KidsAudiologist

Archive for the ‘tinnitus’ Category

Having recently joined the iPad revolution I’ve been thinking about apps which might be useful in our day-to-day work. Tina Childress is an Educational Audiologist and keeps a very comprehensive list of Apps for Kids (and Adults) with Hearing Loss. Also, the Apps in Education blog includes a good section on So what’s on the iPad for the kid in your class with a Hearing Impairment? and the Earmeter site includes How an iPad can be an incredibly useful tool for hearing aid practices. But here are a few that I’ve downloaded, had a play with and that I think have the potential to be useful tools in counselling children, young adults and families about the ears and hearing:

Auditory Verbal Price – £2.49
This little app uses sound, pictures and text of the 6 Ling sounds. The Ling sounds are a fantastic daily check for parents to do with their child to check their child’s hearing aids are working properly and that they are picking up the frequency range of speech sounds. You could download a free sheet of the Ling sounds with pictures from The Listening Room but some parents / teachers may like the convenience of having it on their iPad for daily checks.

Hearing Aid TicTacToe Price – £5.99
This is a game for 2-4 players aged 4+ years to help kids develop independence in using and understanding their hearing aids – first by matching pictures, then matching pictures with labels, and finally pictures with function. This app is one the the most expensive I’ve ever purchased but I can see that it could be a really useful tool for audiologists and Teachers of the Deaf that can be used over and over with different cohorts of children and at different times as they develop.

Cochlear Baha Support Price – £free
Love this and want to see many more of them for the various products around. It’s basically a manual for your Baha on your iPad, but because it’s on your iPad you have all the information to hand during the day if something goes wrong and you can troubleshoot it easily. There is also advice on travelling, using the telephone and MRI scans and includes helpful videos to follow on cleaning etc. Brilliant, really useful.

Blue Tree Publishing Price – £1.99 each
Have produced a range of iEducate apps which include animations and video which are really useful for demonstrating how the parts of the ears work. I think I would use this one quite a lot and it’s worth the £1.99. Bluetree have also produced a range of Drag & Drop Identification apps. These are basically jigsaws although I found them quite hard to do and think they might be good revision aids for students. There might also be the older child who is very interested in the ear or science more generally who would enjoy the challenge. I wasn’t sure if the content alone and the fact that you’re unlikely to use it very often was enough to justify the £1.99 each as it becomes quite expensive to get the full set. So try with one and see how you go first. Inner Ear, Middle Ear and Labyrinth all available.

Draw MD ENT Price – £free
At it’s most basic this is a lovely tool for showing an older child, teenager and family more about the workings of the ear. It gives some really nice detailed pictures of the ear that you can draw on with your finger to highlight parts as you discuss the anatomy and cause of hearing loss etc with them. At it’s most impressive, you can use your own photos which I’m sure ENT surgeons would find useful for showing patients photographs of their own ears. You can add labels and even email the finished picture to the patient if they want it!

Hearing Loss Simulator Price – £2.49
I think this app has the potential to be a great counselling tool for use with families. There are graphics to show where the common sounds, speech, and individual speech sounds are located for loudness and frequency, and there are lots of options in terms of audiogram configurations. All the recorded voices have an American accent but it is possible to record your own voice for use in simulations.

Play it down Price – £free
Pick a song from your library and crank up the age dial for a feel of what music may sound like in the future. It’s a bit gimmiky but it could be a useful tool in couselling teenagers about the potential effects of noise damage.

Relaxing Sounds of Nature Price £0.69 (lite version free)
Finally, there are masses of nature sound apps out there to choose from. I really like this one as it has a really large range of sounds to choose from, you can mix sounds to your taste, and there’s some beautiful pictures of scenary to accompany the sounds. It also includes a variety of white/pink noise to choose from. I wouldn’t hesitate to recommend this one to my tinnitus patients (and anyone else who wants to relax!)

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They’re popping up everywhere and are chosen for their status providing renewable and clean energy – wind farms. Earlier this month I was asked if I could answer a couple of questions about how wind turbines may impact on the hearing, and hearing aid / cochlear implants, of local residents. I have to admit to not really knowing anything about them so I put the question out on Twitter too…

… and although I didn’t get any responses that answered the question I did get some from other users who said they’d be interested in what I found out. So here’s a summary of what I learnt after some research, but I’m still learning so do add any comments with further evidence if you have it.

Q 1. Is there is any research on the implications for deaf people with hearing aids of living near to turbines?

