Hearing Loss and Diabetes: What You Need to Know

Oct 30, 2023

Fact Checked

Uncontrolled blood sugar from diabetes can harm your hearing. Read on to find out symptoms and prevention tips for maintaining your hearing health.

Written By: Steven Marshall, DNP, MSN, BSN, RN

Medical Reviewer: Rachel Magann Faivre, AuD

Reviewed by: Kathleen Cameron, BSPharm, MPH

Key Takeaways

More than 37 million Americans have diabetes.
Experiencing hearing loss is twice as likely in people with diabetes than in those without.
Extended periods of high and low blood sugar can cause damage to the blood vessels and nerves of the inner ear. Hearing loss results from the continued damage to these structures in people with diabetes.
Due to the structural damage caused by diabetes, hearing loss is not reversible.

Diabetes is more prevalent than many people realize and affects roughly 37 million people in the United States ^[1] or one in 10 Americans. Of these, one in five is unaware that they have diabetes. Prediabetes is even more prevalent, affecting more than one in three American adults, with eight in 10 unaware. ^[2]

Many with diabetes may be familiar with its potential complications, including damage to the nerves (neuropathy), eyes (retinopathy), and kidneys (nephropathy). Although the prevalence of hearing loss is twice as likely for those with diabetes, people may not recognize the symptoms themselves as they happen slowly. ^[1]

Similar to high blood pressure, there is no way a health care provider can see hearing loss. These conditions must be diagnosed through measurement with specific devices and by professionals. While blood pressure is a common measurement obtained when visiting your primary care provider, hearing tests require a specialist, like an audiologist, to determine hearing loss. But a validated hearing screener, who could be an assistant or a nurse, can determine if a hearing test is necessary. If you have diabetes, understanding the potential risk of hearing loss may help you seek treatment earlier.

The science behind diabetes and hearing loss

The American Diabetes Association notes the relationship between diabetes and hearing loss isn’t fully understood. Theories suggest damage may occur to the small blood vessels in the inner ear, which then leads to hearing loss. ^[1]

According to the National Institutes of Health (NIH), hearing loss is twice as likely for people with diabetes. ^[3] Losing your hearing is a common problem with aging, and around 36 million people report some degree of hearing loss. The link between hearing loss and diabetes has been studied and debated since the 1960s or earlier. An analysis spanning 13 studies researching hearing loss in people with diabetes concluded there was a higher prevalence of hearing loss among people with diabetes. ^[4]

This might happen because extended periods of high blood sugar can damage small blood vessels in the inner ear. Over time, low blood sugar can damage the nerves linking the inner ear to the brain. Each of these types of damage can lead to hearing loss. ^[5]

Hypertension, the clinical term for high blood pressure, is a common condition among people with diabetes and can also lead to hearing loss. ^[2] When blood pressure is elevated, blood travels through vessels much faster and can damage the vessel lining. Fatty plaque can build up on the damaged areas. If this combination of damage and plaque buildup occurs in the blood vessels of the ear, it can lead to hearing loss.

Research shows as blood pressure increases, hearing decreases, although this type of hearing loss can be reversed if the blood pressure returns to normal. ^[6]

Smoking is a known cause of Type 2 diabetes, with 30%–40% of smokers more likely to develop the condition. This happens when nicotine and carbon monoxide constrict the blood vessels of the ear. ^[7]

Nicotine and smoke also impact hearing by:

Interfering with the nerves that transmit sound from the ear to the brain
Irritating the eustachian tube and inner ear lining
Increasing sensitivity to loud noises leading to noise-induced hearing loss

Diabetes-related hearing loss can affect anyone with diabetes, but it’s observed more commonly in people who have had long-standing diabetes or those who have not adequately managed their blood sugar levels. These people tend to have fluctuating or high blood sugar that can lead to damage in the small blood vessels in the inner ear, which in turn can impact normal hearing function.

—Jabe Brown, founder of Australia-based Melbourne Functional Medicine

Research shows 73.6% of people with diabetes have hypertension, which can lead to hearing loss. Additionally, people with diabetes who currently smoke are more likely to experience hearing loss. ^[8] Quitting smoking eliminates the additional constriction of the blood vessels in the ear and may reduce hearing loss.

Past studies have also shown hearing impairment in people with diabetes was more common in those under 60. ^[4] But in general, people with poorly controlled diabetes may experience hearing loss due to extended high and low blood sugar periods. ^[5]

Why does hearing loss matter?

