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ORIGINAL ARTICLE
Year : 2017  |  Volume : 23  |  Issue : 3  |  Page : 155-161

Evaluation of effects of diabetes mellitus type 2 and hyperlipidemia on hearing


Department of ENT and HNS, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India

Date of Web Publication31-Aug-2017

Correspondence Address:
Pushkar Khare
314, PG Hostel, Muzaffarnagar Medical College, National Highway-58, Muzaffarnagar - 251 203, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_136_16

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  Abstract 

Background: Age related hearing loss or Presbyacusis may be defined as mid to late onset, bilateral, progressive sensorineural hearing loss, where underlying causes have been excluded. In recent decades there has been a rapid progression in population aging, and with advancing age, chronic diseases and functional impairments become more common. Varying ranges of the prevalence of sensorineural deafness in subjects with diabetes and hyperlipidemia has been reported. The present study was undertaken to determine whether or not diabetes mellitus type 2 and hyperlipidemia induced auditory dysfunction. Materials and Methods: A cross sectional observational study was undertaken which comprised of a total of 200 subjects who were divided in 4 groups, which comprised of 50 control subjects in one group and 150 case subjects in the other 3 groups with presence of diabetes mellitus type 2, hyperlipidemia and those having both diabetes mellitus type 2 and hyperlipidemia. All subjects were evaluated by conducting pure tone audiometry and blood investigations like lipid profile and fasting and postprandial blood sugars. Results: It was observed that hearing loss was more prevalent (62%) and highly significant (P 0.001) as compared to controls in patients with both diabetes mellitus type 2 and hyperlipidemia together. The hearing loss was significantly more for higher frequencies in air and bone conduction thresholds. Conclusion: The prevalence of sensorineural hearing loss was increased in subjects having both diabetes mellitus type 2 and hyperlipidemia and these subjects are at a higher risk of developing sensorineural hearing loss. The hearing loss was progressive, bilateral and affected mainly higher frequencies.

Keywords: Diabetes mellitus type 2, hearing loss, hyperlipidemia, pure tone audiometry


How to cite this article:
Parmar SM, Khare P, Chaudhary M. Evaluation of effects of diabetes mellitus type 2 and hyperlipidemia on hearing. Indian J Otol 2017;23:155-61

How to cite this URL:
Parmar SM, Khare P, Chaudhary M. Evaluation of effects of diabetes mellitus type 2 and hyperlipidemia on hearing. Indian J Otol [serial online] 2017 [cited 2021 Apr 10];23:155-61. Available from: https://www.indianjotol.org/text.asp?2017/23/3/155/213862


  Introduction Top


Age-related hearing loss may be defined as mid- to late-onset, bilateral, progressive sensorineural hearing loss (SNHL), where underlying causes have been excluded from the study. Strictly defined, age-related hearing loss excludes hearing loss caused by primary factors including loud noise exposure, underlying medical conditions (e.g., atherosclerosis, diabetes mellitus, hypertension, Paget's disease of bone, and myxedema), intrinsic ontological disease (e.g., otosclerosis, chronic otitis media, and Meniere's disease), head injury, and ototoxic drug therapies. Age-related hearing loss (SNHL) is one of the most common health conditions affecting individuals aged 65 years and older.[1]

In recent decades, there has been a rapid progression in population aging, and with advancing age, chronic diseases and functional impairments become more common. One of these is age-related hearing loss, the most common sensory deficit, and a significant chronic medical condition in the elderly.[2],[3],[4]

It is well known that presbycusis or age-related hearing loss is a result of various types of physiological degeneration due to aging, plus the accumulated effects of noise exposure, smoking, medical disorders and their treatment, and hereditary susceptibility.[5] It is characterized by bilateral, symmetrical, and slowly progressive reduced hearing sensitivity and speech understanding in noisy environments, slowed central processing of acoustic information, and impaired localization of sound sources.[6]

