Diabetes and Hearing Loss

Diabetes and Diabetes and Hearing LossHearing Loss

by Kathryn Dowd, AuDby Kathryn Dowd, AuDClinical AudiologistClinical Audiologist

Hearing Solution CenterHearing Solution CenterCharlotte, NCCharlotte, NC

www.hearingsolutioncenter.comwww.hearingsolutioncenter.com

Purpose of PresentationPurpose of Presentation

• To make health care providers in NC To make health care providers in NC aware of the link of diabetes to aware of the link of diabetes to hearing loss and the need for hearing loss and the need for intervention: intervention: – Why hearing loss occurs with diabetesWhy hearing loss occurs with diabetes– What is the impact of hearing loss on What is the impact of hearing loss on

quality of life issuesquality of life issues– What are the recommendations for What are the recommendations for

diabetes education in light of hearing loss diabetes education in light of hearing loss

Medical Conditions with Medical Conditions with Secondary Hearing LossSecondary Hearing Loss

• A. DiabetesA. Diabetes• B. HypothyroidismB. Hypothyroidism• C. Multiple sclerosisC. Multiple sclerosis• D. Chronic Renal DiseaseD. Chronic Renal Disease• E. Alport’s SyndromeE. Alport’s Syndrome• F. Paget’s DiseaseF. Paget’s Disease• G. Cogan’s SyndromeG. Cogan’s Syndrome• H. Other Medical conditions H. Other Medical conditions

Ototoxic DrugsOtotoxic Drugs

• A. Aminoglycoside Antibiotics (mycin A. Aminoglycoside Antibiotics (mycin drugs)drugs)

• B. Loop Inhibiting Diuretics (lasix, B. Loop Inhibiting Diuretics (lasix, furosemide)furosemide)

• C. Salicylates (aspirin, darvon, C. Salicylates (aspirin, darvon, darvocet)darvocet)

• D. Cancer ChemotherapyD. Cancer Chemotherapy• E. QuinineE. Quinine

Diabetes and hearing Diabetes and hearing lossloss

• In people age 60 and older with type In people age 60 and older with type 2 diabetes:2 diabetes:

– High blood sugar causes tiny blood High blood sugar causes tiny blood vessels in the inner ear to break, vessels in the inner ear to break, disrupting sound reception.disrupting sound reception.

– Associated balance problems may come Associated balance problems may come from neuropathyfrom neuropathy

VASCULATURE OF THE EARVASCULATURE OF THE EAR

Blood Vessels of the Blood Vessels of the Inner EarInner Ear

Arteries of the Middle Arteries of the Middle EarEar

CHRONIC KIDNEY DISEASE & CHRONIC KIDNEY DISEASE & HEARING LOSSHEARING LOSS

• Association of CKD & Association of CKD & Hearing Loss Hearing Loss

Known Known for Decadesfor Decades• Kidney & Stria Kidney & Stria

Vascularis of Vascularis of Cochlea Cochlea Share Share Physiologic, Physiologic,

Ultrastructural Ultrastructural and and Antigenic Antigenic SimilaritiesSimilarities

• Diabetes Often Results Diabetes Often Results in in Chronic Renal Chronic Renal DiseaseDisease

• Therefore, the Link Therefore, the Link Between Between Diabetes and Diabetes and Hearing Hearing Loss May Be Loss May Be Indirect Indirect But ExistsBut Exists

MALIGNANT OTITIS MALIGNANT OTITIS EXTERNAEXTERNA

• Osteomyelitis of the Ear CanalOsteomyelitis of the Ear Canal• Often Involves the Adjacent Often Involves the Adjacent

Mastoid BoneMastoid Bone• Pseudomonas Pseudomonas is Commonis Common• Necrosis or Granulation of Necrosis or Granulation of

Canal Canal • Exquisitely Tender to MotionExquisitely Tender to Motion• Temp Often >39˚ C (102.2˚)Temp Often >39˚ C (102.2˚)• May Find Facial Paralysis, May Find Facial Paralysis,

Vertigo or Meningeal SignsVertigo or Meningeal Signs• InterventionIntervention::

