Hearing Impairment in Relation to Severity of Diabetes in a Veteran Cohort

Abstract

Objective Type 2 diabetes is epidemic among veterans, approaching three times the prevalence of the general population. Diabetes leads to devastating complications of vascular and neurologic malfunction and appears to impair auditory function. Hearing loss prevention is a major health-related initiative in the Veterans Health Administration. Thus, this research sought to identify, and quantify with effect sizes, differences in hearing, speech recognition, and hearing-related quality of life (QOL) measures associated with diabetes and to determine whether well-controlled diabetes diminishes the differences. Design The authors examined selected cross-sectional data from the baseline (initial) visit of a longitudinal study of Veterans with and without type 2 diabetes designed to assess the possible differences in age-related trajectories of peripheral and central auditory function between the two groups. In addition, the diabetes group was divided into subgroups on the basis of medical diagnosis of diabetes and current glycated hemoglobin (HbA1c) as a metric of disease severity and control. Outcome measures were pure-tone thresholds, word recognition using sentences presented in noise or time-compressed, and an inventory assessing the self-perceived impact of hearing loss on QOL. Data were analyzed from 130 Veterans ages 24 to 73 (mean 48) years with well-controlled (controlled) diabetes, poorly controlled (uncontrolled) diabetes, prediabetes, and no diabetes. Regression was used to identify any group differences in age, noise exposure history, and other sociodemographic factors, and multiple regression was used to model each outcome variable, adjusting for potential confounders. Results were evaluated in relation to diabetes duration, use of insulin (yes, no), and presence of selected diabetes complications (neuropathy and retinopathy). Results Compared with nondiabetics, Veterans with uncontrolled diabetes had significant differences in hearing at speech frequencies, including poorer hearing by 3 to 3.5 dB for thresholds at 250 Hz and in a clinical pure-tone average, respectively. Compared with nondiabetic controls, individuals with uncontrolled diabetes also significantly more frequently reported that their hearing adversely impacted QOL on one of the three subscales (ability to adapt). Despite this, although they also had slightly poorer mean scores on both word recognition tasks performed, these differences did not reach statistical significance and all subjects performed well on these tasks. Compared with Veterans with controlled diabetes, those with uncontrolled disease tended to have had diabetes longer, be insulin-dependent, and have a greater prevalence of diabetic retinopathy. Results are generally comparable with the literature with regard to the magnitude of threshold differences and the prevalence of hearing impairment but extend prior work by providing threshold difference and hearing loss prevalence effect sizes by category of diabetes control and by including additional functional measures. ...

Diabetes-Associated Changes in Cortical Auditory-Evoked Potentials in Relation to Normal Aging

“…Effects of DM on hearing sensitivity have been widely reported. We and others have found that those with DM have poorer hearing than control participants without DM and that this difference in hearing is most apparent among those under the age of 50 – 60 years, before age-related changes begin to dominate (Frisina et al 2006; Vaughn et al 2005; Bainbridge et al 2008; Austin et al 2009; Bainbridge et al 2011; Konrad-Martin et al 2015; Horikawa et al 2013; Akinpelu et al 2014a). Combining data across multiple studies, a recent meta-analysis estimates the odds of having a hearing loss of 25 dB HL or greater among individuals with type 2 DM is roughly twice that observed among controls (OR 1.91; 95% confidence interval [CI] 1.47–2.49) (Akinpelu et al 2014a).…”

“…Significant effects of DM on pure tone thresholds and central ABR components are found more often than not upon investigation, however, there is substantial between-study heterogeneity in the findings (hearing and ABR: Akinpelu et al, 2014a; hearing: Horikawa et al 2013; Konrad-Martin et al 2015). There are a number of possible reasons for this.…”

Características audiológicas de pacientes com diabetes mellitus Tipo 2

“…There was no association of age with the absence of responses in the OAE. Some studies involving individuals with older age, observed the relation of DM with the hearing loss 14,18,23 and with the absence of OAE 2 , while others found no association 15,24 .…”

Vascular and Neuroepithelial Histopathology of the Saccule in Humans With Diabetes Mellitus

“…DM is epidemiologically associated with sensorineural hearing loss (4-6). The cochleae of humans and animals with DM manifest corresponding microangiopathic and neuroepithelial changes, including capillary basement membrane thickening in the stria vascularis, thickening and occlusion of cochlear arterioles and arteries, and variable degrees of cochlear hair cell and spiral ganglion cell loss (7, 8).…”