. Despite this, tinnitus in children is a relatively unrecognised problem and consequently, tinnitus treatments and health services for children are far less established versus those available for adults .
In the UK, the majority of tinnitus services exist in audiology departments, with over 140 UK audiology departments providing an adult tinnitus service [7, 8]. In contrast, tinnitus services for children are sparse . Both UK-based and international research has indicated that very few children with tinnitus access specialist care [6, 9,10,11], and it is common for children to be managed within adult services rather than child-specific services [6, 12]. The need to optimise clinical management of children with tinnitus was highlighted by members of the public and clinicians in a 2011/2012 priority setting consultation exercise . To address this need, the 2015 BSA “Tinnitus in Children Practice Guidance”  was developed, offering a toolkit of child-friendly clinical management strategies to support paediatric service providers. Whilst the guidance was based on the authors’ clinical experience and research evidence available at the time , the authors highlight the lack of robust scientific evidence to support their assessment and treatment recommendations. To date, there is limited understanding of how paediatric tinnitus is managed in the UK, and the extent to which current practice reflects the recommended approaches described in the BSA Guidance.
The importance of health services tailored to the needs of children is well recognised in hearing health and more broadly across other disease areas [16, 17]. Children differ from adults in terms of their physical, emotional, and intellectual development, and this has implications for their treatment needs, both in terms of the treatment they receive and the environment in which they are cared for. When providing care, the needs of the child’s family must also be carefully managed. The BSA Guidance supports the provision of child-specific tinnitus services. Whilst the tinnitus ‘sound’ may be experienced similarly by children and adults, research has highlighted key differences in how children and adults present at clinic, and these differences have important implications for the provision of appropriate care. For example, whilst several studies have found children and adults often use similar words to describe the sound of tinnitus (e.g. “ringing” or “buzzing”) [18, 19], it is also common for children to use emotive or creative descriptors (e.g. “angry bees” buzzing) , or to form narratives to help them make sense of their experience (e.g. belief tinnitus is caused by “a monster in their head”) . Furthermore, several studies have shown children to rarely spontaneously discuss their tinnitus with adults [19, 21], which may mean they are less forthcoming when discussing tinnitus with a health care provider. These linguistic and communication differences highlight the challenges of reliable tinnitus assessment and measurement of treatment benefit in children, underlining the importance of skilled practitioners and child-friendly approaches. The BSA Guidance advises that adult models of tinnitus management should be adapted for use with children, ensuring that children’s communication, development, and linguistic needs are catered to. The use of play, drawing and visual or simplified methods of communication are suggested as helpful techniques .
Studies have found children to report some of the same tinnitus-related problems commonly experienced by adults . However, whilst the problems experienced by adults are well documented [2, 23, 24], there is limited understanding of the scope and impact of tinnitus-related problems experienced by, and important to, children. Knowledge of tinnitus problems in adults has guided and improved clinical assessment and treatment practices, e.g. directly informing the design of clinical questionnaire measures of tinnitus impact, and supporting clinicians in their assessment of tinnitus severity and measurement of treatment-related change [25,26,27]. Several tinnitus questionnaire measures are available for use with adults and are sensitive to the tinnitus-related problems they experience, however, none have been designed for use with children .
The purpose of this service evaluation was to 1) profile how tinnitus in children is managed in UK clinical practice, and assess to what extent care provided by services reflects advice included within BSA Guidance, 2) collate clinician opinions on how services may be optimised, and 3) identify common problems experienced by children who present with bothersome tinnitus in clinic.
This study was a part of a British Tinnitus Association (BTA) service evaluation of tinnitus services in UK National Health Service audiology departments. The evaluation is carried out annually or bi-annually and is conducted as an online survey containing about 50 items. The primary objective of the evaluation was to generate a database of up-to-date information about the tinnitus services available throughout the UK. The main survey is a consistent set of questions used every time the survey is conducted. With each issue, a small set of questions are added to capture more detailed information about one aspect of the service. In 2017, this involved eight questions about paediatric tinnitus services (Appendix 1). The data from these eight questions were analysed here. Data were analysed with the support and permission of the data controller (EB). This use of the data complies with the governance procedures of the charity. As this survey only used data for the purpose of service evaluation, individual consent was not sought, and research ethics committee review was not required . Survey respondents were clinical professionals and minimal personal data was collected. This service evaluation is reported according to Checklist for Reporting Results of Internet E-Surveys (CHERRIES) .