A. No. There is no research, literature or other evidence (that I can find) of any positive or negative impact on hearing aids, cochlear implants or their wearers living near wind turbines. I can find two statements written by members of the public saying that turbines cause problems for hearing aid / cochlear implant users but cannot find any fuller description, case study, or evidence as to why this should be.

and

Q 2. Can you offer a professional opinion about the impact on of the turbine on a young person’s hearing and possible damage?

A. What I have established in relation to wind turbines and the ear/hearing:

  • There is no evidence that the noise generated by wind turbines causes hearing loss, and wind turbines are not loud enough to cause hearing loss.
  • It is known and widely acknowledged that wind turbines generate significant levels of infrasonic acoustic energy (noise that is below the frequency range that the human ear detects as sound).
  • There is some limited lab-based research evidence  (such as this) that suggests infrasonic sound (vibration) may cause some disruption or abnormal stimulation of the inner ear (cochlea and vestibular system) that may form the basis of the symptoms of ‘wind turbine syndrome’. These symptoms include tinnitus, vertigo, disturbed sleep, headaches, memory and concentration deficits, irritability and anger, fatigue and loss of motivation.
  • Wind turbine syndrome is not experienced by the majority of people living near turbines. The data may be difficult to establish as those closest to the turbines (ie those who rent land to the energy companies) are often motivated to be positive about turbines due to financial incentives, and/or gagging clauses in contracts that prevent them saying anything negative about them. But many of the symptoms can also be explained by other factors such as stress and annoyance etc.
  • Planning guidelines in the UK says that turbine noise should not exceed 5 decibels above background, ambient noise. A wind farm produces a noise of about 35-45 decibels at a distance of 350m. Rural night-time background noise typically ranges from 20 to 40 decibels. No indoor levels are specified.
  • Most hearing aid wearers would be able to follow a close one-to-one conversation easily in this level of background noise.
  • In terms of background noise levels and the effect on hearing aid wearers it would be my opinion that if these levels were accurate and maintained, that outdoors the natural noise of the wind would be likely to be more of a hindrance than the turbine noise to the hearing aid or cochlear implant wearer (wind blows over the microphone and is amplified, wind also carries voices away from the listener etc). Indoors it is unlikely that these levels of background noise from outside would be significant or even heard. These background noise levels are certainly a lot lower than the average town or city dweller experiences most of the time.

I have located just one document for audiologists “Wind-Turbine Noise; What Audiologists Should Know” (Audiology Today, Jul/Aug 2010). It includes lots of information on the acoustics, infrasonic vibration levels, and the potential health problems that could be associated with wind turbines (such as tinnitus and vestibular disturbance) but is clear that the levels generated aren’t loud enough to cause noise damage and makes absolutely no mention of problems associated with hearing aids or cochlear implants.

There is probably still much we don’t know about the turbine technology, as well as the potential impact on the technologies on the human body. At the moment audiologists serving populations in areas where there are wind farms should be aware of potential health problems that patients may complain of. But I can find no evidence of any significant negative impact on existing hearing loss or on any hearing aids or cochlear implants that are worn.

Further reading

Wind turbine sound and health NHS Choices, January 2010

Scientist Challenges the Conventional Wisdom That What You Can’t Hear Won’t Hurt You June 2010

Analysis of How Noise Impacts are Considered in the Determination of Wind Farm Planning Applications Hayes McKenzie Partnership, June 2011

Wind myths: Turbines can damage your health February 2012

Hansard – Written Answers (Wind Power), 27th March 2012

Last updated 24th November 2016

Useful resources for families on the ear, hearing and hearing loss in languages other than written English. If you know of others that are publically available to share please comment below.

Cochlear implants

Communicating with deaf children

Ear infection & glue ear

Hearing aids

Hearing tests

Helping your deaf child to learn

Newborn hearing screening

Parenting & families

  • Positive Parenting DVD with options for spoken English, Polish, Urdu, Sylheti, Punjabi and Somali with English subtitles and British Sign Language
  • Parenting a deaf child parenting tips available in Welsh
  • Who am I? DVD with options for spoken English, Polish, Punjabi and Urdu, with English subtitles and British Sign Language
  • All Together DVD with options for spoken English, Urdu, Sylheti and Punjabi, with English subtitles and British Sign Language
Speech and language development

Vision care

In addition to above the New South Wales Multicultural Health Communication Service in Australia hosts a selection of leaflets in other languages, and the National Institute on Deafness and other Communication Disorders has a large selection of leaflets on hearing, deafness, tinnitus, speech & language development etc in Spanish.

