Download Diabetes and hearing loss

DIABETES AND
HEARING LOSS
Reporter: 樊樂遠
Supervisor: VS 廖文輝
Diabetes complication
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Cardiovascular disease : stroke or a fatal cardiac event
is two to four times higher
Diabetic retinopathy : leading cause of blindness in the
United States
Renopathy: leading cause of kidney failure.
Nerve disease: major cause of lower extremity
amputations.
Diabetic autonomic neuropathies: can affect
cardiovascular, gastrointestinal, bladder, and erectile
function.
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According to the American Diabetes Association,
nearly 26 million people in the U.S. have diabetes,
and another 34.5 million have some degree of
hearing loss.
Etiology
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Small blood vessels and nerves in the inner ear.
High blood glucose levels can damage these vessels
and nerves, diminishing the ability to hear.
Histopathological evidence
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Vascular or neurological involvement obtained from
autopsied patients with diabetes
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sclerosis of the internal auditory artery
thicker vessel walls of the stria vascularis
demyelination of the cochlear nerve
atrophy of the spiral ganglion.
Makishima, K., & Tanaka, K. (1971). Pathological
changes of the inner ear and central auditory pathway
in diabetics. Annals of Otology, Rhinology &
Laryngology, 80, 218–228.
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Loss of outer hair cells has also been observed
among patients with diabetes.
Fukushima, H., Cureoglu, S., Schachern, P., Paparella,
M., Harada, T., & Oktay, M. (2006). Effects of type 2
diabetes mellitus on cochlear structure in humans.
Archives of Otolaryngology—Head & Neck Surgery,
132, 934–938.
http://en.wikipedia.org/wiki/Stria_vascularis
_of_cochlear_duct
Fukushima, H., Cureoglu, S., Schachern, P., Paparella,
M., Harada, T., & Oktay, M. (2006). Effects of type 2
diabetes mellitus on cochlear structure in humans.
Archives of Otolaryngology—Head & Neck Surgery,
132, 934–938.
Fukushima, H., Cureoglu, S., Schachern, P., Paparella,
M., Harada, T., & Oktay, M. (2006). Effects of type 2
diabetes mellitus on cochlear structure in humans.
Archives of Otolaryngology—Head & Neck Surgery,
132, 934–938.
Review
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Researchers in the Framingham cohort study
averaged pure-tone air conduction thresholds
above 250, 500, and 1000 Hz as well as 4000,
6000, and 8000 Hz in the better ear and worse
ear
they defined hearing impairment as a pure-tone
average > 40 dB HL
no association with diabetes
Gates, G., Cobb, J., D'Agostino, R., & Wolf, P.
(1993). The relation of hearing in the elderly to
the presence of cardiovascular disease and
cardiovascular risk factors. Archives of
Otolaryngology—Head & Neck Surgery, 119,
156–161.
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Hispanic Health and Nutrition Examination Study,
examined pure-tone air conduction thresholds at
500, 1000, 2000, and 4000 Hz by diabetes status
higher threshold among diabetic persons only at a
single frequency (500 Hz)
Ma, F., Gomez-Marin, O., Lee, D., & Balkany, T.
(1998). Diabetes and hearing impairment in
Mexican American adults: A population-based
study. The Journal of Laryngology and Otology,
112, 835–839.
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Epidemiology of Hearing Loss Study, a communitybased investigation conducted in Beaver Dam,
Wisconsin
defined impairment as the pure-tone average
above 500, 1000, 2000, and 4000 Hz > 25 dB HL
in the worse ear
a modestly increased occurrence of hearing
impairment among adults with diabetes compared
to those without diabetes
Dalton, D., Cruickshanks, K., Klein, R., Klein, B.,
& Wiley, T. (1998). Association of NIDDM and
hearing loss. Diabetes Care, 21, 1540–1544.
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National Health and Nutrition Examination Study
investigators evaluated hearing impairment using
high-frequency (3000-, 4000-, 6000-, and 8000Hz) as well as low- or middle-frequency (500-,
1000-, and 2000-Hz)
at two levels of severity (>25 and >40 dB HL)
in both the worse and better ear
Bainbridge, K., Hoffman, H., & Cowie, C. (2008).
