Contributor: Chris Memering, BSN, RN, CDE

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Hearing impairment is much more common in those with diabetes than without diabetes. Research shows diabetes increases the risk for hearing sensorineural loss in a way similar to the effects of other neuropathies through demyelination of auditory nerve fibers causing damage. In addition microvascular changes can occur in the cochlea that create thickening of blood vessels causing changes in blood flow and further damage to the nerves of the inner ear. (Rinker, 2014; Disogra, 2017) Hearing loss does not increase the risk for diabetes, however, this complication can make management difficult due to problems understanding verbal instructions. It can also cause increases in fatigue, depression, and stress due to trying to understand what is being said in everyday life, as well as in health care related interactions. (Disogra, 2017)

When hearing loss occurs due to sensorineural loss, what is lost is the ability to comprehend speech, especially the longer the duration of the impairment, and this can be progressive if not treated. (Rinker, 2014) Disogra (2017) describes well how to help when educating those with diabetes and hearing loss. He suggests the following (p34 & 36):

• Be patient
• Establish good eye contact
• Speak slowly and clearly
• Stay in the room
• Say the person's name first
• Announce each topic
• Don't jump from topic to topic
• Use short, direct sentences

These strategies allow the person receiving the education to focus in on what is being taught. People with diabetes and hearing loss may also want to request that instructions from their appointments be in written form, which may be a better way to refer to the information.

Education on the impact of hearing loss on quality of life should also be incorporated. Fatigue, frustration, and depression are all emotional effects of hearing loss. With hearing loss, the person must work harder to hear, comprehend, and process the words being used. Treating hearing impairment, as well as tightening glucose management to help prevent faster progression of loss, can help to ease these social and emotional effects.

As hearing loss is twice as common in those with diabetes, especially when other neuropathies, hypertension, and cardiovascular disease exist (Morrison, Morar, Morrison, Purewal, & Weston, 2014), screening for hearing difficulties is recommended at visits. Administering hearing tests at diagnosis and repeating annually may lead to further evaluation with an audiologist. (Disogra, 2017) Written screenings such as the Hearing Handicap Inventory for Adults (Disogra, 2017) or Hearing Handicap Inventory for the Elderly (Rinker, 2014) can be quick tools to help assess the need for further follow-up. However, remember that friends and family usually notice an issue first and that denial is a huge barrier to seeking care and may need to assist in the screening. It is important when working with people, both professionally and personally, to help people understand the physical, social, and emotional effect of hearing loss. Showing the empathy of understanding how hard living in a world where communication isn't as clear as it used to be can help to overcome the barrier of denial.

This education/communication is, of course, easier to do as a nurse working with a patient, or at least it has been in my personal experience, than a daughter-in-law nurse and a father-in-law with hearing impairment who refuses to seek treatment.

References:
Disogra, R.M. (2017). Hearing Loss in Diabetes: Communication Strategies. AADE in Practice; 32-37.

Morrison, C.L., Morar, P., Morrison, G., Purewal, T.S., & Weston, P.J. (2014). Hearing Loss and Type 2 Diabetes: Is There a Link? Practical Diabetes, 31(9); 366-369.

Rinker, J. (2014). Hearing Loss: Another Diabetes Complication. AADE in Practice; 42-43.

Chris Memering has been an RN since 2002. She has a Bachelor of Science Degree in Chemistry and Nursing and has worked as an Inpatient Diabetes Educator for the last 10 years and as a Certified Diabetes Educator for the last 8 years. Chris is a member of Sigma Theta Tau, the nursing honor society. Chris is also a member of the Diabetes Advisory Council for the state of North Carolina, and sits on various advisory boards, as well as serving as a board member on the Board of Directors for AADE. Chris is currently in Grad School for a Master’s of Science in Nursing with a specialization in Diabetes Nursing at Capella University. Chris’s favorite holiday is Halloween which her whole family enjoys celebrating and is her eldest child’s birthday. When she is not busy with her two kids or doing her own schoolwork, Chris enjoys kicking back and watching movies.