Diabetes and Hearing Loss

Purpose of Presentation

To make diabetes educators aware of the link of diabetes to hearing loss and the need for intervention: Hearing loss and chronic disease/ototoxic meds Why does hearing loss occurs with diabetes What is the impact of hearing loss on quality of life

issues What are the recommendations for Patients with

Diabetes, in light of hearing loss

Chronic Disease with Secondary Hearing Loss

A. DiabetesB. Thyroid disease (hypothyroidism)C. Multiple sclerosisD. Chronic Renal DiseaseE. Cardiovascular DiseaseF. Alport’s SyndromeG. Paget’s DiseaseH. Cogan’s SyndromeI. Dementia

Chronic Kidney Disease & Hearing Loss

Association of CKD & Hearing Loss Known for Decades

Kidney & Stria Vascularis of Cochlea Share Physiologic, Ultrastructual and Antigenic Similarities

Diabetes Often Results in Chronic Renal Disease

Therefore, the Link Between Diabetes and Hearing Loss May Be Indirect but Exists

Vasculature of the Ear

Blood Vessels of the Inner Ear

Arteries of the Middle Ear

Comorbidity of Diabetes and other Health Issues

Heart Problems

Balance Issues

Vision Impairment

Hearing Loss

Neuropathy/Pain Management

PAIN MANAGEMENTINFECTION CONTROL

HORMONE REPLACEMENTFLUID RETENTION

CANCER CHEMOTHERAPY

WHO IS CHECKING YOUR PATIENT’S HEARING WHEN THEY USE THESE

MEDICINES?

Medicines and Your Diabetes Patients

Ototoxic Drugs

A. Aminoglycoside Antibiotics (mycin drugs)B. Loop Inhibiting Diuretics (lasix,

furosemide)C. Salicylates (aspirin, darvon, darvocet)D. Cancer ChemotherapyHormone Replacement treatmentE. Quinine

Diabetes and Hearing Loss

In people age 60 and older with type 2 diabetes:

High blood sugar causes tiny blood vessels in the inner ear to break, disrupting sound reception.

Associated balance problems may come from neuropathy Mechanisms related to neuropathic or microvascular

factors, inflammation, or hyperglycemia may be mediating the association of diabetes and hearing impairment (Bainbridge et al, 2010)

Significant hearing differences were at all frequencies for NIDDM subjects, but for IDDM subjects, differences were at 1,000 Hz and below, and 10,000 Hz and above (Austin et al, 2009)

FIRST STEP: SCREENING IN YOUR OFFICE

SECOND STEP: REFER TO AN AUDIOLOGIST

THIRD STEP: TREATMENT AND FOLLOW UP

FOURTH STEP: GETTING USED TO A NEW WAY OF HEARING

Detection, Identification, Diagnosis and Treatment

of Hearing Loss

Effects of Untreated Hearing Loss

embarrassment, fatigue, irritabilitytension/stressavoidance of social activities withdrawal from personal relationships depression, negativismdanger to personal safety social rejection by othersimpaired memory and ability to learn new tasksPoor job performance and reduced earning powerDiminished psychological and overall health

(Better Hearing Institute, 2009)

Auditory Deprivation

Although we hear with our ears, it is the brain that is the true hearing organ

Over time, the brain’s ability to understand speech is often affected by hearing loss

Once the ability to understand is lost, that ability can be difficult, if not impossible, to regain

Wearing hearing instruments can assist the brain in keeping the ability to understand from being lost

Recommendations for Monitoring Hearing

Get a hearing test when first identified with diabetes

Ongoing assessment of hearing levels at least once a year

Encourage use of hearing aids if recommended

Seek an audiologist for comprehensive hearing services and monitoring

Improved Hearing Means:

Better family relationships and communication Less isolation and less prone to depression

Better job performance

More energy/less stress

Better quality of life: involvement in church, family and group activities

Your Audiologist will:

Knows Your History & Meds

Watch For Otologic Complications

Refer to Primary or Specialty Care

Reinforce the Team Goals with Diabetes Educators

Swift Intervention for Malignant Otitis

NC Diabetes State Plan

Clinical Interventions “Improve screening for and management of diabetes

by encouraging healthcare providers to follow ADA guidelines, and include oral health and auditory screening as part of baseline assessments for people with diabetes.”

Counseling and Education “Raise awareness about diabetes uncommon co-

morbidities including hearing loss and sleep apnea.”

Resources: Hearing Screening

Questionnaires Patient Spouse

Test Equipment Automated

Whisper test/Word test

Resources: Audiologists in NC

http://www. ncboeslpa.org http://webportal.audiology.org/Custom/

FindAnAudiologist.aspx http://www.audiologist.org/audiologist-

directory-search