Diabetes and hearing impairment in the United
States: Audiometric evidence from the National
Health and Nutrition Examination Survey, 1999
to 2004. Annals of Internal Medicine, 149, 1–10.
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The prevalence of hearing impairment depends on
how the condition is defined
a greater prevalence of hearing impairment was
observed among adults with diagnosed diabetes
than without, regardless of the definition used.
http://www.asha.org/aud/articles/diabeteshearing-impairment/
http://www.asha.org/aud/articles/diabeteshearing-impairment/
http://www.asha.org/aud/articles/diabeteshearing-impairment/
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Persons with diabetes may experience hearing loss
at earlier ages.
In the younger group, people with diabetes had a
2.6 times higher likelihood of impaired hearing.
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Audiologists seeing middle-aged patients with
unexplained hearing loss may wish to inquire about
history of diabetes and family history of diabetes.
Patients with diabetes should be encouraged in their
efforts to maintain good blood glucose control in
accordance with guidelines from the American
Diabetes Association (2010).
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The study included more than 5,100 adults who had
hearing tests performed as part of a large
nationwide health study in the United States.
People with diabetes were much more likely to have
hearing loss than those without diabetes.
Diabetes and hearing impairment in the United States:
audiometric evidence from the National Health and
Nutrition Examination Survey, 1999 to 2004, by
Kathleen E. Bainbridge and colleagues. Annals of
Internal Medicine 149:1-10, 2008
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The higher risk of hearing loss in people with
diabetes did not seem to be related to other
common causes of hearing loss.
younger diabetics were at even higher risk than
older adults, though they could not explain why.
Type 1 or type 2 DM?
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In 2008, researchers from the U.S. National
Institutes of Health (NIH) saw similar patterns in a
sample of more than 11,000 people, with people
with diabetes twice as likely to have hearing loss as
those without.
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Another limit of the analysis, Zonszein said, is that
many studies did not differentiate between people
with type 1 and type 2 diabetes.
Type 2 diabetes, which often is related to aging
and obesity, is far more common than type 1, which
is an immune-system disease that usually arises at a
young age.
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Data were obtained from 13 eligible studies
(20,194 participants).
Overall pooled OR (95% confidence interval) of
hearing impairment for diabetic participants
compared with nondiabetic participants was 2.15
(1.72–2.68).
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Horikawa's team found that diabetics were 2.15
times as likely as people without the disease to
have hearing loss.
But when the results were broken down by age,
people under 60 had 2.61 times the risk while
people over 60 hand 1.58 times higher risk.
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The strength of the association between diabetes and
prevalence of hearing impairment was not
significantly influenced by whether participants
were matched for gender (P =0.68) or whether
participants chronically exposed to noisy environments
were excluded (P = 0.19).
Conclusions
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Current meta-analysis suggests that the higher
prevalence of hearing impairment in diabetic
patients compared with nondiabetic patients was
consistent regardless of age.
Better sugar control?
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No one knows yet whether gaining better control
over your blood sugar will curb any risk of hearing
loss.
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Women between the ages of 60 and 75 with wellcontrolled diabetes had better hearing than women
with poorly controlled diabetes, with similar hearing
levels to those of non-diabetic women of the same
age.
The study also shows significantly worse hearing in
all women younger than 60 with diabetes, even if it
is well controlled.
Dr. Handzo, Henry Ford study authors are
Virginia S. Ramachandran, Au.D.; Brad A.
Stach, Ph.D.; Ed S. Peterson, Ph.D.; and
Kathleen L. Yaremchuk, M.D.
Diabetes Affects Hearing Loss, Especially
in Women. Jan. 26, 2012
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Men, however, had worse hearing loss across the
board compared to women in the study, regardless
of their age or whether or not they had diabetes.
“Our study really points to importance of patients
controlling their diabetes, especially as they age,
based on the impact it may have on hearing loss.”
http://visual.ly/diabetesalert-day-2012-connectionbetween-diabetes-andhearing-loss
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