Question
Is there a way to test a child for childhood hyperacusis or tinnitus, if the child is too young to verbalize the discomfort? Also, would either of these conditions interfere with normal speech development in very young children, or cause behavior problems and mood swings when the condition is worse?
Answer
My initial reaction to this challenging question was to ask under what circumstances would one think that the very young non-verbal child had tinnitus or hyperacusis? If so, would the presence of these disorders create language and behavior difficulties? To my knowledge there is no existing protocol for testing the presence of tinnitus or hyperacusis in those children too young to verbalize the discomfort. Further, assuming that the non-verbal child did present with either tinnitus or hyperacusis, one cannot assume that these conditions interfere with normal language and speech development or create behavior problems and mood changes. Theoretically, it is possible that there could be a correlation between the child's behavior and the presence of tinnitus or hyperacusis. I am not optimistic that in the short term we will find this correlation, but in the long term the question may be resolved.
Until we develop appropriate diagnostic tools to test for hyperacusis or tinnitus in the very young, non-verbal child, one can only offer an opinion based on what is known about children with tinnitus or hyperacusis. There are no formal studies of which I am aware that report the incidence of tinnitus or hyperacusis in children under the age of five or six.
Fortunately, there has been a marked increase in the number of studies regarding tinnitus and hyperacusis in children. For example, a recent study reported at the 8th International Tinnitus Seminar showed that of 190 children ages 5 - 12, 19.6% suffered with tinnitus. Also, 3.2% had hyperacusis. Left-handedness, female gender, and a history of noise exposure were among the risk factors. Also some disorders are associated with a higher risk for tinnitus or hyperacusis. Such conditions as autism, sensorineural hearing loss and ADD (attention deficit disorder) may put the child at greater risk. Is it possible that these conditions are present in the very young, non-verbal child? If so, they may serve as early indicators of tinnitus or hyperacusis.
With the diagnostic potential of fMRI (functional Magnetic Resonance Imaging) and PET scan (Positron Emission Tomography), it may be possible in the future to determine the presence or absence of tinnitus or hyperacusis in the very young, nonverbal child. I believe that some day we will have the ability to provide repeatable and objective evidence of these disorders in very young child. I believe that such objective data will contribute to a more effective clinical management of these disorders. Further, these objective measurements may contribute to a battery of tests providing answers related to the effect of tinnitus or hyperacusis on normal speech development and mood changes when tinnitus or hyperacusis is at its most uncomfortable level.
Dr. Robert Sandlin is a retired audiologist with forty-eight years of clinical experience. He was a member of the ATA Scientific Advisory Board for twenty years and past director of the California Tinnitus Assessment Center. He has published a number of articles and contributed textbook chapters related to tinnitus.