title: Tinnitus in adolescents: the start of the vulnerability of the auditory pathways.
abstract: BACKGROUND
  Although tinnitus is an increasingly common symptom, few studies have assessed its prevalence or incidence among adolescents.
  
  
  OBJECTIVE
  To assess whether the presence of tinnitus in adolescents is associated with minimal hearing damage, evaluated through high-frequency audiometry (HFA), otoacoustic emission (OAE), and loudness discomfort level (LDL).
  
  
  METHODS
  The sample comprised 168 adolescents of a private school (61.3% boys; mean age 14.1 years old; standard deviation=2). All of them completed a questionnaire about tinnitus and hypersensitivity to sounds (sound intolerance), and then underwent otoscopy, pure-tone audiometry, HFA, LDL, transient and distortion product otoacoustic emissions (TOAE and DPOAE), and tinnitus pitch/loudness matching (the latter only in those with tinnitus). Participants were later divided into three groups: with no tinnitus (n=73, 43.4%), with sporadic tinnitus (n=47, 28%), and with constant tinnitus (n=48, 28.6%).
  
  
  RESULTS
  No significant difference was observed between the groups regarding audiometry thresholds in frequencies from 0.25 to 16 kHz, or TOAE and DPOAE. However, the LDL in adolescents with constant tinnitus was significantly lower than that in other groups, suggesting hypersensitivity to sounds.
  
  
  CONCLUSIONS
  There was no evidence of minimal hearing damage in the audiometry and OAE. Nonetheless, the decreased LDL in adolescents with constant tinnitus suggests that their auditory system is more sensitive. Therefore, this may be the first sign of vulnerability to sounds. Future medium- to long-term monitoring of these students may show whether they will begin a process of functional impairment, altering hearing thresholds, and OAE.
authors.affiliation: Instituto Ganz Sanchez, São Paulo, SP, Brazil.
authors.forename: Tanit Ganz
authors.initials: TG
authors.lastname: Sanchez
authors.affiliation: Instituto Ganz Sanchez, São Paulo, SP, Brazil.
authors.forename: Juliana Casseb
authors.initials: JC
authors.lastname: Oliveira
authors.affiliation: Instituto Ganz Sanchez, São Paulo, SP, Brazil.
authors.forename: Márcia Akemi
authors.initials: MA
authors.lastname: Kii
authors.affiliation: Associação de Pesquisa Interdisciplinar e Divulgação do Zumbido, São Paulo, SP, Brazil.
authors.forename: Katya
authors.initials: K
authors.lastname: Freire
authors.affiliation: Instituto Ganz Sanchez, São Paulo, SP, Brazil.
authors.forename: Jaci
authors.initials: J
authors.lastname: Cota
authors.affiliation: Instituto Ganz Sanchez, São Paulo, SP, Brazil.
authors.forename: Fernanda Vieira de
authors.initials: FV
authors.lastname: Moraes
mesh_terms: D000293:Adolescent; D001309:Auditory Threshold; D001938:Brazil / Q000453:epidemiology; D005260:Female; D034381:Hearing Loss / Q000517:prevention & control; D006801:Humans; D008297:Male; D017084:Otoacoustic Emissions, Spontaneous; D014012:Tinnitus / Q000175:diagnosis* / Q000503:physiopathology