Hearing loss affects about one in four adults with diabetes, making it one of the condition’s most common sequalae, new research shows.
Yet it’s less well acknowledged than other diabetic complications, leading to consequences that can potentially be prevented—starting with simple screening, says Dr Mehwish Nisar, a medical doctor, researcher, and academic from the University of Queensland’s School of Public Health, who led the study.
To quantify its prevalence, Dr Nisar’s team analysed 29 studies that reported audiometric measures in more than 17,000 people with diabetes or prediabetes—finding a pooled prevalence of 24%.
People with diabetes had a more than two-fold increased risk of significant hearing impairment compared to controls without diabetes, they found.
While retinopathy, nephropathy, and neuropathy were recognised and routinely monitored complications, hearing impairment was a “significant, yet under-recognised, complication,’’ Dr Nisar says.
The consequences can be significant, interfering with communication and fuelling isolation, she adds.
Hearing impairment often affects people in their 40s and 50s—appearing within 10 years of diabetes onset, Dr Nisar says.
“Chronic high blood glucose damages blood vessels and nerves in the ear in much the same way it does the retina, kidney and peripheral nerves,” she explains, noting this predominantly results in sensorineural hearing loss.
Despite this clear link, hearing checks are not a routine part of diabetes care protocols—and patients are often unaware of the problem until it’s more advanced, she says.
“This is an irreversible condition. Prevention and early screening are best.”
To screen for hearing problems, Dr Nisar recommends asking a few simple questions during routine diabetes reviews:
If patients report concerns, you can screen further using an in-clinic test (e.g. the Whisper Test) or a free online tool (e.g. from Hearing Australia or National Acoustic Laboratories). Any issues warrant referral for a comprehensive audiology assessment.
Patients with diabetes who see you specifically about hearing difficulties should be referred directly for formal audiology assessment, she adds — recommending a lower referral threshold in patients with other diabetic complications.
“If there are other comorbidities, retinopathy or other microvascular disorders, then it is also necessary to go for assessment at least once a year.”
Patients can access audiology assessments without a GP referral, and they are free of charge, she adds.
Direct referral to an ENT specialist is appropriate when symptoms suggest a more urgent or complex condition, including sudden or asymmetrical hearing loss, ear pain, discharge or associated dizziness.
Dr Nisar suggests annual hearing assessment for patients with diabetes, even in the absence of hearing concerns, with more frequent assessment for those with symptoms or other microvascular complications.
Hearing checks should start sooner rather than later, she stresses. “The clock starts at diagnosis. It’s better to do the checkup early.”
Some medications can be ototoxic, including several commonly prescribed in patients with diabetes—such as metformin and some long-acting insulin analogues, Dr Nisar says.
“Also, some SGLT-2 inhibitors, aminoglycosides, antibiotics, and aspirin can also cause hearing loss. So if a diabetic patient is taking any of these types of medication, it is also necessary to check their hearing.”
AJGP | Diabetes and hearing loss (includes a chart of potentially ototoxic medications)
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