The eight questions on paediatric tinnitus were designed via an iterative process. Initial questions were drafted to assess key aspects of paediatric tinnitus services. Questions were further informed by assessment and treatment practices described in the BSA Guidance, with input from expert clinicians in the field. Questions were first drafted by DJH, and then appraised by EB. A test version of the survey was reviewed before the study was launched. There was a mix of closed questions (dichotomous and multiple response) and open questions. Multi-choice questions included an extensive list of answer options in addition to an ‘other (please specify)’ free text option. Closed questions asked about whether the department offered a paediatric tinnitus service, the clinical roles of those responsible for managing children with tinnitus, assessment procedures used, measurement tools used, and treatments offered. Open questions asked about common problems reported or identified in children with tinnitus, the percentage of children referred to Child and Adolescent Mental Health Services (CAMHS), and requested suggestions regarding how the paediatric tinnitus service could be improved. Responses to each question were optional. The survey was uploaded onto surveymonkey.com with 1–2 questions per page, and logic to omit irrelevant questions. Participants could revisit and edit any of their responses up until the point they chose to submit (on the final page).
The service evaluation was delivered online via surveymonkey.com from 17th July 2017. A link to complete the survey was sent out via email to all contacts registered on the BTA database of UK-based audiologists and National Health Service (NHS) audiology departments (approximately 200). The link was also shared on the BTA’s social media channels. At the time of invitation, respondents were informed about the objective and length of the survey and were informed that, upon survey completion, participants would be sent two complimentary copies of the charity’s quarterly magazine. Responses were obtained between July 2017 and September 2017.
Data collection and analysis
A single representative was asked to complete the questionnaire on behalf of each service. Where duplicate responses from the same department were found, services were contacted to determine which data set was most representative of the service; that dataset was used in analyses. All queries were handled via the data controller (EB). Data from closed questions were analysed in Microsoft Excel and presented as the number and percentage of respondents from the total number answering each question. Qualitative data from open-ended questions were grouped by topic by HS and DJH. An inductive, ‘bottom-up’ approach was used to group responses into topics and sub-topics . Participant quotes are used in this report to illustrate the sub-topics identified.
Eighty-seven participants responded to the survey, representing 87 individual UK NHS audiology departments. Of these, 46 (53%) reported that their department provided a paediatric tinnitus service. Most commonly, audiologists (including senior and specialist audiologists) were reported as responsible for the management of children with tinnitus (80%, n = 35). Hearing therapists (39%, n = 17), ENT specialists (39%, n = 17), audio-vestibular physicians (16%, n = 7), clinical psychologists (7%, n = 3), and clinical scientists (7%, n = 3) were also involved. One respondent reported that a “paediatrician specialising inaudiology” was involved in the management of tinnitus in children at their service.
Management of tinnitus in children/ use of BSA recommended approaches
Figure 1 shows the elements that services included in their assessment of children with tinnitus. Most services assessed tinnitus history (tinnitus characteristics – descriptions of sounds) (100%, n = 43), hearing difficulties (98%, n = 42), current coping strategies (98%, n = 42), and factors that affect the child’s tinnitus (e.g. external stresses) (95%, n = 41). Fewer services assessed mental health (42%, n = 18).
When asked about the use of measurement tools to assess tinnitus-related problems in children, 35% (n = 15) did not report the use of any measurement tools. Others reported the use of visual analogue scales (37%, n = 16), self-devised questionnaire measures (26%, n = 11), Likert scales (12%, n = 5), adult tinnitus questionnaires (12%, n = 5), and/or paediatric questionnaires relating to psychological health or education (9%, n = 4). Adult questionnaires used were the Tinnitus Handicap Inventory (THI) , the Tinnitus Functional Index (TFI) , and the Mini-Tinnitus Questionnaire (Mini-TQ) . Of the five respondents who reported the use of adult questionnaires, two reported that use was limited to older children. Paediatric questionnaires used were the Revised Children’s Anxiety and Depression Scale (RCADS) , the Paediatric Index of Emotional Distress Questionnaire (PI-ED) , the Strengths and Difficulties Questionnaire (SDQ) , and questionnaires for educational assessment. It is unknown if parent and/or child versions of the RCADS or SDQ were used. One respondent reported the use of a “0-10 scale for the parent to rate how intrusive the tinnitus appears to be” when assessing very young children. Another respondent reported use of a “children’s anxiety index scale”.
