Diabetes and Hearing Loss
By Hope Warshaw
Less-than-ideal blood glucose levels can cause nerve and circulatory damage in the ears over time and result in hearing loss and, potentially, balance issues. There are steps you can take to prevent, detect and manage these complications.
It's estimated that 48 million people in the US have hearing loss, yet just 20 percent of these people have been diagnosed and treated. Uncorrected hearing loss can make a person seem confused and inattentive to what’s happening around them. It can make a person feel depressed, isolated, lonely or anxious.
According to the CDC, people with diabetes are more likely to develop hearing loss and should get their hearing checked often. Below you will find tips on choosing hearing aids, should you need them, and learn how one audacious audiologist has been advocating relentlessly to get the link between hearing loss and diabetes recognized globally.
Basics of Diabetes-Related Hearing Loss
People can experience hearing loss for lots of reasons including aging or having spent a lot of time around loud noises over many years. While people with diabetes, and even prediabetes, may develop hearing loss for these reasons, they also may experience hearing loss due to having high glucose levels over a long period of time.
Hearing loss, both in the high and low frequency range, is twice as common in people with diabetes in people of the same age. “Cardiovascular issues, congestive heart failure and/or kidney disease — all common in people with diabetes — may also impair hearing over time,” says Kathy Dowd, audiologist and executive director of The Audiology Project, based in Charlotte, North Carolina.
Glucose levels that are regularly too high or too low, along with out-of-range blood lipid levels, and high blood pressure over the years, can damage the small blood vessels and nerves in the inner ear. Damage specifically takes place in the cochlea, part of the ear that plays an essential role in how sound is heard.
Six Signs of Hearing Loss
Loss of hearing can occur slowly and over time. People you spend time with may notice and ask you about your hearing before you realize it’s a problem. Use these six signs of hearing loss to do your own self-check.
Regularly asking people to speak louder
Trouble hearing people or children with soft voices
Difficulty following conversations with multiple people
Turning up the volume on the TV or other listening devices to hear or being told that the volume is too loud
Assuming people who are talking to you are mumbling
Difficulty hearing in noisy places, restaurants, public transportation, etc.
If you have some or all of these signs of hearing loss, get your hearing checked. In fact, the CDC recommends that people with diabetes get their hearing checked at diagnosis and then annually.
“People who are at particularly high risk of hearing loss are those with prediabetes or diabetes who have had high blood glucose levels over long periods of time, are over the age of 60, and have overweight or obesity (BMI over 25),” said Susan Weiner, owner of a private nutrition practice based in New York focused on diabetes, and author of the well-known “Diabetes in Real Life” column for Endocrinology Today.
How to Check Your Hearing
Start with an online hearing loss screening tool, like HearScreenUSA (also recommended by CDC) to detect whether you have a problem. If you fail the screening, talk to your healthcare provider about seeing an audiologist, who can assess your hearing, auditory processing and ability to hear people speaking in noisy situations.
“An audiologist should also ask about your medical history and recommend next steps, such as the need for hearing aids, medical follow up and/or how often to get your hearing checked in the future,” Dowd said.
Regarding insurance coverage for a hearing loss evaluation, Medicare and private health plans will generally cover an annual hearing test if there is a medical need, such as a diagnosis of diabetes. Request a referral from your healthcare provider. Most audiologists are Medicare providers and will bill for the basic hearing tests.
“You may need additional tests which may be out of pocket expenses,” Dowd said. Ask about the potential out of pocket costs before they’re (anything is) done.
Hearing Aid Basics
Selecting the right hearing aids for you can be challenging. Here are a few basics. “For starters note there’s a range of technology, devices and associated service with a range of pricing,” Dowd said.
Hearing aid technology continues to improve. Today some hearing aids offer the ability to link directly to your phones and/or automatically reduce background noise in a restaurant or other group settings. Some hearing aids can link loop (hearing loop) to a T-coil (telecoil) available in some public places, such as religious venues, train stations or sports arenas. (The T-coil acts as a receiver for the user.) Since hearing aids today can be programmable, any changes in your hearing over time can be corrected by the audiologist with a simple change in the programming.
Dowd notes that any hearing aid will lead to a significant improvement in a person’s ability to hold a conversation, perform well in a classroom or work setting, and/or easily participate in social events.
