Many people living with diabetes are not aware of the importance of audiology and how diabetes may affect their hearing and balance system. Sakhile Nkosi and Kayla Van Rie tell us more in a Q&A.
Our bodies are made up of 30 trillion cells. Each cell has its own specific function and operates all day like a factory, absorbing and producing products that our body needs to survive daily.
For our cell factories to be operational, they need to have electricity (power). This power is provided to our cells by a substance known as glucose. It essentially keeps all the lights on and all the operations in the cell running smoothly.
When you have diabetes, the hormone, insulin, that allows the cell to absorb glucose is not sufficient. This causes your body’s cells to be less efficient and sometimes causes the cells to die, causing the factory to shut down completely.
Because the entire body is made up of cells, diabetes can affect the whole body and every organ, including the hearing and balance organs.
As a person living with diabetes, you may find yourself needing to consult with a team of medical professionals to make sure you are managing your diabetes well and that it isn’t causing other side effects. However, many diabetes patients are not aware of the importance of audiology and how diabetes may affect their hearing and balance system.
What is an audiologist?
The Health Professions Council of South Africa (HPCSA) defines an audiologist as “a healthcare and educational professional who deals with the prevention, identification, treatment and management of organic disorders of the auditory and balance system, auditory processing disorders and developmental or acquired speech disorders caused by hearing loss.”
Why should I visit an audiologist as a person living with diabetes?
Since 1857, it has been known that persons living with diabetes are at risk of developing hearing and balance problems compared to healthy individuals.
When the cell bodies of the ear experience an irregular ‘power shortages,’ the cells may begin to be less effective. You may not notice that you’re not hearing or balancing well immediately, because the cells are weakened slowly over time, especially if your diabetes is left unmanaged.
Signs of hearing and balance deterioration
The signs of hearing and balance deterioration will not usually be obvious, for example, you may experience one of the following:
- You may start to realise that you are not hearing well when you are struggling to discriminate what someone is saying whilst in a noisy setting.
- You may experience a high-pitch ringing sound in your ears (known as tinnitus) every now and again, or all the time.
- You may notice that your balance is not what it used to be when you are walking on a gravel road at night.
- You may notice that you seem a bit clumsier while walking, stumbling more regularly.
These small signs may be cues that you need to visit your audiologist. It’s best to consult with an audiologist as soon as possible so action can be taken to prevent the effects of hearing and balance difficulties from having dire consequences on your life. As with most things, early intervention is key.
How can I prevent having a hearing and balance impairment?
There are no special preventative precautions dedicated to diabetes. This precaution, however, may be applied by every human being:
- Limit exposure to harmful noise. If exposure cannot be avoided especially in a case of occupational noise exposure, the use of hearing protection devices is mandatory.
With regards to diabetes, it’s advisable to take note of the following:
- Take your medication as prescribed to prevent advanced diabetic complications.
- Find out about the side effects of any medicine you take and ask for a medication review.
- Importance of diabetes control (ABCs). This refers to A1c, blood pressure, cholesterol and smoking. All of which needs to be closely monitored and managed to prevent diabetes progression and diabetes-related complications (including hearing loss).
How will an audiologist quantify hearing and balance problems in a context of diabetes?
Audiological procedures are non-invasive, meaning they are pain free. First your audiologist will take a thorough case history which will broadly comprise of your medical, hearing and communication history. The following questions may be asked:
- Are you struggling to understand speech, particularly in noisy environments?
- Are you experiencing any ringing in your ears?
- History of high levels of noise exposure.
- History of ototoxic drug use (ototoxic drug use implies any medication that has potential to damage your auditory organ).
- Sensitivity to loud sounds.
- Ear pain or drainage.
- Dizziness or imbalance complaints.
- History of falls.
- Concern for falling.
Diagnostic hearing assessment
The second step to your evaluation would be a diagnostic hearing assessment. The audiologist will perform a series of test procedures such as:
Pure tone audiometry which is used to determine the type and severity of a hearing loss.
Speech audiometry which will identify if the effects of diabetes have affected your ability to discriminate speech at normal levels and in noisy environments.
