Over the past 20-25 years, the percentage of Americans with type 2 diabetes has nearly doubled to over 9% of the nation’s population. Diabetes is defined as high blood glucose levels as a result of underproduction - or no production - of insulin, which is needed to break down glucose in the body. Diabetes occurs in several types including: prediabetes, type 1 diabetes, type 2 diabetes, and gestational diabetes. This piece refers to the impact of prediabetes and type 2 diabetes in the United States.
In the US, it is currently estimated to take 9-12 years before a person is diagnosed with prediabetes or type 2 diabetes. This highlights the lag time in the person’s body of high glucose levels, potentially causing damage to sensitive structures in the body, without a person knowing. Damage from diabetes to sensitive structures in the body is called microangiopathy. This affects the small blood vessels in the body leading to high prevalence of damage to the eyes, kidneys, and hearing organs. This also results in high prevalence of infections in the body and diagnosis of other chronic illnesses such as cardiovascular disease or chronic kidney disease
The inner ear structures are composed of the cochlea, vestibular, and vestibulocochlear nerve all fed by small blood vessels. As these organs are affected by microangiopathy, this can cause damage to the blood vessels in the cochlea (stria vascularis), sensory structures in the vestibular system (type 1 hair cells), and/or nerve bundles of either system. Nerve damage from chronically high blood sugar levels not only can occur in the ear, but can occur in the lower limbs or visual system, which are more commonly known. The problem then with this type of damage from uncontrolled blood sugar levels in the auditory and vestibular system is that these structures are like a “black box;” the effects on these structures are unable to be physically seen. Instead, the effects are able to be evaluated functionally with an audiologic or vestibular evaluation. Without either of these, a person with diabetes may not know how these systems have been affected by their disease. As healthcare providers, we urge this population to be evaluated for hearing loss or vestibular dysfunction as well as routinely monitored for progressive effects. Hearing loss is not able to be detected by pure observation until the severity has increased significantly. Consequences of hearing loss in other professions can appear as the patient misunderstands verbal instructions, misses instruction altogether, noncompliance with an outlined treatment plan as a result, and results in poor patient outcomes. Consequences of vestibular dysfunction increases fall risk, increased fear of falling, increased fractures due to falls, and can lead to high cost medical care as a result of falls.
As a result of the effects seen in persons with diabetes, audiologists are a critical part of the interprofessional team managing these cases. According to The Audiology Project, the outlined recommended plan for audiology care for persons with diabetes is as follows:
A thorough case history including: medications, medical history, history of noise exposure, trauma to the head or neck, hospitalizations over the past 10-20 years, family history, and complaints about hearing or balance.
Balance screening for Vestibular Evaluation if warranted
Treatment recommendations including monitoring protocol
Referral for diabetes education if not already in place
At Professional Hearing Center, we would like to be a part of the team aiding in superior health care for persons with diabetes. Contact our nearest clinic today to set up an evaluation if you or a loved one has been diagnosed with diabetes.