Download DIABETES and HEARING LOSS CONNECTION

DIABETES and HEARING LOSS
CONNECTION
Presented by :
Gai Downes RN.
Nurse Audiometrist
Singleton Community Health
IS THERE A CONNECTION?
(1)
• First suggested in 1857 that there may be a
link between diabetes and hearing loss.
• Many clinical studies with inconsistent results.
• More recently, approximately 13 studies
involving over 20,000 patients including 7,800
diabetes clients.
• Nine studies based on general population and
four on hospital based patients.
U.S.National Health and Nutrition
Examination Survey• NHANES USA- conducted 1999- 2004
published 2008 (Bainbridge et al) (2)
• Surveyed 5,418 participants aged from 20 - 69
years
• ‘Potential Mediators of Diabetes Related Hearing
Impairment in the US Population’. (3)
• Risk Factors for Hearing Impairment Among U.S.
Adults with Diabetes.(4)
• Diabetes and Hearing Impairment in United
States: Audiometric Evidence from NHNES. (5)
NHANES outcomes
• The prevalence of hearing loss was more than
double in those with diabetes compared to
those without diabetes.
• Diabetes is associated with a 67% increased
odds of high frequency loss and
• 100% increased odds of low/mid frequency
hearing loss.
• The strongest association between diabetes
and hearing loss is in the younger age groups.
BLUE MOUNTAINS STUDY
• Published by Mitchell et al in 2009
• Study looked at Type 2 Diabetes clients.
• 3,654 participants aged over 49yrs with
5 year then 10 year follow-up.
• Conducted 1992-94 then 1997- 2004.
(6)
Blue Mountains Hearing Study
• Conclusion:
• Newly diagnosed Type 2 diabetes clients were
more than twice as likely to experience an
accelerated progression of hearing loss over 5
years than non- diabetic subjects.
• Earlier onset of SNL similar to age related loss.
• Type 2 diabetes is associated with prevalent
hearing loss in the older population.
Temporary noise induced hearing loss
in rats
(7 )
• Experiment involved three groups of rats:
Control group, NIDDM and IDDM.
• Exposed to 110 db for 8 hours
• Hearing levels checked measuring ABRs
at 1, 2, 4, 7 hours, and 14 days.
• Control group return to normal at 1 day post exposure.
• NIDDM not back to normal by 14 days.
• IDDM group even slower return to normal hearing.
• Study demonstrated that diabetes may delay recovery
from temporary NIHL.
Permanent noise induced hearing loss
in mice
(8 )
• Mice with artificially induced diabetes
• Hearing tested at 1, 3 and 5 months after
diabetes induced.
• Before and after noise exposure • ABRs were measured
• Cochlea blood flows measured and
• spiral ganglion counted
POOR MICE !
• Five months after diabetes induced,
mice exposed to prolonged noise at 105db
• Findings:
• Recovery from noise exposure significantly
reduced.
• Decreased cochlea blood flow
• Loss of spiral ganglion cells.
• Thickened cochlea vessel walls.
At Risk? Diabetes and Noise injury
• Diabetes may be associated with an increased
risk of noise injury and hearing loss due to noise
exposure.
• Studies suggest diabetes impairs recovery from
noise exposure. (7)
• More susceptible to noise induced hearing loss. (7)
• Diabetics prone to more severe NIHL. (9)
• Automobile workers with high fasting BSLs had
significant raised 4K threshold. (10)
YOUNGER TYPE 1 DIABETES CLIENTS
(11,12)
• Several studies conducted• Hearing loss is more common in diabetic
children than children without diabetes. (11)
• Predominantly affects mid and high
frequencies
• Bilateral, symmetrical SNL.
• Generally related to duration and glycaemic
control. (12)
• Children under 18yrs with Type 1 – recommend
hearing checks within 5 yrs of diagnosis (11)
AUDIOLOGICAL FINDINGS
• Diabetes related hearing loss is generally
described as (3)
• Gradual onset, bilateral, progressive SNL loss.
• Predominately affecting the higher
frequencies but may progress to involve all
frequencies.
• Thresholds at all frequencies higher in
diabetes particularly the younger age groups.
• Delayed ABRs found in IDDM. (13)
AUDITORY BRAINSTEM RESPONSES
(14,)
• Data suggests ABRs deteriorate long before
hearing impairment appears.
• Studies show ABR significantly delayed in
Diabetes.