Tympanometry which will identify if there are any abnormalities or infections within the middle ear.
Otoacoustic emissions is used to assess the hair cells (hearing cells) in the cochlear, which are commonly damaged in people living with diabetes.
Auditory brainstem which will identify if the effects of diabetes as caused to your auditory nerve or portions in the brainstem that process sound.
Balance evaluation enables the audiologist to look at the interaction of your vestibular (portion of the ear that controls balance), visual and somatosensory (sensors in your body that tell your brain where your body is in space) systems to identify if you have any abnormalities that may be causing balance difficulties or if you are at risk of falling.
Your audiologist may decide on any additional tests or alter the test battery according to his or her objectives.
After the hearing or balance evaluation, your audiologist will discuss the findings and develop an intervention plan tailored for your needs.
How often should I visit an audiologist?
Your audiologist will develop a personalised plan of care after the initial appointment. This plan is normally based on what the audiologist might have come across during your baseline hearing and balance assessment.
In an event where hearing loss or balance difficulty was identified, your audiologist might ask you to visit on a regular basis to start intervening.
In a scenario where your hearing or balance was found to be normal, studies recommend an annual or two-year interval visits to your audiologist to monitor your hearing and balance functioning.
Is there home-based hearing screening?
The following screening questions regarding perceived hearing difficulty may provide insight on hearing status and help inform the need for further evaluation. These questions are based on those used in the Guide for Pharmacy, Podiatry, Optometry, and Dentistry [PPOD] for Diabetes Management):
- Do you or your family perceive any change in your hearing?
- Do you have hearing difficulty in quiet or noise?
- Do you feel unsteady when standing or walking?
- Do you worry about falling?
- Have fallen in past year?
- Have you had your hearing tested in the past two years?
- Do you know how diabetes can affect your hearing?
- Do you know what to do if you perceive a change in hearing?
- Do you know how to reduce your risk for hearing loss?
If you answer “Yes” to questions 1 through 4 or “No” to questions 3 through 6, it’s recommended you visit an audiologist for a diagnostic audiological and balance evaluation.
Other home-based hearing screening methods includes the use of smart phone-based hearing screening applications such as HearZA hearing screening app:
It’s however important to understand that this screening app may miss subtle forms of hearing loss, such as slight, mild losses or auditory processing difficulties. Hence, the screening app does not substitute a visit to an audiologist for a full diagnostic hearing assessment
To find an audiologist, click here.
Adebola, S. O., Olamoyegun, M., Sogebi, O., Iwuala, S., Babarinde, J., & Oyelakin, A. (2016). Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria. Brazilian Journal Otorhinolaryngology, 82(5), 567-573. doi:dx.doi.org/10.1016/j.bjorl.2015.10.016.
Akinpelu, O., Mujica-Mota, M., & Daniel, S. (2014). Is type 2 diabetes mellitus associated with alterations in hearing? A systematic review and meta-analysis. Laryngoscope, 124, 767–776. Retrieved from https://doi.org/10.1002/lary.24354.
Arlinger, S. (2003). Negative consequences of uncorrected hearing loss – A review. International Journal of Audiology, 42(2), S17–2 S20.
Hlayisi, V., Petersen, L., & Ramma, L. (2018). High prevelance of disabling hearing loss in young to middle-aged adults with diabetes. International Journal of Diabetes in Developing Countries, 39(1), 148-153. doi:10.1007/s13410-018-0655-
MEET THE EXPERT
Sakhile Nkosi is an audiologist in clinical practice at a district hospital, South Africa. He obtained his undergraduate degree in Communication Pathology (Audiology) at University of Pretoria. He is chairing the South African state cohort at The Audiology Project (TAP), a project that aims to advocate for the inclusion of audiological services in the care of patients with diabetes. Sakhile is currently completing his master’s degree in Audiology at the University of KwaZulu-Natal. theaudiologyproject.com
MEET THE EXPERT
Kayla Van Rie is a research, clinical and training audiologist at Amtronix Diagnostics. She is passionate about her patient’s quality of life and a has a special interest in vestibular audiology. Kayla is currently completing her Master’s Degree in Audiology at the University of the Witwatersrand.