Can You Hear Me? Diabetes and Hearing Loss

Hearing health is an important, yet often overlooked, aspect of diabetes management, and proactive screenings can significantly enhance a person’s well-being. People with diabetes must be screened for hearing loss to treat any level of hearing issues early and improve their overall quality of life.

The Importance of Hearing Screenings for People with Diabetes

Every clinician or member of a diabetes care team who interacts with a person with diabetes should ensure that the person had a hearing screening at diagnosis and follow-ups as indicated by an audiologist. Have you been screened for hearing loss?

According to the Centers for Disease Control and Prevention (CDC) National Diabetes Statistics Report, 38.4 million people in the United States are diagnosed with diabetes. According to the NIH, about 37.5 million people live with hearing loss. For people who have prediabetes, the rate of hearing loss is 30% higher, and for those who live with diabetes, it is twice as common as for those who do not have diabetes. Hearing loss for a person with diabetes often presents earlier than in those without diabetes, and the risk increases when that person also has co-conditions, such as neuropathies, high blood pressure, and cardiovascular disease. And for women, keep in mind that gestational diabetes increases the risk of cochlear damage, which shows significant high-frequency hearing loss. High-frequency loss might include the inability to hear birds chirping, a vacuum cleaner, a fire alarm, or an airplane taking off.

Screening Tools and Self-Assessment for Hearing Loss

Did you know that you can take an easy screening assessment called HearScreen, through the Audiology Project: HearScreen — THE AUDIOLOGY PROJECT This only takes 3 minutes or less and can give you a clear answer if you need to see an audiologist immediately.

Additionally, with the following six questions, you can screen for hearing loss now and easily see if you should be referred to an audiologist:

Do you or those around you perceive any change in your hearing?
Do you have hearing difficulties in quiet or in noise?
Have you had your hearing tested in the last two years?
Do you know how diabetes can affect your hearing?
Do you know what to do if you perceive a change in your hearing?
Do you know how to reduce your risk of hearing loss?

Refer to Audiologist if:

You answered yes to #1 or #2
You answered no to #3 or #6

How Diabetes Affects Hearing

You’re probably wondering what happens in the body that leads to problems with hearing loss. The key issue is prolonged elevated blood glucose levels. Just like all the other places in the body where there are small blood vessels (eyes, kidneys, heart, and nerves), there are also tiny vessels in the ear. When glucose levels are elevated, as in prolonged periods of hyperglycemia, the small vessels in the inner ear start to break. Those broken blood vessels then have a drastic impact on the ability to send messages from the ear to the brain. Microangiopathy (disruption of small blood vessels) and neural degeneration (loss of the nerve covering) with diabetes are the factors that can affect the auditory processing of speech in the brain.

These factors will interrupt the auditory signal as it passes from the ear, through the brainstem, to the auditory cortex and then the prefrontal and frontal lobes of the brain. This may result in auditory processing issues that must also be assessed and treated, in addition to hearing loss.

Essentially, communication is disrupted. What’s even more important to know is that the longer hearing loss is untreated, the longer a person struggles to process speech. The longer this happens, the more rehabilitation it takes to regain the ability to process speech and normal communication.

Rehabilitation and Support for Hearing Loss

If you experience hearing loss, you should share with your loved ones that as you regain the ability to process and communicate, you want them to slow down (not talk louder) and give you a chance to process what they’ve said. You also want them to make sure they’re looking directly at you when they talk so that you can see their facial expressions, watch their lips move, etc. Hearing loss can cause drastic amounts of fatigue due to how hard it is to listen, process, and understand. As the hearing loss is rehabilitated, this will get easier and less overwhelming.

This is why people who have prediabetes and diabetes really need to advocate for hearing screenings at diagnosis and at least every two years unless your audiologist indicates that you have a level of hearing loss and need more frequent check-ins to be sure your treatment plan is right for you.

The Role of Diabetes Care Teams in Hearing Health

The reason why these regular screenings are so important is because hearing loss doesn’t happen abruptly. It is gradual and could go unnoticed for years. The key thing to remember is that although you may feel uncomfortable bringing up any signs that your hearing may be affected by prolonged hyperglycemia, your diabetes care team is there to help! Diabetes Care and Education Specialists (DCES) and healthcare team members are poised to screen and advocate for treatment for all people with diabetes. These screenings are simple! The key to treatment is ensuring that your diabetes care team has an audiologist available for referral once a screening indicates audiology intervention is necessary. Find an audiologist in your area at www.audiologist.org/resources/patients/find-an-audiologist.

Understanding Hearing Loss Levels

The level of hearing loss is measured by decibels. My favorite way to really understand what a person with hearing loss can and can’t hear is outlined in the Down’s Audiogram, which can be found here. The great thing about this graphic is that people with hearing loss can look at this and understand what they can and can’t hear.

Treatment Options for Hearing Loss

In 90% of people treated for hearing loss, the treatment is hearing aids. It is easier now than ever before to get hearing aids, but it’s important to be sure they are fitted by an audiologist to be comfortable and at the correct settings. Each of them needs to be customized to the person wearing them. Once that is complete, a person can feel more empowered to increase socialization and interaction.

Other Factors Contributing to Hearing Loss

Beyond diabetes, chronic diseases and some medicines cause hearing loss. Not only diabetes but also cardiovascular issues, kidney problems, and thyroid issues must be monitored for hearing problems at the time of diagnosis and annually.

What is important is that when asked, people will rarely admit if they have hearing loss or observe or guess that there is hearing loss. A valid online hearing screening will give the most accurate information about current hearing levels and the need for a referral to audiology.

Hearing Assessments in Underserved Populations

One specific underserved population is those living in assisted living. In 1987, there was a mandate for hearing assessments within four days of admission to a skilled nursing facility and annually. One example is the current laws in North Carolina, which mandate a hearing assessment within 14 days of admission.

If you’re wondering why these hearing screenings are so important, keep in mind that they can help to rule out various misdiagnoses. Cognitive evaluations of adults must first include a hearing assessment since hearing loss appears as a cognitive issue. Additionally, per a Lancet report, hearing loss is a modifiable risk factor for Alzheimer’s.

Ototoxic Medications and High-Risk Factors

Ototoxic medications for infection, cancer chemotherapy, loop-inhibiting diuretics, and pain management raise the need for monitoring hearing as a baseline, every two weeks and then six months after cessation of the medication.

High-risk factors for ototoxicity include 1) impaired renal function, 2) prolonged treatment course, 3) advanced age (over 65), 4) previous aminoglycoside therapy, 5) sensorineural hearing loss, and 6) occupational noise exposure while taking these medications.

Any noise exposure from guns, lawnmowers, leaf blowers, and work in noisy settings can damage hearing. Head trauma from falls and accidents can also contribute to hearing damage.

The Benefits of Treating Hearing Loss

The overall outcomes of hearing loss treatment are largely focused on improved quality of life. The biggest benefits are decreased fatigue, decreased frustration and depression, and less social anxiety caused by the fear that others are talking about you. Lastly, the benefits from all of the above are overall blood glucose management and decreased risks for additional complications.

Take Action Today

If you are reading this article, we encourage you to act. Get Screened. Talk to your healthcare team about getting a hearing test. Please encourage your loved ones and friends to get screened as well. This will improve your quality of life!