• Difference in ABR waves between IDDM
& NIDDM
• Prolonged ABRs should alert to possible early
auditory nerve damage.
• .
WHO IS AT RISK?
• Hearing loss is three times more common in the under
60 years diabetes age group. (1)
• Poorly controlled or complicated hospital based
diabetes patients are four times more likely to have a
hearing loss. (1)
• Hospital based study of type 2 diabetes patients ,
average age 45.7 years, measuring ABRs found
significantly delayed responses.
• Positive correlation between duration, degree of
control and hearing loss.(15)
• Poorer hearing has been demonstrated in adults with
impaired fasting BSLs. (16)
• Younger women may be at greater risk of hearing loss
associated with diabetes. (16)
WHY IS THIS SO?
(17)
• Complications and damage to the nerves and
vessels of the inner ear relating to neuropathy,
inflammation or hyperglycaemia may be
mediating factors associated with diabetes
and hearing impairment.
• Microvascular changes which often lead to
neuropathy and retinopathy may also affect
cochlear vasculature.
Histopathological characteristics
(17)
• Cochlea microangiopathy and degeneration of
outer hair cells and stria vascularis demonstrated.
• Demylination 8th cranial nerve
• Loss of outer hair cells
• Narrowing of internal auditory artery
• Thickening of vessel walls and stria vascularis
• Atrophy of spiral ganglion
• .
Diabetes and Keratin
(18)
• Diabetics often lack Keratin which forms a
protective barrier within the ear canal.
• Deterioration of epithelial tissue in ear canal
can cause chronic irritation and susceptible to
yeast and fungal infections.
• The ear canal can be more sensitive to some
plastics used in hearing aids.
American Diabetes Association
(15)
• ADA expo day 2012, Portland Oregon,
trialled free hearing screening.
• Surprised at high percentage of hearing loss.
• ADA expo days 2013, hearing screening
increased now available at 5 major centres.
• Portland, Los Angeles, Minnessota, Seattle
and San Antonio.
• Await results.
Diabetes and Hearing Loss
Connection
• Positive association between Diabetes and the
increased incidence of hearing impairment.
• Earlier onset, faster decline of hearing levels
especially in younger or poorly controlled
Diabetes.
• This connection is under-recognised in the
Diabetes care pathway and education.
Diabetes and Hearing Checks??
• No recommendations for hearing assessments
in diabetes care.
• No formal guidelines for assessment, even
baseline evaluation.
• Dr Ross Walker – Australian guide to Hearing
Services 2010 (Audioclinic) recommends
yearly assessment.
• This is not standard practice.
CONCLUSION.
• Hearing loss remains an under- recognised
and under-diagnosed complication of
Diabetes.
• Increased education and discussion re
possibility and risk factors in diabetes care.
• Guidelines and routine assessment may assist
in early diagnosis and intervention.
Discussion
• What can we offer?
• Should hearing assessment be routine in
Diabetes care?
• Who makes this recommendation?
• Is it possible or even suitable to incorporate
hearing assessments into Diabetes care at a
local level?
References
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1 Boschert,Sherry; 2011. Risk of hearing loss doubled with diabetes. MD CONSULT Australia. July 15 2011
2. National Institute of Health. Hearing Loss is Common in People with Diabetes. NIH News release. June 16 2008
3.Bainbridge,KE; Cheng,YJ; Cowie CC; 2010. Potential Mediators of Diabetes-Related Hearing Impairment in the US Population: National
Health and Nutritrion Survey 1999-2004. Diabetes Care 33.4 Apr 2010: 811-6
4. Bainbridge K E; Hoffman, HJ; Cowie CC. Risk Factors for Hearing Impairment among US Adults with Diabetes National Health and
Nutrition Examination Survey 199-2004. Diabetes Care 34.7. Jul 2011: 1540-5
5.Bainbridge KE,Hoffman HJ, Cowie CC 2008. Diabetes and Hearing Impairment in the United States: Audiometry Evidence from the
National Health and Nutrition Examination Surveys 1999- 2004, Annuls of Internal Medicine July 1 2008 vol.149,no1 pp1-10
6 .Mitchell, P.; Gopinath,B ; McMahon, C.M .; Rochtchina,E.; et al 2009. Relationship of Type 2 Diabetes to the prevalence, incidence and
progression of age-related hearing loss. Blue Mountains Hearing Study. Diabetes Medicine. May 2009. Vol 26(5) p 483-488.
