Diabetes and Its Link to Hearing Loss, Tinnitus, and Balance Disorders
According to the Centers for Disease Control (CDC), more than 37 million people in the United States have diabetes, or approximately 11% of the population. Diabetes is the seventh leading cause of death in the US, and the number-one cause of kidney failure, lower-limb amputations, and adult blindness. Lesser known, however, is the connection between diabetes and hearing loss.
According to the CDC, hearing loss is twice as common in people who have diabetes as it is in people of the same age who don’t.
What is diabetes?
Diabetes is a serious chronic (long-term) medical condition that causes the body’s blood glucose levels—also referred to as blood sugar—to become too high.
After eating, carbohydrates are broken down into glucose, which is absorbed into the bloodstream. The rise in blood sugar levels signals the pancreas to release the hormone, insulin, which helps the glucose enter our body’s cells for use as energy.
For people with diabetes, the pancreas doesn’t make enough or any insulin, or is unable to effectively use the insulin it produces. This means that the glucose from food stays in the blood and doesn’t reach the cells in the body. Over time, having too much glucose in the blood (known as hyperglycemia) can cause damage to the body, increasing the risk of short- and long-term health problems.
Insulin helps blood sugar enter the body's cells so it can be used for energy and also signals the liver to store blood sugar for later use. In people with type 1 diabetes, the pancreas makes little or no insulin; people with type 2 diabetes have bodies that are unable to use insulin properly.
There are four main types of diabetes:
Type 1 diabetes
Type 1 diabetes can develop at any age, though is usually diagnosed in children and young adults. If you have type 1 diabetes, your body produces very little or no insulin. It is thought to be caused by an autoimmune reaction, where the immune system mistakenly attacks the cells in the pancreas that make insulin.
Type 2 diabetes
Type 2 diabetes is the most common form of diabetes, affecting 90-95% of those diagnosed with diabetes in the US. It most often develops over many years and is usually diagnosed in people over the age of 45, although more and more children, teens, and young adults are becoming affected. For people with type 2 diabetes, the body doesn’t make or use insulin well, meaning it cannot maintain healthy blood sugar levels.
In the US, 96 million US adults—over a third of the population—have prediabetes, and more than 8 in 10 of them don’t know they have it. Prediabetes means you have a higher-than-normal blood sugar level, which is not yet high enough to be considered type 2 diabetes.
Gestational diabetes affects 2% to 10% of pregnancies in the US. It develops in some pregnant women who don’t already have diabetes and usually disappears after giving birth. Women who have been affected by gestational diabetes and their children have a greater chance of developing type 2 diabetes later in life.
What is the prevalence of diabetes and hearing loss?
In a 2008 National Health and Nutrition Examination Survey (NHANES) analysis to determine whether hearing impairment is more prevalent among US adults with diabetes, the incidence of hearing loss in diabetes was approximately 30%. Hearing loss was also found to be twice as common in adults with diabetes compared to those who do not have the disease.
Moreover, adults with pre-diabetes have been found to have a 30 percent higher rate of hearing loss compared to those with normal blood sugar tested after an overnight fast.
Further evidence of the connection was found by researchers who analyzed data from 13 studies involving 20,104 participants. They discovered that people with diabetes were more likely to have hearing loss than those without the disease, regardless of their age.
Given that the number of adults diagnosed with diabetes in the last 20 years has more than doubled, awareness of the association between diabetes and hearing loss is key for people with diabetes and physicians in order to monitor any changes in hearing and treat any associated hearing loss in the early stages, limiting the impact on daily life.
How might diabetes cause hearing loss and tinnitus?
According to CDC, over time, high blood sugar levels from diabetes can cause damage to small blood vessels and lead to nerve damage that affects many parts of the body, including your hands, feet, eyes, kidneys, and even your ears. In fact, it’s possible that vascular-related problems may be a root-cause of many of the chronic illnesses associated with hearing loss, including diabetes.
Kathy Dowd, AuD, founder of The Audiology Project (TAP), a non-profit organization that gathers research and advocates for clinical audiology guidelines for patients with diabetes told HearingTracker, “The disruption of small blood vessels and decline of the nervous system affects both hearing and balance organs.”
New Jersey audiologist Robert M. DiSogra, AuD, who writes and lectures on a variety of hearing loss topics notes, “The hearing loss is usually gradual and not complete, generally affecting the higher frequencies which give words clarity.”
Those affected may first start to notice words becoming muffled or begin to experience tinnitus (ringing in the ears). Often, it is family members of the person with hearing loss who notices it first.
The inner ear has two main parts: the hearing organ (cochlea) and the balance organ (semicircular canals). Research shows both can be negatively affected by cardiovascular issues and diabetes.