Figure 2 shows the tinnitus treatment approaches used by paediatric services. The general therapeutic approach of ‘explanation’ and ‘advice giving’ was used most widely (100%, n = 43). There was also widespread use of hearing aids (84%, n = 36) and non-wearable sound enrichment (84%, n = 36). Less commonly used approaches were those addressing psychological problems (i.e. narrative therapy [14%, n = 6], CBT [28%, n = 12], and mindfulness techniques [28%, n = 12]).
Child and Adolescent Mental Health Services (CAMHS) refers to the UK NHS services responsible for working with children and young people who have difficulties with their emotional or behavioural wellbeing. The BSA Guidance advises that referral to CAMHS should be considered for children who show signs of significant psychological distress such as anxiety or depression, and would therefore require help from a trained mental health practitioner . When asked about the percentage of children who require referral to CAMHS, respondents reported a range between 0 and 50%, with most services referring ≤20% of children. Several respondents reported that although few children were referred from their service to CAMHS, many were already under CAMHS, or had been referred by CAMHS to their service.
Clinician opinions on how services may be optimised
Table 1 reports data from an open-ended question whereby respondents were asked to suggest ways in which their paediatric tinnitus service could be improved. The most common suggestions called for improved connections with mental health/paediatric services, more child-friendly resources, and more general training in the area of paediatric tinnitus. There were single suggestions regarding improved staff expertise and access to therapeutic devices.
Common problems experienced by children with bothersome tinnitus
Respondents reported a variety of common problems they encountered in children with bothersome tinnitus (Table 2). Most frequently reported topics were sleep difficulties, concentration difficulties at school, situation-specific concentration difficulties, and emotional distress. Less frequently reported topics were lack of support from others, fatigue, behaviour problems, and worries.
This service evaluation assessed how tinnitus in children is currently managed in UK clinical practice, collated clinician opinions on how services may be optimised, and identified a variety of common problems experienced by children who present with bothersome tinnitus in clinic.
Management of children in UK clinical practice
Assessment of children in UK paediatric tinnitus services largely reflects the recommended procedures described in the BSA Guidance . Whilst the child’s ‘mental health’ was the least commonly assessed factor, the majority of respondents reported that their service assessed the ‘social/psychological impact of tinnitus’, and the child’s ‘annoyance/distress level’. Given several respondents reported the common presentation of children with tinnitus-related emotional problems, assessment of these factors is highly relevant. The BSA Guidance advises that paediatric questionnaire measures of psychological health can be helpful in providing a formal assessment of the child’s mental health. These measures can not only be useful in understanding the impact of tinnitus on the child’s emotional wellbeing, but can also screen for significant psychological distress. Data collected may also help to facilitate the referral of a child to mental health services when necessary. It may therefore be useful for paediatric services to include this assessment approach, in appropriate cases, where they are not already doing so. Unsurprisingly, given the lack of a child-specific tinnitus questionnaire, this evaluation found limited and inconsistent use of measurement tools to assess children. Amongst those that used tools, a small minority reported the use of adult tinnitus questionnaires when assessing children. The formal use of adult tinnitus questionnaires with children is not appropriate given that instruments are likely to be overly complex and burdensome for children to complete  and are unlikely to have relevance to children in terms of assessing the tinnitus-related problems that are important to them. These findings suggest that the assessment of tinnitus in children may benefit from the provision of standardised, child-specific measures. A suggestion from a respondent in this study supported this idea, stating that a “child-friendly tinnitus questionnaire” would help to improve their service.
This evaluation found that the treatment provided by UK paediatric tinnitus services was largely reflective of the approaches described in the BSA Guidance. However, despite tinnitus-related emotional difficulties being reported as common in children presenting in clinic, only a minority of services used psychological therapies. The BSA Guidance advises that psychological techniques can be helpful in giving children strategies to overcome tinnitus-related emotional difficulties, and often practitioners within paediatric audiology services can deliver these strategies. The infrequent use of narrative therapy, CBT, or mindfulness, in addition to respondents’ suggestions for more training in this area, indicate a lack of confidence amongst clinicians in delivering these approaches. Furthermore, varied rates of referral to CAMHS, in addition to calls for improved connections with mental health services, suggests paediatric services are limited in their ability to refer children with significant psychological distress. Together, these findings suggest that the provision of appropriate and accessible psychological treatment represents a service area in need of development. Similarly, a 2012 evaluation of UK NHS adult audiology services found less than half of adult tinnitus services offer psychological interventions . To address this unmet need, work is ongoing in the UK to support the inclusion of psychological support for adults with tinnitus into routine audiologist practice .
