Could Diabetes Be Behind Your Hearing Loss and Tinnitus?

By Robert M. DiSogra, AuD

The number of people in the

United States who have tinnitus is approximately the same as those with diabetes or hearing loss. Almost three times as many people are considered “pre-diabetic.” Details and incidence figures can be found in the Centers for Disease Control and Prevention (CDC) National Diabetes Statistics Report: 2020. 1

What Is Diabetes?

Diabetes is a metabolic disease caused by the body’s inability to create or effectively use its own insulin, which is produced in the pancreas. Insulin helps regulate blood sugar (glucose) levels — providing energy to body cells and tissues.

Without insulin, the body’s cells would be starved, causing dehydration and destruction of body tissues. Cardiovascular, eye, dental, kidney problems, and stroke could occur as well as hearing loss.

Types of Diabetes

There are three types of diabetes: type 1, type 2, and gestational. • Type 1 is usually identified in young children (although adults, too, can have type 1). They must have insulin delivered by injection or a pump to survive. • Type 2 is the most common.

Approximately 20 percent of people over age 65 develop type 2. Many people with it can control their blood glucose by following a healthy diet and a program of

“Tinnitus from hearing loss that could be related to diabetes should be of concern to persons under the age of 60. If the hearing loss has an unknown cause, there is a possibility that the loss may be related to pre-diabetes or diabetes.”

regular physical activity, losing excess weight, and taking medications. Medications for diabetes often change for individuals during the course of the disease. Insulin can also be used to control blood glucose in people with type 2 diabetes. • Gestational diabetes can occur during pregnancy but usually resolves after delivery.

Diabetes Management

The CDC offers the Diabetes SelfManagement Education and Support (DSMES) program to help people with diabetes learn how to take the best care of themselves. 2

Hearing Loss and Diabetes

A microscopic blood supply in the inner ear (cochlea) nourishes the hair cells critical for transmitting sound to the brain. When there is too much glucose (sugar) in the blood in diabetes (hyperglycemia), the walls of these tiny vessels close in and get narrower. The narrower the opening, the less oxygen that enters the cells, which can lead to cell damage or death. The result is

the outer hair cells do not function properly.

The term used to describe this narrowing or constricting of the blood vessels in the inner ear resulting from diabetes is microangiopathy (MI-croann-gee-OP-uh-thee). This narrowing — like age-related hearing loss — is a slow, gradual process.

Speech and environmental sounds slowly become distorted. This can happen in all the speech frequencies (loudness and clarity) or just the high frequencies, where just the consonant sounds are affected.

Diabetes and Tinnitus

Because tinnitus is a symptom of a problem, establishing a cause is critical.

It is common knowledge that tinnitus can occur from hearing loss or it can be a drug side effect. This is why a person with tinnitus should discuss their tinnitus with their primary healthcare provider, pharmacist, or audiologist.

When the microscopic hair cells in the inner ear do not function properly for any reason (I like the term “short circuit”), tinnitus can result.

If you are younger than 60 years and have tinnitus with or without some degree of high-frequency hearing loss, you may be at risk for diabetes if the cause of the hearing loss can be established. A 2018 study found that 55 percent of people under the age of 60 with diabetes had some degree of high-frequency hearing loss compared to 20 percent of people with the same hearing loss who did not have diabetes. 3

For information about your medications’ side effects, speak to your primary care physician or pharmacist or go online to www. drugs.com or www.rxlist.com [not an endorsement by the author or the American Tinnitus Association].

There are more than 80 overthe-counter dietary supplements available that claim to help tinnitus relief or even cure it. 4 None are approved by the U.S. Food and Drug Administration (FDA) for tinnitus relief. Remember, user testimonials are not a substitute for evidencebased research.

Diabetes Medications and Tinnitus

DiSogra and Meece identified 75 FDA-approved medications for diabetes management: 1 inhalant, 22 injectables, and 52 orals. 5

None had tinnitus as a reported side effect. Therefore, if you have diabetes, tinnitus, and hearing loss, the tinnitus is probably, if not more than likely, a side effect of the hearing loss and not from your diabetes medication.

To view the complete diabetes drug list, go to https://drbobdisogra. com/diabetes-rx-side-effects. The list, current as of May 1, 2020, also shows the side effects that could affect a balance assessment.