Hearing loss can have a significant impact on your overall health and quality of life. It can lead to difficulty communicating with others, social isolation, frustration, and falls. ^[9] These impacts are more common among older adults with hearing loss. ^[10] The incidence of cognitive impairments, including the development of dementia and Alzheimer’s disease, can also be greater in people with hearing loss, ^[11] while people who experience mental health issues, including depression, may experience worsening symptoms as a result of hearing loss.

Hearing loss matters profoundly. It doesn’t just affect an individual’srnability to understand conversations, it also encompasses aspects of balance, alertness to environmental hazards, and the enjoyment of music or the everyday sounds of nature. An impaired hearing can lead to a deficit in these experiences, ultimately compromising the quality of life.

—Jabe Brown

Hearing problems caused by diabetes

People with diabetes may experience multiple hearing complications. Inner ear blood vessel and nerve damage can occur with Type 1 and Type 2 diabetes. ^[5] But the most common hearing loss seen in people with Type 2 diabetes ^[12] is presbycusis or age-related hearing loss.

Presbycusis hearing loss

Presbycusis is bilateral (both ears) high frequency and sensorineural hearing loss, ^[13] which means your ability to hear higher pitches slowly declines. The loss of hearing is usually permanent with this condition, and it affects roughly one in three people age 65–74 and almost 50% of those 75 and older in the United States. ^[14]

Sensorineural Hearing Loss (SNHL)

SNHL occurs when there is damage to the inner ear. ^[13] Poor control of diabetes may result in low blood sugar, which causes damage to the nerves, and high blood sugar causes damage to the blood vessels in the inner ear. ^[5]

Cochlear damage

The ear’s cochlea contains many blood vessels. ^[15] The damage caused to the blood vessels of the cochlea by high blood sugar may lead to hearing loss. The hearing loss, in this instance, results in a decreased blood supply, leading to improper function of the cochlea.

Auditory Neuropathy

Hearing problems in people with diabetes may be due to the loss of outer and inner hair cells and the loss of neurons in the inner ear that lead to auditory neuropathy. ^[16] People with auditory neuropathy may experience hearing loss, tinnitus, and dizziness.

Tinnitus

People with diabetes may also experience ringing (or other sounds) in the ears (tinnitus) as a common symptom. Tinnitus may be present with or without hearing loss. ^[17]

Ear infections and itchiness

People with diabetes have less acidic earwax making them prone to outer ear infections (including the ear canal). Itchy ears can also be caused by diabetes. ^[18]

Auditory neuropathy spectrum disorder (ANSD)

People with this hearing problem have difficulty understanding speech but may be able to interpret sounds normally. ^[19] The causes of the disorder may be related to problems with the ear’s inner hair cells or auditory neurons. Similar to ANSD, Auditory Processing Disorder (APD) is likely linked to diabetes by the same mechanisms. APD indicates the brain piece of hearing (nerves and blood vessels) is what’s damaged, while ANSD is when the peripheral hearing system (cochlea’s inner hair cells and auditory nerve) is what’s damaged.

What people with diabetes can do about hearing loss

If you feel you are having trouble with your hearing or your friends or family have mentioned this to you, take action. You can try online hearing screens, such as the hearScreenUSA from The Audiology Project. ^[20] Some hearing aid brands also have online hearing tests, like Eargo and Jabra Enhance. You can consult your provider or contact a local hearing clinic.

Know the symptoms of hearing loss

Hearing loss occurs over time and can be difficult to recognize. Signs of hearing loss may include:

Asking people to repeat themselves during conversations
Difficulty following a conversation with more than one person
Thinking others are mumbling when they are speaking
Problems hearing in noisy environments, like stores or restaurants
Trouble hearing children and others with soft voices
Having to turn up the volume on the TV or radio to a level that bothers others ^[5]

The degrees of hearing loss are mild or slight, moderate, severe, and profound. ^[21]

The degrees of hearing loss are mild or slight, moderate, severe, and profound.

Protect your ears

People with diabetes should focus on blood sugar control to help prevent hearing loss from diabetes. ^[5] The CDC provides some tips to prevent hearing loss from loud noise. These include:

Decrease the volume of the TV or radio.
Take breaks when listening to loud music.
Use power tools, toys, or recreational equipment designed for quiet operation.
Maintain equipment to prevent noise from worn, loose, or unbalanced parts.
Use hearing protection, like earplugs or earmuffs, when you can’t avoid loud noises. Keep earplugs in convenient locations, like your car or shop, for easy access.
If unable to avoid loud noises, limit the time you are exposed to them. ^[22]

Manage your diabetes

Taking control of your diabetes by following your providers’ recommendations is crucial to your overall health. Work to keep your blood sugar within the target range, and follow your diabetes care schedule to stay on track to meet your goals. ^[23] Maintaining your target blood sugar level will help decrease your risk of hearing loss. You can also attend a diabetes education course in your area. The Association of Diabetes Care & Education Specialists (ADCES) has a locator tool on its website to help you find an education program near you. ^[25]

Try prevention strategies

You can also try proven strategies to cut your diabetes risk.