How might diabetes affect balance?
Though less studied, more evidence is emerging about the effect of diabetes on the balance system.
“The auditory system is a two-part system of hearing and balance.” explains DiSogra. “So, if there's an issue with hearing, there could be an issue with balance.”
According to Dowd, disruption to other parts of the body due to diabetes can contribute to a tsunami of effects, increasing the risk of falls and injury: “In addition to the vestibular (balance) effects. You're losing your eyesight. So, you don't see obstacles in your path. And you have foot neuropathy (nerve damage in your feet), so you don't feel if you’re stepping on something uneven.”
A 2010 NHANES study which investigated the relationship between diabetes and vestibular function found a higher prevalence of vestibular dysfunction in patients with diabetes. For those with diabetes and vestibular dysfunction, the risk of falls was found to be twice as high.
Can diabetes medications impact hearing?
To determine whether diabetes medications may be ototoxic (i.e., potentially cause damage the ear), Dr. Michelle McElhannon, PHARM.D, a clinical pharmacist in Georgia, and DiSogra have recently collaborated on a review for TAP. They looked at all FDA-approved medications for diabetes management, to assess any potential side effects on hearing or balance.
Some medications were identified as having possible side effects such as blurred vision and lightheadedness, which could affect balance. Others were associated with ear congestion and tinnitus. However, DiSogra told HearingTracker, “Out of all FDA approved drugs [at time of review], none of them can exacerbate tinnitus.”
The list of medications can be found on the Education Materials page of TAP.
The CDC recommends all people with diabetes get an initial baseline hearing test at diagnosis followed by annual hearing tests. In addition, periodic hearing screening tests via apps and the internet can also help tip you off to the need for a full diagnostic hearing test.
Should you get your hearing checked if you have diabetes?
Due to the connection between diabetes and hearing loss, CDC recommends you get a baseline hearing test at the time you're diagnosed—whether you feel there is a hearing problem or not. Every year after, you are advised to have another updated hearing test to monitor any changes.
A hearing screening app, HearX, is featured on the TAP website and this can also be found on the CDC website. It is a quick and easy test that gives you a pass or fail and can be used as a first step to checking your hearing on your own.
Dowd explains “If you pass, you can be reasonably sure that both ears are doing okay. But if you fail, then you’ll want to go and get a full diagnostic hearing test.”
What is the value of monitoring your hearing when you have diabetes?
“First of all, recognize that hearing loss is common in people with diabetes,” assures DiSogra. “Then you need to get your hearing evaluated.” He recommends making an appointment with an audiologist who can carry out all the necessary tests to check your hearing and then monitor it over time.
An audiologist can refer you to an ear, nose, and throat doctor (ENT) or balance specialist if necessary, or help you find a suitable hearing loss treatment such as hearing aids, or in the case of more severe hearing loss, cochlear implants.
Loud power tools, music, lawnmowers and snowblowers, firearms, and even some household appliances like vacuum cleaners can emit very high noise levels. Having diabetes makes it even more important to wear earplugs and/or earmuffs.
Helpful tips for conserving your hearing if you have diabetes
The following steps can help you manage your diabetes and limit the risk of developing hearing loss:
Know your numbers
Managing your ABCs, namely A1C (a measure of your average blood sugar levels over 3 months), Blood pressure, Cholesterol, and taking steps to quit smoking can help you monitor your risk of diabetes complications such as hearing loss.
Protect your ears
Christopher Spankovich, AuD, PDH, MPH, Associate Professor, Director of Clinical Research, and Clinical Audiologist at the University of Mississippi Medical Center (UMC), emphasizes the importance of understanding ways to preserve your hearing health. “The patient should be counseled in the use of hearing protection during exposure to very loud noises,” he states. “They should also recognize that if they’re on ototoxic medication, they need to have careful monitoring.”
Medicare pays for 10 hours of diabetes education, where you can learn about healthy eating and controlling your blood sugar levels—a valuable yet underutilized service to which Dowd highlights only 4-5% of people with diabetes are currently referred.
You can find a diabetes education program on the Association of Diabetes Care and Education Specialists (ADCES) website or speak to your doctor who can refer you to a certified diabetes education specialist in your local area.
A final note about diabetes and hearing loss
Our hearing plays a big part in the way we interact with the world and with our loved ones. Hearing loss is associated with loneliness and social isolation, an increased risk of depression, and even cognitive decline. Yet, hearing loss can be easily treated.
If you have diabetes and suspect you might be having trouble hearing, don’t hesitate to make an appointment with your healthcare provider or audiologist. They can help you manage your hearing loss and identify the best treatment option for your needs, reducing the risk of it impacting your physical or mental health, and boosting your quality of life.