Covid-19 and Patients with Diabetes

The coronavirus pandemic is still with us. The CDC reports that all three types of diabetes — type 1, type 2, and gestational — may put people at a higher risk of severe illness from Covid-19. 6 Therefore, the CDC recommends the following actions for patients with diabetes (PWD):

Continue taking your diabetes pills and insulin as usual. Test your blood sugar every four hours and keep track of the results. Make sure that you have at least a two-week supply of your diabetes pills and insulin. Follow the sick day guidelines for people with diabetes. 7

The Juvenile Diabetes Research Foundation reports that PWD (type 1) are no more at risk of getting Covid-19 than non-diabetics but recommends that blood glucose and ketones be monitored more often than usual. Also, the foundation does not recommend changing the patient’s medication schedule but recommends that they have more food available. 8

The American Diabetes Association also recommends monitoring blood glucose and ketones more often than usual for PWD with type 2 diabetes. 9

Both organizations also recommend keeping enough diabetes supplies on hand throughout the pandemic.

Summary

Diabetes affects almost as many persons as the number who have hearing loss. There is a wealth of information about diabetes management that is available online from reliable sources, including national adult and pediatric diabetes organizations as well as the CDC.

Tinnitus from hearing loss that could be related to diabetes should be of concern to persons under the age of 60. If the hearing loss has an unknown cause, there is a possibility that the loss may be related to prediabetes or diabetes.

All 75 medications approved by the FDA for diabetes management are not suspect as a cause for tinnitus in persons with diabetes.

PWD should monitor their blood glucose/ketones more regularly and have more than the usual amount of supplies on hand during the coronavirus pandemic.

As always, if you have any questions about your hearing or tinnitus, speak to your physician or audiologist.

Robert M. DiSogra, AuD, is an audiology consultant in Millstone, NJ (USA). He currently holds faculty positions at the Department of Audiology, University of the Pacific, San Francisco, CA (USA), and the Department of Communication Sciences and Deafness, Kean University, Hillside, NJ (USA). He is also the consultant to The Audiology Project (see resource 5). Address all correspondence: 7 Nurko Rd., Millstone, NJ 08535; email: bobd1030@aol. com; website: www.drbobdisogra.com.

Resources

1 Diabetes Self-Management Education and

Support (DSMES) Services Program: www.cdc. gov/diabetes/managing/education.html 2 American Diabetes Association: www.diabetes.org 3 Juvenile Diabetes Research Foundation: www.jdrg.org 4 Association of Diabetes Care and Educational

Specialists: www.diabeteseducator.org 5

The Audiology Project: www. theaudiologyproject. com/education-materials

References

1 Centers for Disease Control and

Prevention. (2020). National Diabetes

Statistics Report: 2020. Atlanta, GA: CDC. 2 Centers for Disease Control and Prevention.

Diabetes Self-Management Education and

Support (DSMES) services. Retrieved from www. cdc.gov/diabetes/managing/education.html 3 Hlayisi, V. G., Petersen, L., & Ramma, L. (2018).

High prevalence of disabling hearing loss in young to middle-aged adults with diabetes. International

Journal of Diabetes in Developing Countries.

Advance online publication. doi:10.1007/s13410- 018-0655-9 4 DiSogra, R. M. (2015). Over the counter tinnitus relief products. (ESCO/Oaktree Products publication. Out of print but available at www. drbobdisogra.com) 5 DiSogra, R. M., & Meece, J. (2019). Auditory and vestibular side effects of FDA approved drugs for diabetes. Seminars in Hearing, 40(4), 315–326. 6 Centers for Disease Control and Prevention. (2020, May 14). Coronavirus disease (Covid-19):

Groups at higher risk for severe disease.

Retrieved from www.cdc.gov/coronavirus/2019- ncov/need-extra-precautions/groups-at-higher-risk. html#diabetes 7 Centers for Disease Control and Prevention. (2019, August 1).Diabetes: Prevent complications.

Retrieved from www.cdc.gov/diabetes/managing/ problems.html 8 Juvenile Diabetes Research Foundation. (2020,

May 18).Coronavirus and type 1 diabetes: What you need to know. Retrieved from www.jdrf.org/ coronavirus 9 American Diabetes Association. Diabetes and coronavirus. Retrieved from https://www. diabetes.org/coronavirus-covid-19

More Resources from Dr. DiSogra

Listen to Conversations in Tinnitus podcasts with guest speaker Bob DiSogra, AuD, on dietary supplements for tinnitus as well as ototoxicity and tinnitus. To listen, use the following links: • https://www.ata.org/podcasts/episode-8-part-1-over-counter-medicationstinnitus-relief • https://www.ata.org/podcasts/episode-8-part-2-ototoxicity-and-tinnitus Editor’s Note: Dr. DiSogra also authored Ototoxicity: Tinnitus as a Drug Side Effect for Tinnitus Today, Summer 2018, and Over-the-Counter Dietary Supplements for Tinnitus: Do They Really Help? in Tinnitus Today, December 2014.