It is believed that hyperlipidemia and diabetes mellitus type 2 may lead to auditory dysfunction.[7] It has been postulated that the microvascular complications affect the hearing of individuals with diabetic dyslipidemia. Hyperviscocity of the blood serum, vascular occlusion or increased susceptibility to noise may be the reasons for auditory dysfuncyion which is seen in hyperlipidemia.[8],[9] Histopathological studies have shown damage to the nerves and vessels of the inner ear of the individuals with diabetes and hyperlipidemia, which have been theorized to be an important causative factor for neuronal degeneration in the auditory system.[10],[11]

In the literature, many different types of hearing loss which are found in diabetic patients have been reported. Some reported a progressive, gradual, bilateral sensorineural loss which affected, especially the high frequencies,[12],[13] and the elderly and others had reported hearing loss in the low and medium frequencies.[14]

The present study was undertaken to determine whether or not diabetes mellitus type 2 and hyperlipidemia induced auditory dysfunction.

Aims of study

  1. To evaluate the effect of diabetes mellitus type 2 on hearing among patients 50 years and above
  2. To evaluate the effect of hyperlipidemia on hearing among patients 50 years and above
  3. To evaluate the combined effect of diabetes mellitus type 2 and hyperlipidemia on hearing.



  Materials and Methods Top


A cross-sectional observational study was conducted in the outpatient department of our hospital after getting a clearance from the ethical committee. The study comprised a total of 200 participants who were divided into 4 groups, which comprised 50 controls in 1 group and 150 cases in the other 3 groups.

The study population included patients above 50 years of age with complaints of decreased hearing and tinnitus, known cases of diabetes mellitus type 2 and hyperlipidemia alone, and having diabetes mellitus type 2 and hyperlipidemia together.

The study excluded patients below 50 years of age, with history of chronic suppurative otitis media and its complications, history of previous ear surgeries, head trauma, temporal bone fracture, ototoxic drugs intake, radiotherapy, autoimmune diseases, and occupational noise exposure and also excluded patients with history of systemic diseases such as hypertension, cardiac diseases, and renal failure.

Group I comprised controls. Group II comprised patients with hyperlipidemia, Group III included patients with diabetes mellitus type 2, and Group IV included patients with both hyperlipidemia and diabetes mellitus type 2 [Figure 1].
Figure 1: Distribution of patients in groups

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All the participants underwent pure tone audiometry using Audiometer by Hughson-Westlake Method for audiometric evaluation. The air-conduction thresholds were measured for and bone-conduction thresholds were checked for the tones of 250, 500, 1000, 2000, 4000, 6000, and 8000 Hz. The bone-conduction thresholds were measured for 250, 500, 1000, 2000, and 4000 Hz. Both the air- and bone-conduction thresholds were tested for either ear of the patients, and the readings were recorded and plotted on an audiogram.

The participants also underwent blood tests for fasting glucose, postprandial glucose levels, and lipid profile.

In this study, we considered the following levels of glucose in participants to be termed as diabetics as per the National Institute For Clinical Excellence guidelines [15] published in July 2015.

In this study, we considered the following levels of lipid profile in participants to be termed as dyslipidemia as per the National Cholesterol Education Program Adult Treatment Panel-III guidelines [Figure 2].[16]
Figure 2: The National Cholesterol Education Program Adult Treatment Panel-III guidelines

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The entire data were collected, were entered into a spreadsheet. Descriptive tables were generated, and Chi-square test and the ANOVA statistical techniques were used to demonstrate the findings. P < 0.05 was considered to be statistically significant.

Observation

In the study, there were a total of 117 male and 83 female patients.

The mean age varied in all the four groups. It was 56.5 years in Group I, 55.6 years in Group II, 57.3 years in Group III, and 55.8 in Group IV [Figure 3] and [Table 1].
Figure 3: Distribution of patients according to age and gender

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Table 1: Distribution of patients according to age and gender

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It was observed that hearing loss was present in only among 3 patients of the control group. Twenty out of fifty patients with hyperlipidemia had hearing loss. Twenty-eight out of fifty patients with diabetes mellitus showed hearing loss, and 31 out of 50 patients showed hearing loss who had diabetes mellitus type 2 along with hyperlipidemia [Figure 4] and [Table 2].
Figure 4: Distribution of hearing loss

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Table 2: Distribution of hearing loss among study groups

