How To Avoid Hearing Loss With Diabetes
By Hope Warshaw
October is National Protect Your Hearing Month. While glucose levels can impact the ears over time, there are steps you can take to prevent, detect and manage hearing loss.
It's estimated that 48 million people in the US have hearing loss, yet just 20% of people have been diagnosed and treated. Uncorrected hearing loss can make a person seem confused and inattentive to what’s happening around them and has even been linked to cognitive changes. Hearing loss can also make a person feel depressed, isolated, lonely or anxious.
In addition, people with diabetes are more likely to develop hearing loss. Keep reading for more on the link between hearing loss and diabetes, as well as ways to to prevent hearing loss and tips for choosing hearing aids, should you need them.
Signs of hearing loss
Loss of hearing can occur slowly and over time – in fact, people you spend time with may notice before you realize it’s a problem – so it can be helpful to use these six signs of hearing loss to do your own self-check. You may have hearing loss if you:
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Regularly ask people to speak louder
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Have trouble hearing people or children with soft voices
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Have difficulty following conversations with multiple people
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Turn up the volume on the TV or other listening devices to hear, or are often told by others that your volume setting is too loud
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Often think people who are talking to you are mumbling
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Have difficulty hearing in noisy places, such as in restaurants and on public transportation
Risk factors for hearing loss
“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 a BMI over 25,” said Susan Weiner, a New York-based registered dietitian focused on diabetes who writes the “Diabetes in Real Life” column for Endocrinology Today.
Why hearing loss may be related to diabetes
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People can experience hearing loss for a number of reasons, including aging or having spent a lot of time around loud noises over many years. While people with diabetes and prediabetes may develop hearing loss for these reasons, they also can experience hearing loss due to having high glucose levels over a long period of time, typically many years.
Hearing loss is twice as common in people with diabetes compared with people of the same age. Glucose levels that are regularly too high, along with high cholesterol 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, the part of the ear that plays an essential role in how sound is heard.
The ADA Standards of Care state that low HDL-cholesterol, coronary heart disease, peripheral neuropathy and general poor health have been reported as risk factors for hearing impairment in people with diabetes.
“Cardiovascular issues, congestive heart failure and/or kidney disease – all common in people with diabetes – may also impair hearing over time,” explained Kathy Dowd, a Charlotte, North Carolina-based audiologist and founder of The Audiology Project, an advocacy nonprofit focused on hearing and balance health in people with diabetes.
How and when to screen for hearing loss
The first step recommended by researchers is to get your hearing checked; if you notice some or all of the signs of hearing loss mentioned above, get your hearing evaluated as soon as possible.
Start with an online hearing loss screening tool, like HearScreenUSA to detect whether you have a problem. If you fail the screening, talk to your healthcare provider about being referred to an audiologist, who can assess your hearing, auditory processing and ability to hear people speaking in noisy situations.
“An audiologist should also ask you 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.
The American Diabetes Association recommends that people newly diagnosed with diabetes get a referral to an audiologist if indicated by their doctor. Whether you’re newly diagnosed or not, you should have your hearing checked annually or more often if need be. 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. Many audiologists are Medicare providers and will bill accordingly for the basic hearing tests.
Treatment for hearing loss with the latest hearing aids
Hearing aid technology continues to improve: Any changes in your hearing over time can be corrected by the audiologist with simple changes, and some hearing aids also offer the ability to link directly to your phone and automatically reduce background noise in loud settings.
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 easily participate in social events. There’s also a connection being made between hearing loss and cognitive decline. In a recently published study, hearing aids in people with hearing impairment reduced cognitive changes by about half in adults with risk factors for dementia, such as high blood pressure and diabetes.
Newly FDA-approved over-the-counter (OTC) hearing aids can be a good option for certain types of hearing loss. “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,” Dowd said, adding a caveat: “The downside of getting OTC hearing aids and not going through an audiologist is if the person requires hearing aids with prescriptive programming and proper fit by an audiologist.”
General ways to prevent of hearing loss
People living with diabetes can minimize their hearing loss risk by keeping blood glucose, lipid, and blood pressure levels in target. In addition, there are some general steps that anyone can take to avoid hearing loss:
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Get your hearing checked when you are diagnosed with diabetes, then again annually.
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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. This list includes a few antibiotics, diuretics, salicylates (aspirin, acetaminophen), and some chemotherapies.
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Wear ear protection around loud noises such as lawn mowers, leaf blowers, and chainsaws.
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Reduce background noise, whether it’s music on the radio, a vacuum cleaner, or crowd noise.
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Minimize exposure to recreational noise (such as personal listening devices) as well as occupational noise (such as construction noise).
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Avoid cleaning your ears with cotton swabs, pencils or paper clips.
Ears, balance, and diabetes
The ear is the site of the vestibular system, which provides the brain with 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, 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 or frequently falling. 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.
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. In addition, practice self-care behaviors like healthy eating, being physically active, glucose monitoring, and not smoking whenever possible.
Recommendations in this article are aimed at adults with type 1 and type 2 diabetes and exclude children and adolescents as well as pregnant people with diabetes. Discuss your targets with your healthcare providers; recommendations may vary based on a number of personal factors.
About this series
Each year the American Diabetes Association updates its Standards of Medical Care in Diabetes based on current science. We’ve translated key points of the up-to-date Standards into plain English so you know how to stay healthy and minimize diabetes complications.
Other articles in this series:
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Current Targets for Lipids, Cholesterol, Blood Pressure, Time in Range, and A1C
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How to Avoid Nerve Damage in Your Hands and Feet With Diabetes