This evaluation found just over half of UK audiology departments offer a paediatric tinnitus service, indicating there are significantly fewer services available for children than are available for adults. Several respondents suggested that their paediatric tinnitus service received very few referrals, and that more patients and experience are needed in order to establish and improve their service. This reflects other UK and international studies in this field, where very few children have been reported to have accessed treatment [9,10,11]. Whilst small numbers of children accessing care could suggest a limited demand for paediatric tinnitus services, this idea contrasts with findings from prevalence studies that have indicated significant numbers of children experience troublesome tinnitus. Limitations in children’s ability to report their tinnitus-related problems may explain this discrepancy. Unlike adults, children communicate their health problems via an adult gatekeeper (e.g. a parent) in order to seek help. As stated previously, several studies have found that children rarely report tinnitus spontaneously to adults [19, 21]. Yet when asked directly, more children will report their tinnitus [19, 21, 38]. Age-related cognitive and linguistic limitations could play a role, restricting children’s ability to communicate their symptoms clearly . Furthermore, it is also possible that, when children raise concerns about their symptoms, their complaints are not being recognised as significant. A general lack of public awareness that tinnitus can affect and cause problems in children may contribute to this issue . These factors represent barriers to parents becoming aware of the child’s tinnitus, recognising it as a significant problem, and accessing care for their child.
Barriers to children accessing care may also exist within the healthcare system. Sometimes tinnitus in children may be overlooked because clinicians lack awareness, confidence, or training in how to manage it. A study in Finland by Szibor et al.  found an average 12 month delay between children first reporting tinnitus symptoms and their presentation at a specialist tinnitus clinic, suggesting significant delays between children visiting local services and their referral to a specialist. Surveys of UK clinicians managing tinnitus in children conducted in 2009 and 2012 by Kennedy et al.  evidenced a need for more child-specific training on tinnitus management. These surveys also found some clinicians were reluctant to discuss tinnitus with children due to an unfounded fear that it could draw the child’s attention to tinnitus and cause unnecessary distress. The need for more child-specific training, staff expertise, and support networks, was also reported by respondents in the present study. In the UK, there are two professional courses that offer child-specific training on tinnitus management; the University College London “Tinnitus and Hyperacusis in Adults and Children: Mechanisms, Assessment and Management Masterclass”  and the BTA “Assessment and Management of Tinnitus in Children” course . Adults attending audiology services are routinely asked about tinnitus as part of clinical history taking . To ensure fairness across child and adult services, and to ensure that problematic tinnitus in children is not overlooked, the BSA Guidance recommends that all children attending audiology appointments are also routinely asked about tinnitus, and whether it is bothersome . Where this approach has been adopted, paediatric tinnitus services have seen referral numbers steadily increase, indicating that this approach has enabled children to access needed care when they would not have done so previously .
Tinnitus-related problems in children
A range of common problems experienced by children with troublesome tinnitus were identified suggesting that, like adults, children experience tinnitus-related problems that have a detrimental impact on their day-to-day life and wellbeing. The common problems identified by clinicians in this study; sleep difficulties, concentration difficulties, and emotional distress, were reflected in a recent review of children’s tinnitus-related problems reported in the literature . Tinnitus problems relating to sleep, concentration, hearing, and psychological difficulties have also been reported as common in adult populations [2, 23, 24]. Unique to paediatric tinnitus, this evaluation highlighted children’s common experience of tinnitus-related concentration and hearing problems when at school or when studying. This suggests that consideration of the child’s school environment and educational demands are critical when assessing a child with tinnitus and deciding on an appropriate treatment strategy.
In this evaluation, a minority of respondents reported ‘lack of understanding of tinnitus’ or ‘lack of support from others’, as common experiences for children with tinnitus. Similar problem domains have shown fairly low prominence in adult studies. Watts et al.  found a minority of adults reporting a “need for knowledge” and Tyler and Baker  reported just one adult experiencing difficulty ‘explaining tinnitus to others’. Although, this could be due to Tyler and Baker’s participants feeling well informed and supported through their engagement in a self-help group . Future research should establish whether ‘lack of understanding of tinnitus’ and ‘lack of support from others’ are particularly important issues for children with tinnitus. Unlike adults, children cannot easily access information to help them understand their tinnitus percept. Furthermore, children are limited in their ability to explain their difficulties to others around them . To address the lack of child-friendly tinnitus resources, the BTA published a range of children’s information leaflets in and activity booklets .
