Tinnitus prevalence data suggest it may be as common in children as it is in adults and that some children experience tinnitus disorder (clinically significant tinnitus that negatively affects their day-to-day life) [3, 7]. A 2022 systematic review of tinnitus in children and adults by Jarach et al. [8] reported estimates of tinnitus prevalence in children ages 5–17 years ranging from 8.5 to 21% (pooled estimate of 13.0%) and a pooled estimate of ‘severe tinnitus’ in children of 2.7%. Interestingly these estimates were higher than those for young adults (aged 18–44 years, prevalence of 9.7% for ‘any tinnitus’ and 0.4% for ‘severe tinnitus’). The variability of estimates in children and these differences according to age is at least partially explained by the questions asked and definitions of tinnitus used; Jarach et al. concluded that data on tinnitus in children are more prone to different interpretations of the question used to assess tinnitus, that children are perhaps more frequently asked about tinnitus without specifically mentioning it by name, and that it is generally inadequately assessed in paediatric populations. In an earlier systematic review by Rosing et al. [9], children as young as 3 years old were reported to experience tinnitus. The prevalence estimates reported in that review ranged from 4.7 to 46%, higher (from 23.5 to 62.2%) in children with hearing loss, and the prevalence of ‘troublesome tinnitus’ in children varied from 0.6 to 49.2%. A subsequent study by Humphriss et al. [7], which aimed to determine the number of children with clinically significant tinnitus (defined as bothersome tinnitus that is more than seconds in duration), found a prevalence rate of 3.1%, so close to the lower estimates in earlier studies.

Rhee et al. [10] investigated the prevalence of tinnitus and associated risk factors in adolescents, in a nationwide sample of 1593 middle and high school students in South Korea. The prevalence of tinnitus was 46.0% and of severe tinnitus was 9.1%. Associated risk factors were older age, female gender, history of ear infection and sinusitis, leisure noise exposure, gaming, alcohol consumption, and cigarette smoking. Adolescents with tinnitus were also found to suffer more physical and mental health problems than those without tinnitus.

Further prevalence estimates were reported for Danish children aged 10 to 16 years by Nemholt et al. [11]. Their study involved 501 children recruited from eight mainstream schools. Using broad tinnitus questions, they estimated the prevalence of ‘any tinnitus’ to be 66.9%, the prevalence of ‘spontaneous tinnitus’ to be 53.7%, and of ‘noise-induced tinnitus’ to be 35.7%. Furthermore, they estimated that 34.6% and 2.4% of the children with ‘any tinnitus’ had ‘bothersome’ or ‘severely bothersome’ tinnitus. In terms of risk factors, females were nearly three times more likely than males to be bothered by tinnitus, and the odds of having hyperacusis were nearly five times higher in children who reported ‘spontaneous tinnitus’.

The largest prevalence study and arguably the most reliable estimates of tinnitus in a general child population came from Raj–Koziak et al. [12]. They performed audiometry and collected child and parent reports of tinnitus for 43,064 children aged 11 to 13 years old in Poland. They found that 3.1% of children reported tinnitus that was either constant or was experienced regularly and that constant or regular tinnitus was significantly more frequent (9%) in children who had hearing loss. A further 28% of children had experienced tinnitus briefly on occasion.

The prevalence of tinnitus in a clinical child population was estimated in a hospital-based study in Nigeria [13]. Of 2123 children seen in an ear, nose, and throat clinic, 132 (6.2%) presented with tinnitus. Likely causes of tinnitus were identified as febrile illnesses, otitis media, noise exposure, impacted earwax, ototoxicity, or of unknown cause. There was some evidence that prevalence in children increases with age, with the highest prevalence seen in 11–15-year-olds. In a further hospital-based study, the prevalence of tinnitus and hearing loss were determined in a caseload of children with COVID-19 infections [14]. Of the 192 children who recovered from COVID-19, 20 reported tinnitus, 16 reported hearing loss, and eight reported both hearing loss and tinnitus (prevalence was 14.6%). The authors concluded that neurological features like hearing loss and tinnitus can be found in children with COVID-19 infection and that more studies are required to confirm the underlying pathophysiology in children with COVID-19 infection, although their estimates fell well within the range seen in other child populations.

The most recent prevalence study identified the estimated prevalence of tinnitus and hyperacusis and associated hearing abilities and listening behaviours in children aged 9–12 years in Flanders [15]. The study involved a questionnaire distributed to 415 children in four different Flemish schools and determined the prevalence of permanent tinnitus in the sample to be 10.5%. Some children in this study also reported tinnitus causing anxiety (20.1%), problems with sleep (36.5%), and problems with concentration (24.8%). Notable also was that one-third of children reported high levels of daily noise exposure using personal listening devices, and less than half reported ever using hearing protection.