Led by the British Tinnitus Association (BTA) the 6th-12th February is Tinnitus Awareness Week and the theme of ‘Raising Awareness in Primary Care.’

The BTA have published these great tips so please help spread the word by downloading their Ten Top Tinnitus Tips factsheet and sharing with your GP and other interested health professionals:

1 At any point in time around 10% of the population experience tinnitus – both sexes are equally affected and although tinnitus is more common in the elderly it can occur at any age, including childhood. The perceived sound can have virtually any quality – ringing, whistling and buzzing are common – but more complex sounds can also be described.

2 Most tinnitus is mild – in fact it is relatively rare for it to develop into a chronic problem of life-altering severity. The natural history of tinnitus in most patients is of an acute phase of distress when the problem begins, followed by improvement over time. But for a minority of patients the distress is ongoing and very significant, and they will require specialist support.

3 Tinnitus is more common in people with hearing loss – tinnitus prevalence is greater among people with hearing impairment but the severity of the tinnitus correlates poorly with the degree of hearing loss. It is also quite possible to have tinnitus with a completely normal pure tone audiogram.

4 Tinnitus can be associated with a blocked sensation – for reasons that are not clear tinnitus and sensorineural hearing loss can give rise to a blocked feeling in the ears despite normal middle ear pressure and eardrum mobility. Otoscopy and, if available, tympanometry can exclude Eustachian tube dysfunction. Decongestants and antibiotics are rarely helpful.

5 Giving a negative prognosis is actively harmful – it is all too common to hear that patients have been told nothing can be done about tinnitus. Such negative statements are not only unhelpful but also tend to focus the patient’s attention on their tinnitus and exacerbate the distress. A positive attitude is generally helpful and there are many constructive statements that can be made about tinnitus, such as: most tinnitus lessens or disappears with time; most tinnitus is mild; tinnitus is not a precursor of hearing loss.

6 Enriching the sound environment is helpful – useful sources of sound to reduce the starkness of tinnitus include quiet uneventful music, a fan or a water feature. There are inexpensive devices that produce environmental sounds, and these are particularly useful at bedtime. They can be purchased online from the British Tinnitus Association at www.tinnitus.org.uk or by calling 0800 018 0527

7 Hearing aids are helpful – straining to listen causes increased central auditory gain and this increased sensitivity can allow tinnitus to emerge or, if already present, to worsen. Correcting any associated hearing loss reduces this central auditory gain and thereby reduces the level of the tinnitus. Hearing aids are useful even if the hearing loss is relatively mild and an aid would not normally be considered. Recent Department of Health guidelines have emphasised the value of audiometry in a tinnitus consultation, and this is the definitive basis for decisions about hearing aid candidacy. If in doubt, refer for an audiological opinion. In our view, all people who describe tinnitus deserve an audiological assessment. Decisions on when to start using a hearing aid and what sort to use are up to the individual patient and audiologist.

8 Underlying pathology is rare, but be vigilant – in many cases tinnitus is due to heightened awareness of spontaneous electrical activity in the auditory system that is normally not perceived. It can however be a symptom of treatable and significant otological pathology, such as a vestibular schwannoma or otosclerosis. One should be especially vigilant if the tinnitus is unilateral, or if it has a pulsatile quality.

9 There is no direct role for drugs – although they can be used to treat associated symptoms such as vertigo, insomnia, anxiety or depression. There is also no conventional or complementary medication that has been shown to have specific tinnitus ameliorating qualities and there is anecdotal suggestion that repeatedly trying unsuccessful therapies worsens tinnitus.

10 Self-help is often effective – the British Tinnitus Association provides excellent information on tinnitus and common sense advice on managing symptoms. It runs a telephone helpline 0800 018 0527 as well as offering advice through its website www.tinnitus.org.uk

These tips were written for the BTA by: Dr David Baguley PhD, Head of Audiology, Addenbrooke’s Hospital, Cambridge and Mr Don McFerran, Consultant ENT Surgeon, Essex County Hospital, Colchester.

What is Hyperacusis?

Hyperacusis is a term used to describe a general oversensitivity of the hearing so that everyday environmental sounds appear loud, intrusive and sometimes painful to the person affected. Often, children with hyperacusis have normal levels of hearing. A Deafness Research UK study suggests that 6% of children may suffer with oversensitivity to noise although certain groups of children seem to be particularly affected by hyperacusis, for example those with Autism Spectrum Disorder, Williams’ syndrome and Down’s syndrome. Many children with hyperacusis also have tinnitus.

