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. Diabetes B. Thyroid disease (hypothyroidism) C. Multiple sclerosis D. Chronic Renal Disease E. Cardiovascular Disease F. Alport’s Syndrome G. Paget’s Disease H. Cogan’s Syndrome I. 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 MANAGEMENT INFECTION CONTROL HORMONE REPLACEMENT FLUID 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 Chemotherapy Hormone Replacement treatment E. 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, irritability tension/stress avoidance of social activities withdrawal from personal relationships depression, negativism danger to personal safety social rejection by others impaired memory and ability to learn new tasks Poor job performance and reduced earning power Diminished 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 ncboeslpa.org iologist.aspx search