Variations in the prevalence estimates of tinnitus and tinnitus disorder in children likely reflect differences in study design, study populations, and particularly how tinnitus was defined and measured using various unvalidated approaches. There is a clear need for a standardised use of language and of tools that detect tinnitus and detect and measure tinnitus disorder. One further issue that will affect estimates is awareness and reliance on spontaneous reports by the child. A survey of parent knowledge conducted by the British Tinnitus Association (now Tinnitus UK) found that only 32% believed children under the age of 10 can have tinnitus, and only 37% believed it can affect children aged 10–16 years old (patient.info/news-and-features/signs-of-tinnitus-to-look-out-for-in-children). Reflecting this, Raj–Koziak et al. [12] found that, whereas 3.1% of children reported tinnitus, only 1.4% of parents reported that their child had spoken to them about having tinnitus. So, whilst we might work towards a consensus or evidence-driven method of assessing tinnitus and measuring the effects of tinnitus on the child, clinicians and researchers also need to be pro-active in asking the child about their experience of tinnitus.

In terms of pathophysiology, the precise mechanisms underlying subjective tinnitus in children are no more fully understood in children as they are in adults. Research suggests that irreversible cochlear damage, caused by excessive noise exposure, ageing, infection, head and neck trauma, and ototoxic drugs, is a likely trigger for tinnitus. Cochlear damage reduces input from the ear to the auditory brain, causing change in neural connectivity or activity (e.g. cortical reorganisation, increased central gain) which results in tinnitus [16]. This may explain the strong associations seen between hearing loss and tinnitus. Whilst pathophysiology has been theorised and studied relatively extensively in animal models [e.g. 17,18,19], translating into research involving adults who have tinnitus to either test hypotheses derived from animal models or to determine effects of intervention on putative tinnitus-related physiology [e.g. 20,21,22], such lines of study have yet to extend to tinnitus in children.

Hearing loss as a risk factor for tinnitus in children has been demonstrated in some studies, however. In a cross-sectional study on children aged 5–18 years who attended a tertiary care teaching hospital in Eastern India with a primary complaint of hearing impairment, Swain and Baliarsingh [2] examined the relationship between pure tone audiometry (up to 8 kHz) and tinnitus (assessed by questionnaire). Of the 172 children enrolled in the study, 104 self-reported tinnitus, of whom 67 (64.4%) were subsequently diagnosed with hearing loss. Of the 68 children who did not report tinnitus, just nine (13.2%) were diagnosed with hearing loss, indicating a strong association and likely causative factor.

A more extensive evaluation of causative or predictive factors for tinnitus was conducted by Levi et al. [23] in a retrospective chart review of 248 children and young people aged 1–19 years old, who presented with tinnitus in a tertiary paediatric hospital in the USA. Data included demographics, symptoms, historical data, imaging, and laboratory results, and these were compared with normative data. In contrast to some previous studies, their tinnitus sample had the same prevalence of dizziness as the general population, a lower incidence of otitis media, a lower prevalence of Eustachian tube dysfunction, otitis media, and headaches, but a higher incidence of rhinosinusitis. The authors identified the latter as a gap in the literature on tinnitus co-factors. They also suggested imaging children who present with tinnitus and hearing loss, and whether psychiatric diagnoses are associated with tinnitus in younger children as important further lines of research. Their sample had the same prevalence of hearing loss as the general child population. This is in line with some prevalence studies which find hearing loss is not more common in children who experience tinnitus than do not; although as discussed later, evidence is mixed [9].

Furthermore, a neuroimaging review concluded the aetiologies of continuous (as opposed to pulsatile) tinnitus in children are frequently associated with pathologies of middle and inner ear structures including vestibular schwannomas, cholesteatomas, trauma, Chiari malformations, and labyrinthitis ossificans [24, see also for a review of imaging for pulsatile tinnitus in children]. They propose computed tomography and magnetic resonance as complementary in paediatric tinnitus assessment, the former best to evaluate the integrity of the temporal bone structures and the latter to investigate the presence of masses or malformations and assess the vestibulocochlear nerve. Indications for imaging were not specified; although according to the British Society of Audiology (BSA) tinnitus in children guidance [5], these would include pulsatile tinnitus, unilateral tinnitus, or asymmetrical bone conduction thresholds, or suspicion of vestibular schwannomas or palatal myoclonus.

A final study to mention here is one conducted in Serbia examining the relationship between dietary factors and tinnitus in school-going adolescents aged 15–19 years [25]. From 1287 invitees, 1003 respondents completed a tinnitus screener questionnaire and food frequency questionnaire designed for the study. Logistic regression revealed the risk of tinnitus increased with increased intake of white bread, carbonated drinks, and foodstuffs classified as ‘fast food’. In contrast, there was a strong negative correlation between consumption of fresh vegetables and fruits and the presence of tinnitus, i.e. a ‘good’ diet (whether singularly or as part of some combination of factors) appears protective.

In summary, whilst tinnitus and tinnitus disorder appear to be common in children (comparable with rates in adults), estimates vary dramatically, in part due to differences in how it is diagnosed and the need to use age- and ability-appropriate language. Even then there is concern that tinnitus goes undiagnosed or a tinnitus-related issue goes misdiagnosed, e.g. as a problem with auditory processing. Potential risk factors identified in the literature include pathologies of middle and inner ear structures, bone or nerve malformations, rhinosinusitis, and social factors such as poor diet. However, whether these are mediating or moderating factors of tinnitus in children has yet to be modelled.