Are there other types of sound intolerance?

Yes. Hyperacusis is used to describe a general oversensitivity of the hearing to all everyday sounds. If dislike or fear is specific to a particular sound, then the term phonophobia is used. Recruitment is used to describe a specific form of reduced sound tolerance in people who have a hearing loss.

What should I do if my child suffers from over-sensitivity to sound?

If your child wears hearing aids then they should be programmed taking into account any recruitment so that sounds are not amplified above the level comfortable for the child. If a baby or young child appears to startle or be upset by loud noises with their hearing aids in the audiologist should adjust the hearing aids to ensure that sound levels are comfortable to wear.

If your child doesn’t wear hearing aids and/or appears to have normal hearing levels then the first thing to do is ask your GP for a referral to an audiologist for a full assessment of their hearing. If the hearing tests are normal then your audiologist or GP can arrange for you to see a paediatrician who specialises in audiology or an audiovestibular physician (doctor who specialises in hearing and balance problems). The best course of action for each child depends exactly on their circumstances and needs. For some children a simple explanation of hyperacusis and knowing that they aren’t alone and lots of people experience it is enough to reassure them. For those childen who are very affected by their hyperacusis (and tinnitus if they have both) then they will be helped by specialist help from a paediatric audiology team with experience of childhood hyperacusis and tinnitus. Following assessment they will use a combination of techniques including an auditory desensitisation programmeTinnitus Retraining Therapy (TRT) and cognitive behavioural therapy.Combined with providing tools to help children self-manage these will give children back some control and reduce the impact of the hyperacusis on their day-to-day life.

Where can I get further information and support?

The British Tinnitus Association (BTA) has some great information on-line and available to download.  There is also a case study ‘When the world is too loud: understanding hyperacusis’ about techniques to help people manage their hyperacusis, and a book review of  Hyperacusis: Mechanisms, Diagnosis and Therapies by David M Baguley and Gerhard Anderson (published by Plural Publishing).

Information on auditory desensitisation and managing hyperacusis in children is available from Deafness Research UK.

The Tinnitus and Hyperacusis Centre (London) provides in-depth information about the biological and auditory processes of hyperacusis.

The Hyperacusis Network is a support network for sufferers of hyperacusis.

UCL run an annual Advanced Audiology Masterclass in Tinnitus and Hyperacusis. The 3 day Masterclass starts with a research update on the current understanding of the mechanisms of tinnitus and hyperacusis. It then addresses the different approaches for the assessment and management of these symptoms in adults, before focusing on paediatric patient management. In 2010 the lectures were recorded and can be watched free here including a presentation of a case study ‘Managing anxiety in a child with hyperacusis’.

Updated 19th June 2015 to include new links to useful websites and interesting articles.

In my last post I talked about the importance of acknowledging tinnitus when children mention it for the first time or are upset by it. Although there is rarely a cure for it, learning about and understanding their tinnitus can make managing it much easier.

Tinnitus is very subjective and impossible to measure so we have to rely on what the young person tells us. Tinnitus sometimes interferes with what you’re trying to listen to and often distracts when trying to listen in quiet environments. In noisy environments such as classrooms, the tinnitus isn’t normally noticed but once children start trying to study during quiet periods their tinnitus can be quite distracting.

For children with a hearing loss or auditory processing disorder (APD) the impact of tinnitus should be carefully considered. For many people stress makes their tinnitus worse. One of these stressors may be difficulties in hearing easily. This is cyclical – the harder things get, the worse the tinnitus gets, the more it annoys you and worse it all feels etc. Other stress might include exam periods for example. And tinnitus may cause sleep problems – usually in getting off to sleep – and this may have knock on effects during the day.

The best course of action for each child depends exactly on their circumstances and needs. For some children a simple explanation of tinnitus and knowing that they aren’t alone and lots of people experience it is enough to reassure them. For some children some simple masking or distraction techniques work well. For example, if the main problem is concentrating in the quiet then it can help to introduce some controlled, low-level background noise such as a fan or white noise. Occassionally quiet background music works so long as it’s a music style that you like (listening to classical when your taste is reggae isn’t going to be relaxing) and so long as it doesn’t distract you from what you want to be concentrating on! At bedtime I find it helps to listen to talking books and drop off to those. Some people prefer sounds of the seashore or other relaxing recordings, or plain old white noise. Various bits of equipment that might be of interest can be seen here.

