The Connection Between Hearing Loss and Diabetes

Hearing loss can be a neglected topic of discussion in the diabetes community, but it is certainly an important one. Research has found hearing loss is twice as common in people with established diabetes, and people with prediabetes have a 30% higher rate of hearing loss when compared to those who don't.

"Hearing loss is more common in individuals with diabetes," says Dr. Shelly Borgia, Doctor of Audiology & Founder of NYC Hearing Associates, PLLC. "The hearing organ relies on good circulation and if circulation is compromised, your hearing may be affected."

Read on to learn more about hearing loss, the causes and risk factors, treatment, and prevention for people who have diabetes.

Hearing Loss and Diabetes

Diabetes is a general term for a disease that impairs the body's ability to metabolize glucose (sugar) either due to insulin deficiency, insulin omission, insulin resistance, or some combination. The most common types of diabetes are type 1 and type 2. The association between hearing loss and diabetes does not seem to be influenced by diabetes type.

Type 1 diabetes, is an autoimmune disease in which the body mistakenly attacks the cells of the pancreas that make insulin. Insulin is a hormone with many functions, and is essential for bringing sugar into our cells to use for energy. People with type 1 diabetes need to take insulin via injection or infusion to maintain normal blood sugar levels.

Type 2 diabetes is a progressive disease and the most common type of diabetes. Type 2 diabetes develops when the body becomes less sensitive to insulin and/or doesn't make enough of it. For many people with type 2 diabetes, their disease can be managed through lifestyle modifications like diet and exercise. However, depending on glucose levels and other health conditions, medication may also be necessary.

The discussion around the connection of diabetes and hearing loss has existed for decades, but research as to why this connection exists is complicated. There are many contributing factors that cause hearing loss in people with diabetes.

Causes

The causes of hearing loss in people with diabetes is complex. Human and animal studies suggest both cochlear (inner ear which translates sound) and nerve loss is related to small vessel disease (microangiopathy), oxidative stress, and cell death (also referred to as glutamate excitotoxicity).

Reduced blood supply or circulation issues can also affect hearing. One of the most common types of hearing loss in people with type 2 diabetes is called presbycusis, a sensorineural hearing loss that is permanent and progressive. 

Hearing loss is more common as you age and prolonged exposure to loud noises can also increase the risk of hearing loss. High and low blood sugar, referred to as hyper and hypoglycemia (both side effects of diabetes) may also increase the risk of hearing loss by damaging nerves.

In the Diabetes Control and Complications Trial Epidemiology of Diabetes and Complications (DCCT/EDIC) cohort, among participants with type 1 diabetes, for every 10% increase in hemoglobin A1c (three month average of blood sugar,) there was a 32% increase in impaired speech perception and a 19% increase in high-frequency hearing loss. Therefore there appears to be a correlation between glycemic control and hearing loss.

Other research suggests that certain types of medications that are prescribed to people with diabetes, such as aspirin, specific antibiotics, and glucose lowering medications, can contribute to hearing loss.

Additionally, other health conditions may contribute to hearing loss. Some of these include diabetic retinopathy and nephropathy; these microvascular complications of diabetes affect the small vessels in the body.

Risk Factors

Age is one of the biggest risk factors for hearing loss. Approximately 1 in 3 people between the ages of 65 and 74 has hearing loss and nearly half of those older than 75 have difficulty hearing. The National Institute of Deafness and Other Communication Disorders reports that age is the strongest predictor of hearing loss among adults aged 20-69, with the greatest amount of hearing loss in the 60 to 69 age group.

Further risk factors include gender, race, economic status, and additional health conditions. Men are almost twice as likely than women to have hearing loss among adults aged 20-69.

Researchers collected data from 536 participants, aged 20–69 years, with diagnosed or undiagnosed diabetes who completed hearing testing during 1999–2004 in the National Health and Nutrition Examination Survey (NHANES). They found that there was a greater likelihood of hearing impairment for those who were older, non-Hispanic White, male, or who have lower income. People with diabetes with low high-density lipoprotein (HDL), a history of coronary heart disease, symptoms of peripheral neuropathy, or those who report poor health also exhibited a greater likelihood of hearing impairment.

Whether or not glycemic control, both hyperglycemia and hypoglycemia increase the risk of hearing loss is conflicted. Some research suggests that glycemic control (high or low blood sugars) is associated with an increased risk of hearing loss, while other researchers did not find an association in hearing impairment with hyperglycemia and diabetes duration.

Diagnosis

Hearing loss can happen slowly, and family members may pick up changes in your hearing before you do. Problems with hearing can impact your balance and your quality of life by making it harder to hear in noisy places and asking others to repeat themselves.

If you are concerned about your hearing or the hearing of a loved one, you should consult with an audiologist. An audiologist will conduct a full workup to evaluate your hearing and balance. They can also assist you with treatment options.

Dr. Borgia recommends having a hearing test at any age. "It is important to know your personal hearing levels. At a minimum, everyone ages 50 and older should have their hearing tested because 1-out-of-10 individuals are affected by age-related hearing loss."

Treatment

Treatment for hearing loss should be individualized and will depend on the type of hearing loss and severity. Some treatments options include:

• Hearing aids
• Tinnitus maskers
• Vestibular repositioning
• Rehabilitation

Prevention

People with diabetes may be able to prevent hearing loss by:

• Keeping their blood sugars in good control
• Maintaining a healthy diet
• Moving their body regularly
• Getting annual checkups
• Evaluating their medications
• Refraining from high noise exposure

A study suggest that adopting a Mediterranean style of eating may help to prevent hearing loss.

When to See a Healthcare Provider

If you have diabetes and have never seen an audiologist, you should have a baseline assessment of your hearing and follow up annually or every two years for reevaluation. In addition, "Everyone who has had any type of concern about their hearing such as fullness, tinnitus, noise exposure, or pain should see an audiologist or ear nose throat doctor," says Borgia.

A Word From Verywell

There are many reasons why people with diabetes can develop hearing loss, some are in your control and others are not. But the good news is that hearing loss can be prevented and treated.

Maintaining good glycemic control has an impact on your overall health and can reduce the risk of all complications of diabetes. If you need assistance in getting your blood sugars in a healthy range, reach out to your medical team and consider meeting with a Certified Diabetes Care and Education Specialist. They can help you create an individualized treatment plan that addresses lifestyle modifications such as diet and exercise, as well as medication management, and prevention and treatment of high and low blood sugars.

If you are age 50 or older and never seen an audiologist, you can schedule a screening. Even if you don't think you have any issues with your hearing, early screening can assist in prevention.