By Robert M. DiSogra, Au.D.
The Centers for Disease Control and Prevention (CDC) defines diabetes as a chronic disease where the body either doesn’t produce enough insulin or can’t effectively use the insulin it produces, leading to high blood sugar levels. Insulin is a hormone crucial for allowing glucose (sugar) from the blood to enter cells for energy.
Statistically, the CDC reported in 2024 that approximately 38 million people, or about 1 in 10, have diabetes.
Usually a hearing loss is first noticed by family or friends. Credit: @rpnickson/Unsplash
There are several types of diabetes: type 1 mainly affects children (daily insulin injections are necessary), type 2 mostly found in adults (controlled with medication) and gestational diabetes (occurs during pregnancy but usually resolves after childbirth).
More than 90 percent of patients with diabetes have type 2 diabetes. Type 2 diabetes is increasingly affecting younger populations, including children, teens, and young adults. It is estimated that roughly 1 in 5 persons are unaware they have the condition.
How Diabetes Affects Hearing
Because the very small blood vessels in the inner ear (cochlea) can be narrowed by the presence of an increase in blood glucose, the function of the inner ear hair cells can be affected. The first symptom might be tinnitus (ringing in the ear) or an inability to hear words clearly. Since diabetes is a systemic problem, both ears are usually affected.
The same small blood vessels in the eye are also affected (diabetic retinopathy). But when vision is affected, a patient with diabetes will be at a higher risk for falling in addition to having other associated mobility problems (driving, reading, watching television, etc.).
Because mobility is affected by a vision loss, a patient with diabetes will get help much sooner than with a hearing loss. With a hearing loss a person can still “hear” but not as clearly, so they can compensate in many ways (asking to repeat, cupping their ear, reading lips and facial expressions, etc.).
When asked, a person experiencing a mild degree of hearing loss will usually deny they have a loss. Denial is typically the first symptom of hearing loss. A person with hearing loss can still “hear” but the quality/clarity of what they hear is the real problem.
So, sadly, it usually takes about eight years before a hearing loss is noticed till when a hearing test is scheduled, and usually after the person themselves recognizes the problem or a family member/friend makes the suggestion to get a hearing evaluation.
Here are the common signs of hearing loss, which can be isolated or in combination:
Tinnitus
Difficulty understanding speech especially in noisy environments
Difficulty hearing or understanding children’s or female voices
Always asking others to repeat what they said
Complaining that people mumble when they speak
Television or radio volume louder than normal
Difficulty hearing or understanding on the phone
Loss of awareness of environmental sounds
Withdrawal from social situations or not participating in conversations
The Diagnostic Dilemma
Hearing loss is twice as common in people who have diabetes as it is in people of the same age who don’t have diabetes. According to the CDC, people with prediabetes (blood sugar levels higher than normal but not high enough yet to have type 2 diabetes) have a 30 percent higher rate of hearing loss than people with normal blood sugar levels.
Age-related hearing loss has been researched and documented over the decades. Throughout my decades in clinical practice I have had many adult patients whose medical history does not fall in line with the audiometric data: They have a high frequency sensorineural hearing loss at an unexpected younger age (under age 60) than what would be expected with an older patient (older than age 60). Sometimes we cannot fully explain the cause of the loss when the patient’s history is unremarkable.
For patients over the age of 60 the diagnosis is more challenging because this age group almost assures us that there will be some age-related hearing loss. Therefore, a referral to the family physician will be needed to rule out a prediabetes condition.
Next Steps
A diabetes educator will likely be your first referral after diagnosis of diabetes. Officially known as diabetes care and education specialists, these healthcare providers play a pivotal role in the management of a person diagnosed with diabetes regardless of the type of diabetes or the age of the person.
Because a hearing loss will not impede mobility the same way a visual impairment does, diabetes educators will not only establish a medication, diet, and exercise regimen, they will also make a referral for additional testing to establish a baseline for future reference.
About 30 percent of patients with diabetes will have a change in hearing. This is about 10 percent more than a vision loss from diabetes.
If you have been diagnosed with diabetes—and you have not been referred to an audiologist for a baseline evaluation—please set up an appointment and get the test. If changes in hearing occur over time, you have a reference so that a diabetes-related, non-age related cause can be ruled out.
And until a patient with diabetes with communication complaints is evaluated by an audiologist, there are many communication strategies that can be used by a patient with diabetes and their family and friends.
Robert M. DiSogra, Au.D., is a consulting audiologist in New Jersey. He is a founding member and current board member of The Audiology Project, an international nonprofit organization that promotes hearing loss awareness and the management of hearing loss with diabetes and other chronic illnesses.
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