The Mayo Clinic recommends you follow these five tips to prevent diabetes:

Lose extra weight
Be more physically active
Eat healthy plant foods
Eat healthy fats
Skip fad diets and make healthier choices

These lifestyle changes can help prevent the onset of type 2 diabetes, which is the most common form of the disease.

NCOA also recommends you use a program from the Self-Management Resource Center called Diabetes Self-Management. This program is free and helps participants address everyday activities like exercise, nutrition, and symptom management.

Get your hearing checked regularly

People with diabetes have more risk factors for hearing loss. It’s important to include hearing checkups as a part of your diabetes care schedule. ^[23] You should have your hearing tested by an audiologist when first diagnosed with diabetes for a baseline measurement. ^[5] Here are some questions to ask your provider about hearing loss:

Am I taking any medications that potentially cause hearing damage?
Is the metformin appropriate to treat my Type 2 diabetes? This medication may have a lower risk of hearing loss. ^[24]
What blood glucose target range will provide the best hearing protection?
Do you have an audiologist you recommend who specializes in hearing loss in people with diabetes?

Talk to your health care provider about risk factors for hearing loss comorbidities

You can help prevent hearing loss by addressing some common risk factors:

Quit smoking. Nicotine and the carbon monoxide found in cigarette smoke can damage blood vessels in the inner ear resulting in hearing loss. ^[26]
Keep your blood pressure under control. As your blood pressure increases, your hearing decreases. ^[6] The hearing loss from high blood pressure can improve as the blood pressure returns to normal.
Maintain healthy cholesterol levels. A study found people who eat diets high in cholesterol have a 33% higher risk of developing hearing loss. ^[27] Consuming monounsaturated fats, also known as good fats, may reduce the risk of hearing loss.

Be sure to speak with your provider about your options for quitting smoking and maintaining your blood pressure and cholesterol levels. A statin medication may be an option, which has been shown to decrease the hearing loss risk from high cholesterol. ^[27]

Accessing hearing support for people with diabetes

Caring for your diabetes is expensive. The cost of medications, blood sugar monitoring devices, and other supplies can add up quickly. ^[28] Managing hearing loss associated with diabetes can require expensive hearing aids or other assistive devices. Hearing aids or personal sound amplification products (PSAPs) are usually the first line of assistance for people with hearing loss. ^[29] Hearing aids are designed to help impaired hearing, while PSAPs are useful if you have normal hearing but are having difficulty with sound in certain situations, like watching TV.

OTC hearing aids and PSAPs

Assistive devices for hearing loss are no longer limited to prescription hearing aids. Over-the-counter (OTC) hearing aids and PSAPs can be effective lower-cost alternatives.

Several additional costs are associated with prescription hearing aids, including medical exams, audiologist fittings, and purchases from licensed sellers. OTC hearing aids do not require medical exams, prescriptions, audiologist fittings, or licensed sellers.

It’s important to remember OTC hearing aids are only available for adults 18 and over with perceived mild to moderate hearing loss. People of any age can use prescription hearing aids for mild, moderate, or severe hearing loss.

While prescription and OTC hearing aids are medical devices and must comply with FDA requirements, PSAPs are electronic products and are not considered medical devices. These devices are used to amplify sounds for people with normal hearing, who have perceived hearing difficulties. ^[29]

Getting help paying for hearing aids

When you decide the time is right to address hearing loss, you may be able to get financial assistance for hearing aids. Assistance may be available through your private insurance company, Medicare Advantage (Medicare Part C), and Medicaid, but plans vary, so check with your health care provider for specific coverage. Community-specific hearing aid resources are also available through organizations like the U.S. Department of Veterans Affairs (VA), federal employee programs, state vocational rehabilitation plans, and employee benefits programs.

Offsetting diabetes costs

You may also be eligible for financial assistance to help with the cost of treating diabetes and its complications, including hearing loss. Some states, like Washington, offer property tax discounts to older adults with health conditions, including diabetes and hearing loss. ^[30] You can also consult your tax advisor to determine eligibility for income tax breaks on diabetes expenses. ^[31]

How to navigate hearing loss

Problems with your hearing can significantly impact your life. Speak with your provider about hearing tests and other resources available to you. Talking with your friends and family about your hearing problems can help you cope with hearing loss. ^[32] Explain how they can help you hear better by facing you and speaking louder and more clearly. You can also monitor their facial expressions and gestures to help you understand what they communicate, and ask them to clarify anything you didn’t understand.