----Incision & Drainage/CultureIncision & Drainage/Culture--Ototopical & Oral Antibiotics--Ototopical & Oral Antibiotics--Possible IV Therapy In---Possible IV Therapy In-PatientPatient

• Diabetics at Increased Risk Diabetics at Increased Risk Urgent ReferralUrgent Referral

Malignant External Malignant External OtitisOtitisPus Draining from Pus Draining from Necrotic Ear Canal & Necrotic Ear Canal & Underlying Osteomyelitic Underlying Osteomyelitic Bone; Swelling of Auricle Bone; Swelling of Auricle With Loss of Cartilaginous With Loss of Cartilaginous ArchitectureArchitecture

Effects of Untreated Effects of Untreated Hearing LossHearing Loss

• embarrassment, fatigue, irritabilityembarrassment, fatigue, irritability• tension/stresstension/stress• avoidance of social activities avoidance of social activities • withdrawal from personal relationships withdrawal from personal relationships • depression, negativismdepression, negativism• danger to personal safety danger to personal safety • social rejection by otherssocial rejection by others• impaired memory and ability to learn new tasksimpaired memory and ability to learn new tasks• Reduced job performance and earning powerReduced job performance and earning power• Diminished psychological and overall healthDiminished psychological and overall health

(Better Hearing Institute, 2009)(Better Hearing Institute, 2009)

Auditory DeprivationAuditory Deprivation

• Although we hear with our ears, it is the Although we hear with our ears, it is the brain that is the true hearing organbrain that is the true hearing organ

• Over time, the brain’s ability to Over time, the brain’s ability to understand speech is often affected by understand speech is often affected by hearing losshearing loss

• Once the ability to understand is lost, that Once the ability to understand is lost, that ability can be difficult, if not impossible, to ability can be difficult, if not impossible, to regainregain

• Wearing hearing instruments can assist Wearing hearing instruments can assist the brain in keeping the ability to the brain in keeping the ability to understand from being lostunderstand from being lost

Recommendations for Recommendations for Monitoring Hearing Monitoring Hearing

• Screen hearing when identified with Screen hearing when identified with DiabetesDiabetes

• Ongoing assessment of hearing levels at Ongoing assessment of hearing levels at least once a yearleast once a year

• Encourage use of hearing aids if Encourage use of hearing aids if recommendedrecommended

• Seek an audiologist for comprehensive Seek an audiologist for comprehensive hearing serviceshearing services

Improved Hearing Improved Hearing Means:Means:

• Better family relationships and Better family relationships and communicationcommunication– Less isolation and less prone to depressionLess isolation and less prone to depression

• Better job performanceBetter job performance

• More energy/less stressMore energy/less stress

• Better quality of life: involvement in Better quality of life: involvement in church, family and group activitieschurch, family and group activities

NC Diabetes State PlanNC Diabetes State Plan

• Clinical InterventionsClinical Interventions– ““Improve screening for and management of Improve screening for and management of

diabetes by encouraging healthcare diabetes by encouraging healthcare providers to follow ADA guidelines, and providers to follow ADA guidelines, and include oral health and auditory screening as include oral health and auditory screening as part of baseline assessments for people with part of baseline assessments for people with diabetes.”diabetes.”

• Counseling and EducationCounseling and Education– ““Raise awareness about diabetes uncommon Raise awareness about diabetes uncommon

co-morbidities including hearing loss and co-morbidities including hearing loss and sleep apnea.” sleep apnea.”

Resources for Hearing Resources for Hearing ServicesServices

• NC American Academy of AudiologyNC American Academy of Audiology• Better Hearing Institute Better Hearing Institute

www.betterhearing.org • NC Technical Equipment ProgramNC Technical Equipment Program• Easter Seals Easter Seals www.eastersealsucp.com • Community Alternatives Program (CAP)Community Alternatives Program (CAP)• NC Vocational RehabilitationNC Vocational Rehabilitation

– Independent Living Independent Living

Questions?Questions?

Kathryn Dowd, AuD Kathryn Dowd, AuDClinical AudiologistClinical Audiologist

Hearing Solution CenterHearing Solution CenterCharlotte, NCCharlotte, NC

www.hearingsolutioncenter.com