In the last couple of years, many important studies have emerged linking hearing loss to diabetes among other health conditions. This connection is referred to as a “comorbidity,” which can be defined as the simultaneous occurrence of two or more chronic conditions in a patient. According to the NIH (National Institute of Health), approximately 15% of American adults (37.5 million) aged 18 and over report some trouble hearing, approximately 9.4 % of Americans (30.3 million) have diabetes, and 33.9% of American adults (84.1 million) have prediabetes. It is unknown how many people have both hearing loss and diabetes, but from these statistics, it is safe to assume that it is a common comorbidity.
For the diabetic and hearing loss patient the common question is: “Will my hearing get worse?”
Most cases of sensorineural hearing loss progress gradually. You have the best chance of keeping your hearing stable when you take care of your overall health and thus keep your blood sugar stable.
According to the National Institutes of Health (NIH, 2008), people with diabetes experience hearing loss at twice the rate of those without diabetes. People with pre-diabetes have a 30 percent higher rate of hearing loss. The NIH findings derive from the National Health and Nutrition Examination Survey (NHANES) of adults aged 20 to 69. Signs of diabetes-associated hearing loss were detected in study subjects as early as age 30.
This assumption of higher rates of hearing loss among the diabetic population is further supported with a study from Horikawa et al., 2013. This study combined data from multiple studies from 1950 to 2011 and concluded that people with diabetes have twice the risk of hearing loss. The higher prevalence of hearing loss in individuals with diabetes remained after controlling for age and noise exposure.
The Diabetes and Ear Connection
Diabetes is a metabolic disorder that results from difficulties producing and using insulin. Cells in the body no longer make efficient use of carbohydrates, fat, and proteins present in the bloodstream. These nutrients accumulate in the body, causing damage to blood vessels and organs (Parker, 2009).
The inner ear, called the cochlea, receives blood supply from the labyrinthine artery. This artery branches off the anterior inferior cerebellar artery which originates in the basilar artery. The basilar artery communicates with the vertebral arteries in the neck.
In the cochlea, a structure called the stria vascularis maintains the chemical composition of endolymphatic fluid. This chemical makeup enables the proper function of hair cells along the basilar membrane. As you may recall from a high school or college biology class- or a quick anatomy lesson from your friendly local audiologist- cochlear hair cells respond to sounds and generate the signals that travel up the auditory nerve towards the brain.
Any disorder that affects the vascular structures supplying the ear will potentially damage hearing. Usually, the hearing loss progresses gradually as diabetes slowly damages blood vessels. Patients may not initially recognize the change in hearing sensitivity. Family members may be the first to notice difficulties with a patient’s hearing. Regular hearing tests can help monitor changes over time.
However, note that people with diabetes have an increased risk of sudden sensorineural hearing loss (Parker, 2009). Sudden sensorineural hearing loss is an emergency. If a patient with diabetes notices a sudden drop in hearing, the person needs to see an Ear, Nose, and Throat (ENT) physician as soon as possible. Prompt ENT treatment with steroids can sometimes result in recovery of auditory function. Be sure to use the phrase “sudden hearing loss” when calling the ENT office to ensure priority scheduling.
Hearing Loss/Diabetes and Brain Connection
A complex system of neurons relays auditory information from the ears to the brain. Once the auditory cortex has received the signal, other parts of the brain cooperate in interpreting and responding to the sounds. Measurements have shown that people with diabetes show delayed responses along the auditory pathway from the inner ear to the upper level of the brainstem (Sanju & Kumar, 2016). Auditory neural deficits will lead to increased difficulty understanding rapid speech, hearing in background noise, and overall clarity of sound.
Researchers have found evidence that patients with diabetes have greater auditory processing challenges than those without diabetes. In older adults, these deficits appear independently of general cognitive deficits (Humes, 2016).
The QuickSIN is a test of a person’s ability to process speech in noisy environments. People with diabetes obtain worse QuickSIN scores, suggesting declines in brainstem and cortical auditory processing (Sanju & Kumar, 2016). Due to these findings, for those that use hearing aids, assistive technology (remote microphones, TV devices, etc) may also be recommended.
Our Top Eight Recommendations for Patients With Diabetes
As partners in your health care journey, we support the work of your other care providers. If you have diabetes, we recommend that you:
- Make sure that all health professionals know about your diabetes diagnosis. Even your dentist may need to modify procedures.
- Follow the advice of your physicians and diabetes educator. They love to improve patients’ quality of life.
- Take your medications as prescribed. They will not work well if you skip doses.
- Schedule regular vision, hearing, and podiatry checkups. Your ears, eyes, and feet work together to help you keep your balance. When you have problems in one of these areas, you have an increased risk of falls.
- Eat a healthy diet that helps you control your diabetes. Consult with a dietician if needed.
- Exercise regularly. Your physician should be consulted before you begin a new workout program. With professional supervision, include exercises that strengthen your balance.
- Abstain from using cotton swabs and other objects to clean your ears. Not only do you push wax further down your ears, you also risk abrasions of the delicate ear canal skin. You are more susceptible to infections if you have diabetes.
- If you have hearing difficulties, consult with us about hearing aid options. Wear your hearing aids regularly. If diabetes-related neuropathy has decreased your touch sensitivity, we have options to make it easier to insert and adjust hearing aids. Consider remote microphone technology and directional microphones to overcome auditory processing difficulties.
American Diabetes Association. Living with diabetes.
Arlinger, S. (2003). Negative consequences of uncorrected hearing loss- a review. International Journal of Audiology, 42, 2S17-2S20.
Howikawa, C., Kodama, S., Tanaka, S., Fujihara, K., Hirasawa, R., Yachi, Y., … Sone, H. (2013). Diabetes and risk of hearing impairment in adults: A meta-analysis. The Journal of Clinical Endocrinology and Metabolism, 98, 0000-0000.
Humes, L. E. (2016). "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399752/" A retrospective examination of the effect of diabetes on sensory processing in older adults. American Journal of Audiology, 25, 364-367.
National Institutes of Health (2008, June 16). Hearing loss is common in people with diabetes. Retrieved from "https://www.nih.gov/news-events/news-releases/hearing-loss-common-people-diabetes".
Parker, P. (2009). Diabetes and hearing loss. Audiology Practices, 2, 22-23.
Sanju, H. K., & Kumar, P. (2016). HYPERLINK "http://www.hearingreview.com/2015/12/annual-audiological-evaluations-mandatory-patients-diabetes/" Annual audiological evaluations should be mandatory for patients with diabetes. Hearing Review, 23, 14.
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