Whenever there is a hearing loss present, even a slight one, then the most appropriate action is to have hearing aids fitted. The introduction of amplified everyday sounds that you should be hearing help to mask out the tinnitus. And making listening as easy as we can helps reduce stress levels so FM systems with hearing aids, or the iSense for children with APD are helpful in school.

For those childen who appear to be very affected by their tinnitus then they will be helped by specialist help from a paediatric audiology team with experience of childhood tinnitus. Following assessment they will use a combination of techniques including Tinnitus Retraining Therapy (TRT) and cognitive behavioural therapy combined with providing tools to help children self-manage their tinnitus giving them back some control and reducing the impact of their tinnitus on their day-to-day lives. In Tinnitus – it’s not just ringing in the ears! one mum describes how helpful a referral to a children’s tinnitus service was for her son in understanding and managing his tinnitus.

British Society of Audiology’s Audacity magazine (Issue 2 December 2013) includes two useful articles on childhood tinnitus:
pp26-29 Tinnitus Counselling in Children, Dr Alice Emond and Rosie Kentish
pp30-31 Tinnitus in children: Guidelines for Good Practice, Claire Benton

British Society of Audiology’s Tinnitus in Children; Practice Guidance (March 2015)

UCL run an annual Advanced Audiology Masterclass in Tinnitus and Hyperacusis. The 3 day Masterclass starts with a research update on the current understanding of the mechanisms of tinnitus and hyperacusis. It then addresses the different approaches for the assessment and management of these symptoms in adults, before focusing on paediatric patient management. In 2010 the lectures were recorded and can be watched free here.

Updated 19th June 2015 to include new links to useful websites and interesting articles.

Tinnitus is a general term that means any sound that is heard in the ears or head that hasn’t come from an external source. These sounds might be ringing or buzzing for example. The majority of people have experienced tinnitus at some time, for example noticing a ringing in the ears following a gig or night out at a club. However, a much smaller number are worried or bothered by their tinnitus. Tinnitus in children isn’t talked about very much. It’s pretty rare even for audiologists to ask the children they encounter in their clinic if they hear any noises in their ears. Is it possible that tinnitus doesn’t happen in young children? No, both hearing and deaf children can have tinnitus. Children who have tinnitus often do not complain about it as it is part of their normal experience. However for those children who do mention their tinnitus, who are upset by it, or experience tinnitus for the first time it is important that they aren’t dismissed or brushed off. Tinnitus may become increasingly upsetting as a cycle sets in – tinnitus is noticed and is a bit irritating – tinnitus is then focussed on or actively listened to – tinnitus gets louder and more annoying – tinnitus becomes more upsetting – tinnitus gets louder etc. It’s easy to see why periods of stress can exacerbate tinnitus for many children and although there is rarely a cure for it, learning about and understanding their tinnitus can make managing it much easier.

The majority of tinnitus is completely harmless. Occasionally it may be related to another condition, such as an ear infection or as a side-effect of medication. Therefore if tinnitus is noticed for the first time, is in one ear only, or existing tinnitus changes in pitch or loudness it is important that this is discussed with your GP, audiologist, audiology doctor or ENT doctor.

For an insight into the impact of tinnitus for some children read Tinnitus – it’s not just ringing in the ears!

My next post deals with managing tinnitus in childhood.

British Society of Audiology’s Audacity magazine (Issue 2 December 2013) includes two useful articles on childhood tinnitus:
pp26-29 Tinnitus Counselling in Children, Dr Alice Emond and Rosie Kentish
pp30-31 Tinnitus in children: Guidelines for Good Practice, Claire Benton

British Society of Audiology’s Tinnitus in Children; Practice Guidance (March 2015)

The British Tinnitus Association (BTA) is a charity that provides free information and support about tinnitus. The BTA provide information about tinnitus written for children and young people, plus telephone and email peer support. The BTA also produces educational packs for schools.

General information about tinnitus is available from Deafness Research UK

The Tinnitus and Hyperacusis Centre (London) provides in-depth information about tinnitus and tinnitus retraining therapy (TRT)

UCL run an annual Advanced Audiology Masterclass in Tinnitus and Hyperacusis. The 3 day Masterclass starts with a research update on the current understanding of the mechanisms of tinnitus and hyperacusis. It then addresses the different approaches for the assessment and management of these symptoms in adults, before focusing on paediatric patient management. In 2010 the lectures were recorded and can be watched free here.


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