7.Wu,HP; Cheng, TJ; Tan, YL; Hsu, CJ. 2009. Diabetes impairs recovery from noise-induced temporary hearing loss. Laryngoscope
Jun,2009; 119(6): 1190-4
8. Fujita,T; Yamashita D; Katsunuma,S; Hasegawa, S; et al. 2012. Increased Inner Ear Susceptibility to Noise Injury in Mice with
Streptozotocin Induced Diabetes. Diabetes 61.11 Nov.2012: 2980-6
9 Wu,HP; Hsu,CJ; Cheng, TJ; Guo,YL. 2010. N-acetylcysteine attenuates noise-induced permanent hearing loss in diabetic rats. Hear Res.
2010 Aug;267 (1-2):71-7. Epub Apr27 2010
10. Jang, TW; Kim, BG; Kwon, YJ;Im,HJ. 2011 The association between impaired fasting glucose and noise induced hearing loss. J Occup
Health 2011;53(4): 274-9. Epub 2011 Jun 13
11. Poovazhagi V; Nagarajan,M;Suresh,S; 2011. Hearing loss in children with Type 1 Diabetes Mellitus. Practical Pediatrics update 2011.
12.Okhovat, SA; Moaddab MH; Okhovat,SH: Al-Azab AA; et al 2011. Evaluation of hearing loss in juvenile insulin dependent patients with
diabetes mellitus. J Res Med Sci Feb.2011; 16(2): 179-83
13.McDermont,D; Konrad-Martin,D; Austin,DF; Griest,S; et al.2009. The Link between Diabetes and Hearing Loss. ASHA Leader 14.13. Oct
13, 2009. :5-6
14.Durmus C; Yetiser S; Durmus O:2004. Auditory brainstem evoked responses in insulin-dependant (ID) and non-insulin-dependant
subjects with normal hearing. Int J Audiol. Jan 2004: 43 (1):29-33
15Fiore Kristina; 2009. ADA. Complications of diabetes also associated with hearing loss. MedPage Today June 7 2009.
16 Scheck,A; Breaking news: Hearing tests by ADA reveal link between hearing loss and diabetes. The Hearing Journal June 2012.Vol
65(6) pp20,22
17. Fukushima,H; Cureoglu,S; Schachern,P; Paparella,M; et al 2006. Effects of type 2 diabetes mellitus on cochlear structure in humans.
Archives of Otolaryngology- Head & Neck Surgery. Volume 132 (9).Sept 2006, p 934-938
18.Chartrand,MS. 2003. Diabetes Mellitus and Hearing. July 21 2003. ConnectCare.
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Other interesting articles.
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Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and
Nutrition Examination Surveys, 199-2004 . Bainbridge et al availablehttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803029/?log%24=activity
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Potential Mediators of Diabetes –related Hearing Impairment in the US Population NHNES. Availablehttp://search.proquest.com.acs.hcn.com.au/nursing/docview/89235896/fulltextwithgra...
Also available http://proxy2.use.hcn.com.au/docview/89235896/1372889A63BCB841
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Risk Factors for Hearing Impairment among US Adults with Diabetes: NHNES availablehttp://search.proquest.com.acs.hcn.com.au/nursing/docview/877720397/13DC8D38D
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Hearing loss is common in people with diabetes- NIH news release June16 2008 availablehttp://www.nih.gov/news/health/jun2008/niddk-16.htm
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Relationship of type 2 diabetes to the prevalence, incidence and progression of age related hearing loss- available
http://ovidsp.tx.ovid.com/sp-3.8.1a/ovidweb.cgi?QS2=434f4e1a73d37e
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A clinical study of audiological profile in diabetes mellitus patients - available
http://www.ncbi.nlm.nih.gov.pubmed/22695875
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Hearing impairment- an under-recognised complication of Diabetes - Bainbridge K available
www.diabetesvoice.org./files/attatchments/2009-1Bainbridge
.Hearing loss and diabetes: You might not know what you’re missing. Hirose K available
http://www.annals.org/content/149/1/54.full
.Type 2 diabetes mellitus and auditory brainstem responses- a hospital based study. Available
http://www.ncbi.nlm.nih.gov/pcm/articles/PMC3063531/
Link between diabetes and hearing loss highlighted by BHI in recognition of American Diabetes Association Alert day
available- http://www.betterhearing.org/press/news/National_Press_Release_ADA_Alert_Day_pr030
Diabetes and hearing dysfunction: Under-recognized complication of Diabetes? Dabrowski M.
Available- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560143/