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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 23  |  Issue : 2  |  Page : 113-116

Effect of duration of diabetes mellitus on hearing threshold among type 2 diabetics


1 Department of ENT, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Internal Medicine, Endocrine Unit, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Web Publication14-Jun-2017

Correspondence Address:
Stephen Semen Yikawe
Department of ENT, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_40_17

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  Abstract 

Background: Diabetes mellitus (DM) is a syndrome of chronic hyperglycemia due to relative insulin deficiency or resistance. The risk of complications of diabetes has been observed to increase as a function of the duration of hyperglycemia. Objective: The objective of this study is to determine the effect of duration of DM on hearing thresholds among type 2 diabetics. Methodology: This was a cross-sectional descriptive study conducted between October 2015 and May 2016 in Usmanu Danfodiyo University Teaching Hospital Sokoto among type 2 diabetic patients attending the Endocrine Clinic of the hospital. Patients had their blood sugar and hearing thresholds measured. Results: A total of 170 type 2 diabetics were recruited into the study, out of which 98 (57.6%) were females and 72 (42.4%) were males. The mean age was 46.49±10.02 years. One hundred and twenty-two (71.8%) had elevated hearing thresholds. The mean duration of diabetes among participants was 7.81±5.34 years, with durations ranging from <1 year to 30 years. The mean pure tone average increased with increase in duration of diabetes (P < 0.001). Simple linear regression showed that increase in duration of diabetes was positively related with hearing threshold (P < 0.0001). For every year increase in duration of type 2 DM, a 1.036 dB HL increase in pure tone average is to be expected. Conclusion: This study demonstrated a relationship between duration of diabetes and hearing threshold. It has shown that as the duration of hyperglycemia increased, the hearing threshold among participants also increased.

Keywords: Hearing threshold, hyperglycemia, type 2 diabetes


How to cite this article:
Yikawe SS, Iseh KR, Sabir AA, Solomon JH, Manya C, Aliyu N. Effect of duration of diabetes mellitus on hearing threshold among type 2 diabetics. Indian J Otol 2017;23:113-6

How to cite this URL:
Yikawe SS, Iseh KR, Sabir AA, Solomon JH, Manya C, Aliyu N. Effect of duration of diabetes mellitus on hearing threshold among type 2 diabetics. Indian J Otol [serial online] 2017 [cited 2020 Sep 26];23:113-6. Available from: http://www.indianjotol.org/text.asp?2017/23/2/113/208027


  Introduction Top


Diabetes mellitus (DM) comprises a group of common metabolic disorders that share a phenotype of hyperglycemia.[1] DM can be broadly classified into Type 1, Type 2, other specific types of diabetes, and gestational DM. DM is a systemic disease with accompanying pathology affecting multiple organ systems.[1],[2],[3]

Complications of DM can be acute or chronic. Chronic complications are responsible for the majority of morbidity and mortality associated with the disease.[1] The risk of chronic complications increases as a function of the duration of hyperglycemia; they usually become apparent in the second decade of hyperglycemia, and since type 2 DM often has a long asymptomatic period of hyperglycemia, many individuals with type 2 DM have complications at the time of diagnosis.[1]

A number of studies have shown an association between DM and increased likelihood of hearing loss.[4],[5],[6],[7],[8],[9],[10],[11] Although the exact mechanism leading to hearing loss in diabetics remains unknown, the probable mechanisms are microangiopathy of the inner ear, neuropathy of the cochlear nerve, a combination of both, outer hair cell dysfunction, and disruption of endolymphatic potential.[12] However, the effects of different variables such as duration of diabetes, blood sugar control, and the presence of end organ damage on hearing loss have not yet been clarified, despite several studies of this topic.[13] Some studies have observed that increase in duration of diabetes was related with an increase in hearing thresholds, while other studies did not observe any relationship between duration of diabetes and hearing threshold.[6],[7] Isa et al. in a study conducted in Northeastern Nigeria described mild to moderate sensorineural hearing loss with progressively high-frequency losses, with a significant correlation between duration of diabetes and development of hearing impairment.[6] Ologe and Okoro in a tertiary hospital in Ilorin Nigeria did not observe any relationship between duration of diabetes and hearing threshold.[7] The duration of diabetes, as well as glycemic control, were found to have no effect on the incidence of hearing loss in a study done by Rajendran et al., while Krishnappa and Naseeruddin observed a significant relationship between duration of diabetes and severity of hearing loss.[14],[15] This study, therefore, attempts to determine the effect of duration of DM on hearing thresholds among type 2 diabetics.


  Methodology Top


Study design

This was a cross-sectional study conducted among 170 type 2 diabetics attending the endocrinology clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto from October 2015 to May 2016. Ethical approval was obtained from the Ethics and Research Committee of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Informed consent was obtained from the participants before they were recruited for the study. Participants were randomly selected. The inclusion criterion was physician-diagnosed type 2 DM patients attending the Endocrinology Clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Patients with a history of ear surgery performed in the past, history of exposure to loud sounds, history of ear disease, and history of head injury were excluded from the study.