Of approximately 200 NHS audiology services, this survey received responses from 87 departments, representing approximately 44%. Of those who did not respond, it is unknown how many offer a tinnitus service (adult only, or adult and paediatric). Thus, the results from this survey may not fully represent the population of UK paediatric tinnitus services. Furthermore, findings from this evaluation are UK-centric and specific to the nature of services within the NHS, and therefore may have limited relevance to paediatric tinnitus services based outside of the UK. Few studies outside of the UK have explored paediatric tinnitus service provision. Baguley et al.  studied data from expert centres in England, Germany, Poland, and Italy and found it was common for children to be seen within adult services as opposed to child-specific ones. Similarly, Rosing et al.  found children in Denmark were often seen in adult services. Investigators from both studies share the view that regardless of where children are managed, they should receive child-appropriate management from health care professionals with the appropriate skills and knowledge.
Finally, as the eight questions on paediatric tinnitus services were part of a larger service evaluation, they could only cover topics with limited depth. It will therefore be important to triangulate the findings from this evaluation with larger more in-depth research investigating these topics. One important topic that did not emerge from these data was the role of the parent. Particularly for younger children, parents are likely to be an essential source of information regarding the effect of tinnitus on the child’s life. It would therefore be valuable for future research to explore the role of the parent in tinnitus assessment and treatment and how the role of the parent can be harnessed to improve outcomes.
Approaches used to manage children with troublesome tinnitus in UK NHS services are largely consistent and reflective of the current practice guidance. However, findings from this study indicate specialist staff training, access to child-specific tools, and the treatment and referral of children with tinnitus-related psychological problems represent key areas in need of optimisation. Children’s health care needs differ from those of adults and the tinnitus-related problems that are important to them are likely to differ from those considered important to adults. It is therefore essential for children to be managed using child-friendly approaches, by clinicians who are experienced in assessing and treating them. This warrants the development of effective, child-specific tinnitus services.
Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
British Society of Audiology
British Tinnitus Association
Child and Adolescent Mental Health Services
Cognitive Behavioural Therapy
Checklist for Reporting Results of Internet E-Surveys
Ear, Nose and Throat
National Health Service
National Institute for Health Research
The Paediatric Index of Emotional Distress Questionnaire
Revised Children’s Anxiety and Depression Scale
Strengths and Difficulties Questionnaire
Tinnitus Functional Index
Tinnitus Handicap Inventory
Hall D, Fackrell K, Li AB, Thavayogan R, Smith S, Kennedy V, et al. A narrative synthesis of research evidence for tinnitus-related complaints as reported by patients and their significant others. Health Qual Life Outcomes. 2018;16(1):61.
Tyler R, Baker LJ. Difficulties experienced by tinnitus sufferers. J Speech Hear Disord. 1983;48:150–4.
Department of Health. Provision of Services for Adults with Tinnitus: A Good Practice Guide. Department of Health January; 2009. https://webarchive.nationalarchives.gov.uk/20130124045237/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_093810.pdf. Accessed 19 Jul 2018.
Davis AC. The prevalence of hearing impairment and reported hearing disability among adults in Great Britain. Int J Epidemiol. 1989;18(4):911–7.
Humphriss R, Hall A, Baguley D. Prevalence and characteristics of spontaneous tinnitus in 11-year-old children. Int J Audiol. 2016 Mar 3;55(3):142–8.
Kennedy V, Kentish R, Stockdale D. Services for Children with tinnitus . The UK Experience Services for Children with Tinnitus The UK Experience; 2014.
Hoare DJ, Broomhead E, Stockdale D, Kennedy V. Equity and person-centeredness in the provision of tinnitus services in UK National Health Service audiology departments. Eur J Pers Cent Healthc. 2015;3(3):318–26.
Gander PE, Hoare DJ, Collins L, Smith S, Hall DA. Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff. BMC Health Serv Res. 2011;11:162 [cited 2018 Nov 6].