Recently the FDA allowed the sale of over the counter (OTC) hearing aids. “They will only help someone who believes they have hearing loss, but most people can’t properly diagnose their hearing loss,” Dowd advised. “If a hearing evaluation by an audiologist shows mild or moderate hearing loss and no issues understanding speech in quiet or noisy environments, purchasing an OTC hearing aid can be a great choice.”
Tips to Protect Your Hearing
Get your hearing checked at diagnosis of diabetes, then again annually
Ask your healthcare provider about whether any of the medications you take can damage your hearing, and if so, discuss alternatives. “Some medications may damage the ear and cause hearing loss, ringing in the ear or balance disorders,” says Weiner. On the list are a few antibiotics, diuretics, salicylates (aspirin, acetaminophen), and some chemotherapies.
Wear ear protection around loud noises like lawn mowers, leaf blowers, and chainsaws.
Reduce background noise – music, vacuum cleaner, and/or crowd noise/talk
Minimize exposure to recreational noise (personal listening devices), occupational noise
Don’t clean your ears with cotton swabs, pencils or paper clips.
If you have been diagnosed with diabetes and have not had a hearing test, get a baseline check. Then get your hearing checked annually. If you have signs of hearing impairment, get your hearing checked by an audiologist. If you are diagnosed with hearing impairment, take the next steps, whether it is a change of medication, treatment for a health condition and/or purchasing hearing aids. If you have signs of balance issues, share this with your healthcare provider and put an action plan in place.
About Balance and Diabetes
The ear is the site of the vestibular system, or the system that provides the brain information about motion, head position, and coordinating movement with balance. This system can also be damaged by high glucose levels over time. The concern with balance issues is the increased chance of falling and incurring an injury. A fall, particularly for a person with diabetes who may have peripheral neuropathy, decreased peripheral circulation, and/or diabetes-related eye disease (retinopathy), can lead to other problems that affect quality of life and could require a long road to recovery.
Signs of Balance Issues include:
Regularly feeling dizzy, lightheaded, or like your head is spinning
Frequently falling or feel like you may fall
If you’re having signs of balance issues, alert your healthcare provider. They have ways to assess your balance and your vestibular system. An audiologist can check your balance as part of a hearing assessment.
“Treatment recommendations for balance issues can be made based on the test results,” said Dowd.
As is true for the prevention or delay of most diabetes-related problems, there are actions to take daily, like keeping your glucose, blood pressure and lipids well managed. Also, practice self-care behaviors like healthy eating, being physically active, glucose monitoring, not smoking, etc., as often as possible.
Healthcare Provider Spotlight - Profile in Determination
Kathy Dowd, has been an audiologist for nearly 45 years. She ran a private audiology practice for 21 years in addition to working in schools and state agencies around North Carolina. Dowd recalls back to 1993 when she, as a Medicare provider, was instructed to always have a medical reason for testing a person’s hearing.
“Diabetes was most definitely on this list,” she said. Research publications dating back to the 1970s have and continue to make the link between hearing loss and diabetes.
Fast forward to 2011 when Dowd, bound and determined, made contact with a diabetes expert at CDC. Dowd was told they were unaware of this link. As a result, her one-woman campaign to connect the dots between diabetes and hearing impairment went into overdrive. Roughly five years later, in 2016, CDC experts were ready to make the connection. Dowd encouraged several audiology associations to engage in this work with CDC, where they jointly developed educational materials on diabetes and hearing loss.
Since 2012, Dowd has been collaborating with the Association of Diabetes Care and Education Specialists (ADCES) to educate diabetes care and education specialists (DCES) through publications and presentations. Conversely, Dowd has raised awareness among audiology colleagues about the role of DCES and reimbursement for their valuable services.
To further her work, Dowd started a nonprofit organization, The Audiology Project (TAP). TAP, initiated in 2016, is set up as a nonprofit to advocate for hearing and balance health in people with diabetes. Through TAP, Dowd has enlisted other healthcare provider organizations (e.g. pharmacists, podiatrists, optometrists and dentists), to learn about the increased incidence of hearing loss and balance issues in people with diabetes.
Dowd is not stopping. “Now with the recognition and guidelines developed by CDC, the work begins to educate healthcare providers who care for and counsel people with diabetes about the need to screen for hearing and balance impairment across the globe,” she said. This work, Dowd notes, “May take another 10 years.”