Medical and demographic history

The medical history and demographic data of the patients were obtained using an interviewer-administered questionnaire. Duration of type 2 DM was taken with reference to the time the patient was first diagnosed to be diabetic.

Audiometry and general examination

Examination of the ear nose and throat was done after general physical examination. Pure tone thresholds were measured using the Modified Hughson – Westlake method at 250, 500, 1000, 2000, 4000, 6000, and 8000 Hz for air conduction and 500, 1000, 2000, and 4000 Hz for bone conduction using a Diagnostic Audiometer (Oscilla SM 960 – D, Diagnostic memory audiometer, Denmark) in a sound isolated room, which satisfied the criteria of ISO 8253-1. Average of audiometric hearing threshold at 500, 1000, 2000, and 4000 Hz for both air and bone conduction was determined; this was taken to be the pure-tone average for both air and bone conduction. This was categorized in accordance to the WHO grades of hearing impairment as follows normal hearing (<25 dB), mild hearing loss (26–40 dB), moderate hearing loss (41–60 dB), severe hearing loss (61–80 dB), and profound hearing loss (81 dB or greater).

Statistical analysis

Data analysis was done using Statistical Package for the Social Sciences version 21 (IBM-SPSS Inc., Chicago, IL, USA). One-way ANOVA was used to determine the relationship between quantitative variables. The regression analysis was done to test for association between variables. The level of statistical significance was set at P< 0.05.


  Results Top


A total number of 170 participants were enrolled into the study. The mean age of participants was 46.49±10.02 years, with ages ranging from 33 to 87 years. Females accounted for 57.6% of the participants, while 42.4% of them were males. The Male:female ratio was 1:1.4. The mean pure tone average among participants was 32.06±12.31 dB HL, with 71.8% of participants having some degree of hearing loss.

The mean duration of type 2 DM among participants was 7.81±5.34 years with durations ranging from <1 year to 30 years.

The mean pure tone average increased with increase in duration of diabetes, the difference in means of the various intervals of duration of type 2 DM was found to be statistically significant [Table 1] and [Figure 1]. Using simple linear regression, changes in duration of type 2 DM was found to be positively related to increase in pure tone average (P < 0.0001). For every year increase in duration of type 2 DM, a 1.036 dB HL increase in pure tone average is to be expected. From the data set 19.7% of the variability of the pure tone average is due to the duration of type 2 diabetes [Table 2].
Table 1: Mean pure tone average (air conduction) compared with duration of type 2 diabetes mellitus

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Figure 1: Effect of duration of diabetes on mean pure tone average among participants

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Table 2: Simple linear regression of pure tone average (dependent variable) and duration of type 2 diabetes mellitus (independent variable)

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  Discussion Top


The findings in the age and sex of participants in this study agrees with findings by Isa et al., in North-Eastern Nigeria among 127 diabetics where they found a mean age of 47.8±11.6 years among diabetics, ages ranging from 20 to 73 years, with the age group 40–49 years as the age group most frequently seen among diabetics.[6] Bamanie and Al-Noury working on hearing among type 2 diabetics in Saudi Arabia also had similar results (mean age of 47.9 years) among type 2 diabetics, Ren et al. had lower mean age among diabetics (40±6 years).[16],[17] The female preponderance in this study agrees with the findings of Bamanie and Al-Noury, where 52.3% of the diabetic group were females, while 47.7% of the diabetic group were males.[16]

Among the type 2 DM participants in this study, 28.2% of them had normal hearing thresholds, while 71.8% of them had some degree of hearing loss. This agrees with studies conducted by Rajendran et al., and Isa et al. Rajendran et al., observed a prevalence of hearing loss among type 2 diabetics of 73.3%.[15] Isa et al. also observed that 21.2% of the diabetic population in their study had normal hearing, while 78.8% had hearing loss.[6] A review of patients with diabetes by Kakarlapudi et al. observed a prevalence of sensorineural hearing loss among diabetics of 13.1% against 10.3% in nondiabetic controls.[13] This study does not agree with the findings by Kakarlapudi et al.

The mean duration of type 2 DM in this study was 7.81±5.34 years. Simple linear regression of duration of diabetes and pure tone average showed a positive association between duration of type 2 DM and the pure tone average of these participants and for every year increase in the duration of DM the pure tone average was expected to increase by 1.036 dB HL.

This agrees with the study conducted by Isa et al. who found a correlation between duration of DM and development of hearing impairment.[6] Díaz de León-Morales et al. reported a mean duration of DM of 7.2±5.4 years and found that duration of DM affected hearing threshold.[18] In the Blue Mountains study, it was observed that participants with diabetes for 10 years or longer had worse hearing thresholds at each frequency compared with diabetics with duration <10 years. Lasisi et al. also found that for those diabetics with duration of diabetes more than 10 years, the mean hearing threshold was 66 dB, while for those with duration of diabetes <10 years, the mean hearing threshold was 51 dB.[4] The studies conducted by Lasisi et al., Díaz de León-Morales et al. and the Blue Mountains study all agree with the findings in this study. The findings by Rajendran et al. and Ologe and Okoro. however did not agree with the findings in this study. They did not observe any relationship between duration of DM and hearing threshold.[7],[15] Rajendran et al. recruited younger diabetics (40–50 years) who might have had shorter duration of diabetes, and as such assessing the effect of duration of diabetes on hearing threshold might not have been sufficient.


