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Diabetes Associated with Hearing Loss
Posted: Wednesday, June 17, 2009
Diabetic patients with poor glycemic control or vascular or neuropathic complications may also suffer from hearing loss. All patients with hemoglobin A1c levels greater than 7% had hearing impairment.
According to two studies presented at a poster session at the American Diabetes Association meeting, high-frequency sensorineural hearing impairment is a common but underdiagnosed complication of diabetes. "That makes sense, since [patients with diabetes] already have nerve damage in other areas," said Vivian Fonseca, M.D., of Tulane University and the Scott and White Clinic at Texas A&M University, who was not involved in either study. "Here you're also seeing damage in auditory nerves."
Some recent evidence has pointed to an association between diabetes and hearing impairment, but many researchers say sensorineural hearing loss is an under-recognized condition in diabetic patients.
To document such a potential correlation, Kathleen E. Bainbridge, Ph.D., of Social & Scientific Systems in Silver Spring, Md., and Catherine C. Cowie, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases, looked at data from 472 patients ages 20 to 69 enrolled in the National Health and Nutrition Examination Survey (NHANES).
Last year, Dr. Bainbridge and colleagues published a study in the Annals of Internal Medicine that found an increased prevalence of hearing impairment among patients with diabetes.
In the current study, Drs. Bainbridge and Cowie looked specifically at which factors and characteristics in diabetes are associated with two types of hearing loss -- low-to-mid frequency and high-frequency.
They found a six-fold increased risk of high-frequency hearing loss associated with both peripheral neuropathy and coronary heart disease. Suboptimal glycemic control was also associated with a nearly threefold increased risk of high-frequency hearing impairment. They found no evidence of low- to mid-frequency hearing impairment associated with peripheral neuropathy or glycemic control, and only weak evidence of an association with coronary heart disease.
Dr. Bainbridge noted that hearing loss was common in diabetic patients regardless of age.
In a second poster, Mohammed Ismail, M.D., of Manipal University in Mangalor, India, and Prasanna Venkatesan, M.D., also found a significant association between sensorineural hearing loss and glycemic control. They compared 50 patients who had diabetes with 50 matched controls ages 20 to 69 and found that hearing loss was significantly higher in cases than in controls (94% versus 18%, P=0.001).
All patients with hemoglobin A1c levels greater than 7% had hearing impairment, the researchers said (55.5% had mild to moderate impairment, 35% had moderate to severe, and 9% had severe to profound). Only 40% of patients with HbA1c levels under 7% had mild to moderate hearing loss, and the difference was significant .
"The poorer a patient's glycemic control, the greater the hearing loss," Dr. Venkatesan said. They also found that how long patients had had the disease was associated with hearing loss. Of those living with diabetes for more than eight years, 8.33% had mild to moderate impairment, 75% had moderate to severe, and 16.67% had severe to profound impairment. The corresponding figures for those living with diabetes for fewer than eight years were 68.4%, 18.4%, and 5.2% respectively.
Both Drs. Bainbridge and Venkatesan said some of the mechanisms by which hearing is affected in diabetic patients include thickened vessels of the stria vascularis and the internal auditory artery, as well as demyelination of the eighth cranial nerve.
"Hearing loss [in diabetic patients] is certainly underdiagnosed, but these data are based on epidemiological studies and are just associations," Dr. Fonseca said. "We don't know whether there is a direct cause and effect relationship."
Dr. Ismail said physicians should not forget that complications with the "auditory nerve are just as important as diabetic complications seen in the kidney and eyes…. Physicians should be aware that hearing loss is common in patients with diabetes," Dr. Bainbridge said, "especially those with complications such as neuropathy and coronary heart disease."
Explain that high-frequency sensorineural hearing loss was associated with multiple factors in patients with diabetes, and that the condition is underdiagnosed in many.
Note that these studies were published as abstracts and presented as posters at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Source: Diabetes In Control: Bainbridge KE, Cowie CC "Correlates of hearing impairment in the U.S. population with diabetes, National Health and Nutrition Examination Survey, 1999-2004" ADA 2009; Abstract 957-P.
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