Baguley D, Bartnik G, Kleinjung T, Savastano M, Hough E. Troublesome tinnitus in childhood and adolescence: data from expert centres. Int J Pediatr Otorhinolaryngol. 2013;77(2):248–51.
Kim YH, Jung HJ, Il KS, Park KT, Choi J-S, Oh S-H, et al. Tinnitus in children: association with stress and trait anxiety. Laryngoscope. 2012 Oct;122(10):2279–84.
Szibor A, Jutila T, Makitie A, Aarnisalo A, Mäkitie A, Aarnisalo A. Clinical characteristics of troublesome pediatric tinnitus. Clin Med Insights Ear, Nose Throat. 2017;10:1–4.
Rosing S, Kapandais A, Schmidt J, Baguley D. Demographic data, referral patterns and interventions used for children and adolescents with tinnitus and hyperacusis in Denmark. Int J Pediatr Otorhinolaryngol. 2016;89(2):112–20.
Hall D, Mohamad N, Firkins L, Fenton M, Stockdale D. Identifying and prioritizing unmet research questions for people with tinnitus: the James Lind Alliance tinnitus priority setting partnership. Clin Investig (Lond). 2013;3(1):21–8.
Kentish R, Benton C, Kennedy V, Munro C, Philips J, Rogers C, et al. Tinnitus in children practice guidance. 2015.
Kennedy V. Not always a condition of the aged: tinnitus in children. Ann Tinnitus Res Rev. 2016:44–7 Available from: http://www.tinnitus.org.uk.
Getting the right start: National Service Framework for Children. Department of health; 2003 [cited 2019 Dec 12] Available from: www.doh.gov.uk/nsf/children/gettingtherightstart.
Transforming Services for Children with Hearing Difficulty and their Families A Good Practice Guide. Department of health; 2003 [cited 2019 Dec 12] Available from: https://dera.ioe.ac.uk/8739/2/A9R19C3.pdf.
Mills R, Cherry J. Subjective tinnitus in children with otological disorders. Int J Pediatr Otorhinolaryngol. 1984;7(1):21–7.
Savastano M. Characteristics of tinnitus in childhood. Eur J Pediatr. 2007;166(8):797–801.
Kentish R, Crocker S. Scary Monsters and Waterfalls: Tinnitus Narrative Therapy for Children | Ento Key. 2016. https://entokey.com/scary-monsters-and-waterfalls-tinnitus-narrative-therapy-for-children/ Accessed 12 Dec 2019.
Mills RP, Albert DM, Brain CE. Tinnitus in childhood. Clin Otolaryngol Allied Sci. 1986;11(6):431–4 [cited 2017 Dec 8].
Smith H, Fackrell K, Kennedy V, Barry J, Partridge L, Hoare DJ. A scoping review to catalogue tinnitus problems in children. Int J Pediatr Otorhinolaryngol. 2019;122:141–51.
Watts EJ, Fackrell K, Smith S, Sheldrake J, Haider H, Hoare DJ. Why is tinnitus a problem? A qualitative analysis of problems reported by tinnitus patients. Trends Hear. 2018;22:1–10.
Sanchez L, Stephens D. A tinnitus problem questionnaire in a clinic population. Ear Hear. 1997;18(3):210–7.
Kuk FK, Tyler RS, Russell D, Jordan H. The psychometric properties of a tinnitus handicap questionnaire: ear and hearing. Ear Hear. 1990;11(6):434–45.
Newman CW, Jacobson GP, Spitzer JB. Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg. 1996;122(2):143–8.
Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, et al. The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. 2012;33(2):153–76.
Health Research Authority. Do I need NHS Ethics approval?. http://www.hra-decisiontools.org.uk/ethics/. Accessed 6th Mar 2019.
Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Hiller W, Goebel G. Rapid assessment of tinnitus-related psychological distress using the mini-TQ. Int J Audiol. 2004;43(10):600–4.
Chorpita BF, Yim L, Moffit C, Umemoto LA, Francis SE. Assessment of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther. 2000;38:835–55.
O’Connor S, Ferguson E, Carney T, House E, O’Connor RC. The development and evaluation of the paediatric index of emotional distress (PI-ED). Soc Psychiatry Psychiatr Epidemiol. 2016;51(1):15–26 [cited 2018 Sep 28].
Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38(5):581–6.
Eiser C, Morse R. Quality of life measures in chronic diseases of childhood. Health Technol Assess (Rockv). 2001;5(4):609–10.