  Conclusion Top


This study has shown a high prevalence (71.8%) of hearing loss among type 2 diabetics. It has demonstrated a relationship between duration of diabetes and hearing threshold. It has also shown that as the duration of hyperglycemia increased, the hearing threshold among participants also increased. This agrees with the pattern observed with other microvascular complications of diabetes. Early diagnosis and commencement of antidiabetic medications can reduce the duration of hyperglycemia thereby reducing the complications of diabetes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Powers AC. Diabetes mellitus. In: Fauci AS, Braunwald E, Longo DL, Kasper DL, Hauser SL, Jameson JL, et al., editors. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012. p. 2968-3003.  Back to cited text no. 1
    
2.
Gale EA, Anderson JV. Diabetes mellitus and other disorders of metabolism. In: Kumar P, Clark M, editors. Kumar and Clark's Clinical Medicine. 8th ed. Spain: Saunders Elsevier; 2012. p. 669-790.  Back to cited text no. 2
    
3.
Bainbridge KE, Hoffman HJ, Cowie CC. Diabetes and hearing impairment in the United States: Audiometric evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Ann Intern Med 2008;149:1-10.  Back to cited text no. 3
    
4.
Lasisi OA, Nwaorgu OG, Bella AF. Cochleovestibular complications of diabetes mellitus in Ibadan, Nigeria. Int Congr Ser 2003;1240:1325-8.  Back to cited text no. 4
    
5.
Vaughan N, James K, McDermott D, Griest S, Fausti S. A 5-year prospective study of diabetes and hearing loss in a veteran population. Otol Neurotol 2006;27:37-43.  Back to cited text no. 5
    
6.
Isa A, Mubi BM, Garandawa HI, Sandabe MB, Ngamdu YB, Kodiya AM. Diabetes mellitus, glycosylated haemoglobin levels and hearing impairment in adults. Sahel Med J 2012;15:44-9.  Back to cited text no. 6
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7.
Ologe FE, Okoro EO. Type 2 diabetes and hearing loss in black Africans. Diabet Med 2005;22:664-5.  Back to cited text no. 7
    
8.
Mitchell P, Gopinath B, McMahon CM, Rochtchina E, Wang JJ, Boyages SC, et al. Relationship of type 2 diabetes to the prevalence, incidence and progression of age-related hearing loss. Diabet Med 2009;26:483-8.  Back to cited text no. 8
    
9.
Akinpelu OV, Ibrahim F, Waissbluth S, Daniel SJ. Histopathologic changes in the cochlea associated with diabetes mellitus – A review. Otol Neurotol 2014;35:764-74.  Back to cited text no. 9
    
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Austin DF, Konrad-Martin D, Griest S, McMillan GP, McDermott D, Fausti S. Diabetes-related changes in hearing. Laryngoscope 2009;119:1788-96.  Back to cited text no. 10
    
11.
Horikawa C, Kodama S, Tanaka S, Fujihara K, Hirasawa R, Yachi Y, et al. Diabetes and risk of hearing impairment in adults: A meta-analysis. J Clin Endocrinol Metab 2013;98:51-8.  Back to cited text no. 11
    
12.
Panchu P. Auditory acuity in type 2 diabetes mellitus. Int J Diabetes Dev Ctries 2008;28:114-20.  Back to cited text no. 12
    
13.
Kakarlapudi V, Sawyer R, Staecker H. The effect of diabetes on sensorineural hearing loss. Otol Neurotol 2003;24:382-6.  Back to cited text no. 13
    
14.
Krishnappa S, Naseeruddin K. A clinical study of age related hearing loss among diabetes patients. Indian J Otol 2014;20:160-5.  Back to cited text no. 14
  [Full text]  
15.
Rajendran S, Anandhalakshmi S, Mythili B, Viswanatha R. Evaluation of the incidence of sensorineural hearing loss in patients with type 2 diabetes mellitus. Int J Biol Med Res 2011;2:982-7.  Back to cited text no. 15
    
16.
Bamanie AH, Al-Noury KI. Prevalence of hearing loss among Saudi type 2 diabetic patients. Saudi Med J 2011;32:271-4.  Back to cited text no. 16
    
17.
Ren J, Zhao P, Chen L, Xu A, Brown SN, Xiao X. Hearing loss in middle-aged subjects with type 2 diabetes mellitus. Arch Med Res 2009;40:18-23.  Back to cited text no. 17
    
18.
Díaz de León-Morales LV, Jáuregui-Renaud K, Garay-Sevilla ME, Hernández-Prado J, Malacara-Hernández JM. Auditory impairment in patients with type 2 diabetes mellitus. Arch Med Res 2005;36:507-10.  Back to cited text no. 18
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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