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It was observed that the lipid profile was more deranged in Group IV which included patients with both diabetes mellitus type 2 and hyperlipidemia [Figure 5] and [Table 3].
Figure 5: Distribution of lipid profile

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Table 3: Distribution of lipid profile among all groups

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In Group I, mean cholesterol value was 176.2 mg/dl. It was 243.3 mg/dl in Group II. The mean level of cholesterol was 183.9 mg/dl in Group III while it was 236.7 mg/dl among patients of Group IV. The mean cholesterol level was found to the highest in Group IV [Table 4].
Table 4: Comparison of total serum cholesterol levels with hearing loss

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Chi-square test was applied and found to be 39.107 with degree of freedom 3.

P value was >0.0001, which is highly significant.

Here, it was observed that among 100 patients with high cholesterol and 100 patients with low cholesterol of the total 200 study participants, there was significance of cholesterol levels with that of hearing loss as P value was calculated to be <0.004. Chi-square value was 8.268 with degree of freedom (df) to be 1 [Table 5].
Table 5: Distribution of lipid profile among all patients to find significance with hearing loss

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Among 82 participants with normal triglyceride (TG) levels, 18 showed hearing loss and 64 had normal hearing. Furthermore, among 68 patients with high TG levels, 44 participants had hearing loss and 24 had normal hearing. The resultant Chi-square value was 28.022, which showed a highly significant P < 0.0001.

Similarly, high low-density lipoprotein (LDL) levels proved significance with hearing loss as 44 out of 68 participants with high LDL levels had hearing loss. Chi-square value was 8.162 and P < 0.004.

Low high-density lipoprotein (HDL) levels were found in 20 participants. Among them, 10 had hearing loss and the other 10 did not have hearing loss. One hundred and thirty participants had normal HDL levels. Out of these, 72 had normal hearing and 58 had hearing loss. Chi-square value was 0.715 with P < 0.398, which was not significant [Figure 6].
Figure 6: Distribution of lipid profile according to hearing loss

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Here, it was observed that the blood sugar levels of fasting and postprandial tests were relatively high in Group III and Group IV. The mean fasting blood glucose levels were 136.2 and 135.1 mg/dl, respectively, and the mean postprandial blood glucose levels were 214.5 and 219.1 mg/dl, respectively [Figure 7] and [Table 6].
Figure 7: Distribution of blood sugar levels

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Table 6: Distribution of mean blood sugar levels in different groups

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  • For Group I, there was no hearing loss noted
  • For Group II, there was hearing loss noted from frequency 4000 Hz onward
  • For Group III and Group IV, even though the air-conduction hearing loss started at 4000 Hz, it was maximum at 8000 Hz.


After application of ANOVA test, it was observed that hearing loss was seen significantly at 4000, 6000, and 8000 Hz with P < 0.0001, thus suggesting air-conduction threshold hearing loss in higher frequencies [Table 7].
Table 7: Audiogram analysis of mean air-conduction thresholds for the right ear at different frequencies of all groups

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  • For Group I, no hearing loss was noted
  • For Group II, mild hearing loss was noted at 2000 and 4000 Hz
  • For Group III and Group IV, the hearing bone-conduction threshold increased from 2000 Hz and it was maximum at 4000 Hz.


After application of ANOVA test, it was observed that hearing loss was seen significantly at 4000, 6000, and 8000 Hz with P < 0.0001, thus suggesting bone-conduction threshold hearing loss in higher frequencies [Table 8].
Table 8: Audiogram analysis of mean bone-conduction thresholds for the right ear at different frequencies in all groups

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  • For Group I, there was no hearing loss noted
  • For Group II, there was hearing loss noted from frequency 4000 Hz onward
  • For Group III and Group IV, even though the air-conduction hearing loss started at 4000 Hz, it was maximum at 8000 Hz.


After application of ANOVA test, it was observed that hearing loss was seen significantly at 4000, 6000, and 8000 Hz with P < 0.0001, thus suggesting air-conduction threshold hearing loss in higher frequencies [Table 9].
Table 9: Audiogram analysis of mean air-conduction thresholds for the left ear at different frequencies of all groups

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  • For Group I, no hearing loss was noted
  • For Group II, mild hearing loss was noted at 2000 and 4000 Hz
  • For Group III and Group IV, the hearing bone-conduction threshold increased from 2000 Hz and it was maximum at 4000 Hz.


