Diabetes and
Hearing Loss
Purpose of Presentation
 To make diabetes educators aware of the link of
diabetes to hearing loss and the need for
intervention:
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Hearing loss and chronic disease/ototoxic meds
Why does hearing loss occurs with diabetes
What is the impact of hearing loss on quality of life issues
What are the recommendations for Patients with Diabetes,
in light of hearing loss
Chronic Disease with Secondary Hearing Loss
 A. Diabetes
 B. Thyroid disease (hypothyroidism)
 C. Multiple sclerosis
 D. Chronic Renal Disease
 E. Cardiovascular Disease
 F. Alport’s Syndrome
 G. Paget’s Disease
 H. Cogan’s Syndrome
 I. Dementia
Chronic Kidney Disease & Hearing Loss
 Association of CKD & Hearing Loss
Known for Decades
 Kidney & Stria Vascularis of Cochlea
Share Physiologic, Ultrastructual and
Antigenic Similarities
 Diabetes Often Results in Chronic
Renal Disease
 Therefore, the Link Between Diabetes
and Hearing Loss May Be Indirect but
Exists
Vasculature of the Ear
Blood Vessels of the
Inner Ear
Arteries of the Middle
Ear
Comorbidity of Diabetes and other Health Issues
 Heart Problems
 Balance Issues
 Vision Impairment
 Hearing Loss
 Neuropathy/Pain Management
Medicines and Your
Diabetes Patients
PAIN MANAGEMENT
INFECTION CONTROL
HORMONE REPLACEMENT
FLUID RETENTION
CANCER CHEMOTHERAPY
WHO IS CHECKING YOUR PATIENT’S
HEARING WHEN THEY USE THESE
MEDICINES?
Ototoxic Drugs
 A. Aminoglycoside Antibiotics (mycin drugs)
 B. Loop Inhibiting Diuretics (lasix, furosemide)
 C. Salicylates (aspirin, darvon, darvocet)
 D. Cancer Chemotherapy
 Hormone Replacement treatment
 E. Quinine
Diabetes and Hearing Loss
 In people age 60 and older with type 2 diabetes:
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High blood sugar causes tiny blood vessels in the inner ear to break,
disrupting sound reception.
Associated balance problems may come from neuropathy
Mechanisms related to neuropathic or microvascular factors,
inflammation, or hyperglycemia may be mediating the association of
diabetes and hearing impairment (Bainbridge et al, 2010)
Significant hearing differences were at all
frequencies for NIDDM subjects, but for IDDM subjects,
differences were at 1,000 Hz and below, and
10,000 Hz and above (Austin et al, 2009)
Detection, Identification,
Diagnosis and Treatment of
Hearing Loss
FIRST STEP: SCREENING IN YOUR OFFICE
SECOND STEP: REFER TO AN AUDIOLOGIST
THIRD STEP: TREATMENT AND FOLLOW UP
FOURTH STEP: GETTING USED TO A NEW
WAY OF HEARING
Effects of Untreated Hearing Loss
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embarrassment, fatigue, irritability
tension/stress
avoidance of social activities
withdrawal from personal relationships
depression, negativism
danger to personal safety
social rejection by others
impaired memory and ability to learn new tasks
Poor job performance and reduced earning power
Diminished psychological and overall health
(Better Hearing Institute, 2009)
Auditory Deprivation
 Although we hear with our ears, it is the brain that
is the true hearing organ
 Over time, the brain’s ability to understand speech
is often affected by hearing loss
 Once the ability to understand is lost, that ability
can be difficult, if not impossible, to regain
 Wearing hearing instruments can assist the brain
in keeping the ability to understand from being lost
Recommendations for Monitoring Hearing
 Get a hearing test when first identified with diabetes
 Ongoing assessment of hearing levels at least once a
year
 Encourage use of hearing aids if recommended
 Seek an audiologist for comprehensive hearing
services and monitoring
Improved Hearing Means:
 Better family relationships and communication
 Less isolation and less prone to depression
 Better job performance
 More energy/less stress
 Better quality of life: involvement in church, family
and group activities
Your Audiologist will:
 Knows Your History & Meds
 Watch For Otologic Complications
 Refer to Primary or Specialty Care
 Reinforce the Team Goals with Diabetes Educators
 Swift Intervention for Malignant Otitis
NC Diabetes State Plan
 Clinical Interventions
 “Improve screening for and management of diabetes by
encouraging healthcare providers to follow ADA guidelines,
and include oral health and auditory screening as part of
baseline assessments for people with diabetes.”
 Counseling and Education
 “Raise awareness about diabetes uncommon co-morbidities
including hearing loss and sleep apnea.”
Resources: Hearing Screening
 Questionnaires
 Patient
 Spouse
 Test Equipment
 Automated
 Whisper test/Word test
Resources: Audiologists in NC
 http://www. ncboeslpa.org
 http://webportal.audiology.org/Custom/FindAnAud
iologist.aspx
 http://www.audiologist.org/audiologist-directorysearch