Adapt your activity

Changes to your hearing and/or inner ears can lead to problems with balance and increase the risk of falling. ^[33] Choose exercises that will assist your balance in some way, like holding the handrails on the treadmill or sitting on an exercise bike. Some people with hearing loss have found virtual exercise programs work better than in-person options. ^[34] Focusing one-on-one with a virtual trainer makes hearing the instructions easier than in a large in-person class. Wear your hearing devices when exercising to maintain effective communication. Changing exercise options may be necessary to maintain your safety. Consult your provider or other health care professionals to develop a personalized exercise program.

Care for your mental health

Untreated hearing loss can lead to feelings of isolation and depression, which can result in an overall poorer quality of life. Treating depression is important for maintaining your overall mental health. Psychotherapy and medications are commonly used to treat depression. But if left untreated, depression can lead to cognitive decline and worsen your diabetes symptoms. ^[35]

If you decide to pursue therapy as a treatment option, several resources are available to help you choose the right therapist in addition to asking your primary care provider for a recommendation. These include finding your local Mental Health America affiliate ^[36] or using an online therapy directory. ^[37] Hearing support groups ^[38] can connect you with others experiencing hearing loss. National support groups include the Hearing Loss Association of America and the Association of Late-Deafened Adults.

The Audiology Project aims to educate consumers and health professionals about the prevalence of health conditions associated with hearing loss. The project provides information on multiple hearing-related topics related to diabetes.

Stay sharp

Unfortunately, your risk of developing dementia increases with untreated hearing loss. ^[39] Higher demands on cognitive resources from hearing loss may reduce resources available for memory and thinking. This can lead to a faster rate of cognitive decline. Physical changes in the brain result from hearing loss and can also impact cognitive function. You may be able to decrease the rate of cognitive decline through regular physical activity, a healthy diet, social activity, and intellectual stimulation. ^[40]

Brown noted, “Coping with hearing loss is a process that integrates specific lifestyle changes, hearing aids, and regular check-ups. Becoming educated about the relationship between diabetes and hearing loss can significantly help. As part of a holistic approach, staying proactive about maintaining controlled blood sugar levels, having regular hearing assessments, and maintaining a healthy lifestyle can all contribute to better hearing health.”

Bottom line

Thirty-seven million Americans have diabetes and are twice as likely ^[3] to develop hearing loss than those without. ^[1] Hearing loss in people with diabetes is caused by damage to the blood vessels and nerves of the inner ear, which happens when there are prolonged periods of high and low blood sugar. ^[2] Smoking, high blood pressure, and high cholesterol contribute to the risk of hearing loss. Quitting smoking and maintaining normal blood pressure and cholesterol levels can help decrease this risk. Managing diabetes is expensive, and treating hearing loss adds to this cost.

Fortunately, there may be financial assistance programs available to help you. While hearing problems can lead to difficulty with physical activity, mental health, and overall cognitive function, you can reduce your overall risks through prevention and treatment, and minimize the impact of hearing loss on your quality of life.

Have questions about this review? Email us at reviewsteam@ncoa.org.

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Steve Marshall has more than 35 years of clinical and leadership experience in health care. He has worked in various settings, including emergency departments, intensive care units, air and ground transport, oncology, infectious disease, and infusion services. He founded See Doc Nurse Write LLC in 2023 to expand the reach of his clinical knowledge and expertise.

Rachel Magann Faivre, AuD, is the owner of Oklahoma City-based Ash Audiology. She currently serves on The Audiology Project’s Board of Directors and on Northern Illinois University’s Advisory Board. Additionally, Dr. Magann Faivre has served for many years on her National Audiology Association's Advocacy Committee to help improve access and coverage of hearing health care. She received her doctor of audiology from Northern Illinois University and has been the recipient of multiple relevant awards.

Kathleen Cameron, BSPharm, MPH, has more than 25 years of experience in the health care field as a pharmacist, researcher, and program director focusing on falls prevention, geriatric pharmacotherapy, mental health, long-term services and supports, and caregiving. Cameron is Senior Director of the NCOA Center for Healthy Aging, where she provides subject matter expertise on health care programmatic and policy related issues and oversees the Modernizing Senior Center Resource Center.

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