Rosing Susanne Nemholt, Kapandais Anestis, Schmidt Jesper Hvass, Baguley David M
Institute of Regional Health Service Research, University of Southern Denmark, Denmark; Kommunikationscentret, The Social Division in the Capital Region of Denmark, Denmark; Department of Audiology, Odense University Hospital, Odense, Denmark.
Department of Audiology, Odense University Hospital, Odense, Denmark; Department of Nordic Studies and Linguistics, Copenhagen University, Denmark.
Int J Pediatr Otorhinolaryngol. 2016 Oct;89:112-20. doi: 10.1016/j.ijporl.2016.07.036. Epub 2016 Aug 5.
To investigate whether children and adolescents with tinnitus and/or hyperacusis are seen in Ear-Nose-Throat (ENT) clinics and to report the clinical data, treatment and referral patterns of these children. To describe the population of children and adolescents with tinnitus and/or hyperacusis found in Educational- Psychological Advisory services (EPAs) and Centres for special Education for Adults (CEAs) and to identify the referral patterns and interventions used for the children in each of these settings.
A prospective study within 15 ENT clinics was conducted from June 2014 to February 2015. All children with a primary complaint of tinnitus and/or hyperacusis was reported. No changes in daily practice regarding diagnostics, treatment or referral were made. A retrospective case review was undertaken during a five-year period from 01/01/2009 to 31/12/2013 in each Danish municipality and region.
In the prospective ENT study, 12 children were identified and in the retrospective CEA/EPA study 69 children were identified. The 12 children seen by ENT (8 females and 4 male) had an age range from 5.7 to 14 years. The majority of the 69 children seen by CEA/EPA (n = 50, 72.5%) had been diagnosed with tinnitus as a primary complaint. Hyperacusis was the primary complaint in 9 cases (12.8%), and both tinnitus and hyperacusis were reported in 11 cases (15.7%). The findings of this study indicate that a majority of children with tinnitus and/or hyperacusis are seen in settings designed for adult audiological rehabilitation. Counselling, including explanations and discussion of coping strategies was the most commonly reported intervention. Intervention methods corresponding with guidelines for tinnitus management in adults were used in 11 cases (15.9%).
Overall only a small number of children with tinnitus and/or hyperacusis were identified in this systems, suggesting that either the children are seen at general practitioner level or not being referred at all. It may also be the case that the incidence of troublesome tinnitus in childhood is lower than the epidemiological data proposes. Referral pathways indicate a general uncertainty about which services provide acquire sufficient intervention. This study indicates that clinicians working at tinnitus services for adults (CEAs) collectively have the skills to help older children, and that a service development focus should be on the younger children as this point.
调查耳鸣和/或听觉过敏的儿童及青少年是否会前往耳鼻喉科（ENT）诊所就诊，并报告这些儿童的临床数据、治疗及转诊模式。描述在教育心理咨询服务机构（EPA）和成人特殊教育中心（CEA）中发现的患有耳鸣和/或听觉过敏的儿童及青少年群体，并确定在这些机构中针对儿童所采用的转诊模式及干预措施。
2014年6月至2015年2月在15家耳鼻喉科诊所开展了一项前瞻性研究。报告了所有以耳鸣和/或听觉过敏为主诉的儿童。在诊断、治疗或转诊方面未改变日常做法。在丹麦的每个市镇和地区，对2009年1月1日至2013年12月31日这五年期间进行了回顾性病例审查。
在前瞻性耳鼻喉科研究中，确定了12名儿童；在回顾性CEA/EPA研究中，确定了69名儿童。耳鼻喉科诊治的12名儿童（8名女性和4名男性）年龄在5.7岁至14岁之间。CEA/EPA诊治的69名儿童中，大多数（n = 50，72.5%）被诊断为以耳鸣为主诉。9例（12.8%）以听觉过敏为主诉，11例（15.7%）同时报告有耳鸣和听觉过敏。本研究结果表明，大多数患有耳鸣和/或听觉过敏儿童在为成人听力康复设计的机构中就诊。咨询，包括对应对策略的解释和讨论，是最常报告的干预措施。11例（15.9%）采用了与成人耳鸣管理指南相符的干预方法。
总体而言，在该系统中仅发现少数患有耳鸣和/或听觉过敏的儿童，这表明这些儿童要么在全科医生层面就诊，要么根本未被转诊。也有可能儿童期令人困扰的耳鸣发病率低于流行病学数据所显示的情况。转诊途径表明对于哪些服务能提供充分干预普遍存在不确定性。本研究表明，在成人耳鸣服务机构（CEA）工作的临床医生总体上具备帮助大龄儿童的技能，目前服务发展的重点应放在低龄儿童身上这一点。
