Diabetes and hearing loss - how they're connected

If you have diabetes, you likely know that complications can include kidney and heart problems. But did you know it can also affect your hearing and sense of balance?

If this is news to you, you aren't alone: Many people aren't aware of the hearing and balance risks of diabetes, experts say, including health professionals.

For this reason, an organization called The Audiology Project has been working with major health groups to raise awareness. Their efforts are paying off: Both the US Centers for Disease Control and the American Diabetes Association recently added educational pages on the links between ear health, balance and diabetes:

• CDC: Take Charge of Your Diabetes: Healthy Ears
• ADA: Diabetes and Hearing Loss

"Doctors do not ‘see’ hearing loss and rarely refer patients for a hearing test, unless they see that the guidelines from the American Diabetes Association include hearing evaluations every year," said audiologist Kathy Dowd, CEO of The Audiology Project.

For patients, both diabetes and hearing loss can be difficult to self-detect. "Many people do not realize they have hearing loss, so it may be a surprise to know hearing could be affected when they have diabetes," Dowd said. "And those who have a recognized hearing loss will now have an answer for why."

The CDC now recommends that people get their hearing tested every year if they have diabetes. "Make an appointment with a health care provider ... to check your hearing and balance as soon as you are diagnosed with diabetes," their page states.

How diabetes can cause hearing loss

According to the CDC, high blood glucose levels from untreated diabetes can weaken the ear's blood vessels as well as the nerve cells in the inner ear, known as the "hair cells." More on how we hear.

Like other parts of the body, these hair cells rely on good circulation. Once they are damaged or die, hearing is permanently affected.

Diabetes and hearing loss—both common, both treatable

"Diabetes and hearing loss are two of America's most widespread health concerns," the ADA explains. And research has shown time and again that the two often go hand-in-hand:

• People with diabetes are more than twice as likely to have mild to moderate high-freqeuncy hearing loss than those without the disease, a landmark study by the National Institutes of Health (NIH) revealed.
• This finding was confirmed by a meta-analysis in the Journal of Clinical Endocrinology & Metabolism. Researchers analyzed results from 13 studies involving more than 20,000 participants and concluded that diabetics were more likely to have hearing loss than those without the disease, regardless of their age.

Diabetes often affects the eyes, too, yet people are much quicker to get that treated versus hearing loss, notes Dr. Bob DiSogra, an audiologist who gives presentations on diabetes, hearing loss and medications.

"People with hearing loss can still 'hear,' albeit not well — but well enough to postpone getting an audiological evaluation despite concerns by family members and friends," he states on his website.

Balance problems can also occur

"Diabetes damages small blood vessels in your inner ear and your vestibular system, which is the part of your inner ear that helps with balance," the CDC page states.

Dizziness and an increased risk of falls can be the result.

Diabetes and tinnitus

Though not as studied as the link between diabetes and hearing loss, tinnitus (ringing in the ears) does seem to be more common among people with diabetes. In some cases, this may be from unrecognized hearing loss, because hearing loss frequently causes tinnitus, but people with diabetes are also more likely to have tinnitus even when they don't have hearing loss.

Diabetes medications may play a role, too, as many drugs are known to cause hearing loss or tinnitus.

Diabetes and ear infections/itchiness

While many things can cause itchy ears, certain illnesses, including diabetes and liver disease, can also be culprits. Diabetes makes earwax less acidic, making people with diabetes more prone to outer ear infections (which includes the ear canal). Their ear's skin is also more likely to be damaged.

Good diabetes care is key

On their Healthy Ears page, the CDC recommends staying on top of your "ABCs" for good diabetes care:

"A1C (a measure of your average blood sugar over 3 months): The goal set for many people is less than 7% for this blood test, but your doctor might set a different goal for you.

Blood pressure: High blood pressure causes heart disease. The goal is less than 140/90 mmHg for most people but check with your doctor to see what your goal should be. If you experience tinnitus from a high blood pressure drug, talk to your doctor.

Cholesterol: LDL or “bad” cholesterol builds up and clogs your blood vessels. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels. Ask your doctor what your cholesterol numbers should be.

Smoking: If you smoke or use other tobacco products, take steps to quit. Call 1-800-QUIT-NOW (1-800-784-8669) for support." Smoking is a well-known cause of hearing problems.

Another helpful tip?

"Ask your doctor about diabetes education. Medicare pays for 10 hours of this education so you can learn how to control your blood sugar, how to eat right and how to get healthy exercise," Dowd said. "Your doctor will refer you to the nearest certified diabetes education specialist or check Find a Diabetes Education Program."

How else to protect your hearing

• Get your hearing tested annually.
• Add exercise into your daily routine. Even a moderate amount improves circulation and blood flow. Talk to your doctor about what type of exercise is best for you.
• Maintain an appropriate weight. Extra weight makes it more difficult for your heart to pump blood effectively to all parts of your body, including your ears.  
• Prevent hearing loss by turning down the volume on personal electronic devices, the television and car radio.
• Protect your ears from excessive noise with headphones or disposable earplugs if you engage in noisy hobbies.

If you think you have hearing loss, don't delay

The early signs of hearing loss can be tricky to detect, as hearing loss develops slowly. In many cases, people simply feel they "can hear but not understand."

If you have a hunch you're not hearing as well as you used to—or a family member or friend has told you this—then don't delay getting help, as you're putting yourself at risk of auditory deprivation and other complications.

As a first step, you can take the validated hearScreenUSA on The Audiology Project's site, or see a provider near you.

Be sure to share your diabetes diagnosis as part of your medical history with your hearing care provider. This information, along with the results of your hearing test, will help the two of you determine the best course of treatment going forward.

Usually, the recommended treatment will be hearing aids or cochlear devices.

Why is it important to treat hearing loss?

Hearing is vital to communication and well-being. A large body of research shows that people with untreated hearing loss have higher rates of depression, social isolation, injury-causing falls, and loneliness. They're also more likely to develop cognitive decline earlier than people without hearing loss. Even mild hearing loss is linked to dementia.

The good news? Hearing aids boost your health in many ways, from reducing social isolation to delaying the onset of dementia. (Not to mention help you hear better!)