Hoare DJ, Gander PE, Collins L, Smith S, Hall DA. Management of tinnitus in English NHS audiology departments: An evaluation of current practice. J Eval Clin Pract. 2012;18(2):326–34 [cited 2018 Nov 7].
Taylor JA, Hall DA, Walker D-M, McMurran M, Casey A, Stockdale D, et al. A psychologically informed, audiologist-delivered, manualised intervention for tinnitus: protocol for a randomised controlled feasibility trial (Tin Man study). Pilot Feasibility Stud. 2017;3(1):24 [cited 2018 Nov 29].
Savastano M, Marioni G, de Filippis C, M. S, G. M. Tinnitus in children without hearing impairment. Int J Pediatr Otorhinolaryngol. 2009;73(SUPPL.1):S13–5.
Kentish R. Talking about tinnitus (What can young children tell us?). BSA News (n.d.).
British Tinnitus Association reveals majority of UK parents are unaware children can have tinnitus - British Society of Audiology. 2018 [cited 2018 Oct 25].
Tinnitus and Hyperacusis in Adults and Children: Mechanisms, Assessment and Management Masterclass. http://www.ucl.ac.uk/lifelearning/courses/tinnitus-hyperacusis-masterclass. Accessed 6 Dec 2018.
BTA (British Tinnitus Association) Assessment and Management of Tinnitus in Children | ENT & Audiology News. https://www.entandaudiologynews.com/events/event/bta-british-tinnitus-association-assessment-and-management-of-tinnitus-in-children. Accessed 6 Dec 2018.
British Society of Hearing Aid Audiologists. 2014. “Guidance on Professional Practice for Hearing Aid Audiologists” [Online]. Available at: https://www.bshaa.com/write/MediaUploads/BSHAA%20Publications/bshaa_guidance_14%5B1%5D.pdf. Accessed 28 Feb 2020.
Kofahl C. Associations of collective self-help activity, health literacy and quality of life in patients with tinnitus. Patient Educ Couns. 2018;101(12):2170–8.
Support for children with tinnitus | British Tinnitus Association . https://www.tinnitus.org.uk/support-for-children. Accessed 7 Mar 2019.
HS is funded by the British Tinnitus Association (BTA). The BTA administered the questionnaire reported on in this study, as part of their regular annual/ biannual evaluation of UK NHS tinnitus services. DJH is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre programme, however the views expressed are those of the authors and not necessarily those of the NIHR, the NHS, or the Department of Health and Social Care.
Ethics approval and consent to participate
Consent for publication
DJH is currently acting as an Associate Editor for BMC Health Services Research.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Do you have a paediatric tinnitus service in your department?
Which members of your clinical team treat children with tinnitus (tick indicate all that apply)
Ear Nose and Throat doctor
Other (please specify)
What does your paediatric tinnitus assessment include (tick all that apply)
History taking (tinnitus characteristics – descriptions of sounds
Social/psychological impact (e.g. school performance)
Noise exposure history
Other audiovestibular symptoms
Medical and Neurological history
Factors that affect the child’s tinnitus (e.g. external stresses)
The child’s current coping strategies
Other tests (please specify)
What measurement tools do you use to assess tinnitus related problems in children (tick all that apply)
A self-devised multi-item questionnaire measure of tinnitus related problems or distress
A Likert scale (a single line scale using descriptive categories of problem severity)
A visual analogue scale (single line scale without descriptive categories)
The Paediatric Index of Emotional Distress Questionnaire
The Strengths and Difficulties Questionnaire
The Revised Children’s Anxiety and Depression Scale
Questionnaires for educational assessment
Others (please specify)
What in your experience are the most common problems reported or identified in children who have bothersome tinnitus?
What management options for tinnitus in children do you use in your department (tick all that apply)
Explanation, advice and information giving
Wearable sound generators
Other sound enrichment
Cognitive Behaviour Therapy
Other (please specify)
Approximately what percentage of children with tinnitus who present at your service require referral to Child and Adolescent Mental Health Services
What (if anything) do you think could improve your paediatric tinnitus service?
About this article
Cite this article
Smith, H., Fackrell, K., Kennedy, V. et al. An evaluation of paediatric tinnitus services in UK National Health Service audiology departments. BMC Health Serv Res 20, 214 (2020). https://doi.org/10.1186/s12913-020-5040-y
- Care provision
- Clinical management
- Healthcare quality
- Service evaluation