After application of ANOVA test, it was observed that hearing loss was seen significantly at 4000, 6000, and 8000 Hz with P < 0.0001, thus suggesting bone-conduction threshold hearing loss in higher frequencies [Table 10].
Table 10: Audiogram analysis of mean bone-conduction thresholds for the left ear at different frequencies in all groups

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  Discussion Top


Age-related hearing loss is one of the most common chronic health conditions affecting individuals more than 50 years of age.

It has been noted that age-related hearing loss may be associated or occurring with other comorbidities as well.

It is well known that age-related hearing loss is a result of various types of physiological degeneration due to aging along with accumulated effects of noise exposure, smoking, hereditary disorders, and other medical conditions such as diabetes mellitus and hyperlipidemia.

In this study, we tried to find the cause–effect relationship between diabetes mellitus and hearing loss, hyperlipidemia and hearing loss, and combined effect of both diabetes mellitus and hyperlipidemia on hearing.

Age-related hearing loss is characterized as bilateral SNHL affecting high-frequency sounds.[17] Age-related hearing loss occurs more commonly from the age group of 50–60 years.[18],[19] In this study, the mean age of age-related hearing loss was 56.3 years among all the groups combined.

In this study, it was observed that hearing loss is more prevalent among patients with diabetes mellitus and that hearing loss was seen more in higher frequencies of 4000 and 8000 Hz compared to the lower frequencies irrespective of age and gender.

These findings were similar to studies done by Lerman-Garber,[20] Kakarlapudi,[21] Diaz De Leon.[22]

In this study, there was significance seen between hearing loss and diabetes mellitus type 2. The mean values of blood glucose were higher in Group III (patients with diabetes mellitus type 2) and Group IV (patients with diabetes mellitus type 2 and hyperlipidemia). Hearing loss was also seen more in these groups compared to the others, and they had higher air-conduction thresholds at all frequencies except at 250, 500, and 1000 Hz in comparison with controls.

The study revealed that the hearing thresholds of patients with diabetes mellitus type 2 were significantly impaired than the ones who did not have diabetes.

These findings coincided with the findings of Taylor,[23] Kurien,[24] Dalton,[25] Rozanska-Kudelska,[26] and Panchu.[27]

In this study, it was observed that the degree of hyperglycemia is gaining more importance as a causative factor for age-related hearing loss as also seen in studies done by Hsueh.[28]

It was also observed that participants with high total cholesterol levels had hearing loss more, compared with those who had normal cholesterol levels. The comparative test conducted was found to be highly significant (P < 0.0001).

Studies done by Gopinath,[29] Simpson,[30] and Sutbas [31] showed to have similar findings in their studies suggesting that hyperlipidemia also plays a role in the pathogenesis of age-related hearing loss.


  Conclusion Top


It can be concluded that hearing loss is more prevalent in patients with both diabetes mellitus type 2 and hyperlipidemia compared to patients with diabetes mellitus type 2 and hyperlipidemia alone. In patients without diabetes mellitus type 2 or hyperlipidemia, the hearing loss was found to be minimal.

The severity of hearing loss did not increase with increasing age and showed no relevance to gender of the test participants.

In this study, we were able to identify a positive significant correlation between diabetes mellitus type 2 and hyperlipidemia on hearing loss.

Many research studies have been done to find association of diabetes mellitus with hearing loss and hyperlipidemia with hearing loss with varying results in each of them

It is hoped that more research in this area will delineate new insights regarding better understanding of effects of diabetes mellitus and hyperlipidemia on hearing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sutbas A, Yetiser S, Satar B, Akcam T, Karahatay S, Saglam K. Low- cholesterol diet and antilipid therapy in managing tinnitus and hearing loss in patients with noise-induced hearing loss and hyperlipidaemia. Int Tinnitus J 2007;13:143-9.  Back to cited text no. 31
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    Figures

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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