Diabetes and Hearing Loss A Silent Complication. Britt A. Thedinger, MD, FACS Ear Specialists of Omaha-Bellevue April 7, 2018

Transcription

1 Diabetes and Hearing Loss A Silent Complication Britt A. Thedinger, MD, FACS Ear Specialists of Omaha-Bellevue April 7, 2018

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8 Auditory Pathways

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12 Hearing loss adversely affects physical, cognitive, behavioral, and social function, as well as the general quality of life, and has been linked to depression and dementia. the capacity to hear is so essential to overall health! Murlow, et al (Ann Intern Med, 1990) Bentler and Bridges (Hearing Journal, 1998) Yueh, et al. (JAMA, 2003)

13 Diabetes and Hearing Loss twice as common! Top health concerns 30 Million with Diabetes which is 9.3% of the population (2015 data) 40 Million (about 15% of population) with Hearing Loss According to ADA hearing loss is twice as common in people with diabetes NIH 2008 study Hearing loss 30% higher in those with prediabetes.

14 Why Diabetes and Hearing Loss (2011 Survey) Unknown complication (49% aware of the relationship between diabetes and hearing loss) 95% rarely or never refer patients for hearing screening 98% do not use any hearing screening tools Referral networks: 28% indicated good network; 10% indicated excellent

15 Why Diabetes and Hearing Loss (2017 Survey) Known complication: 95% are aware 76% rarely or never refer patients for hearing screening 96% do not use any hearing screening tools Referral networks are improving: 35% indicated good network; 7% indicated excellent

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17 Type 2 diabetic patients had significantly higher incidence for at least a mild degree of HL when compared with controls Laryngoscope Mar;124(3): Our study reveals that there is relationship between the presence of type 1 DM and an increased risk for developing mild and subclinical hearing impairment Laryngoscope Jul;127(7):

18 Hearing and Balance IDDM/NIDDM Common Pathophysiology Cochlear - Vestibular Microangiopathy Blood glucose effects 8th Nerve Hearing degeneration Vestibular degeneration Brain Microvascular effects on auditory cortex

19 The American Diabetes Association theorizes that a person with a higher percentage of glycated hemoglobin, or A1c, possesses a greater risk of developing hearing loss in the future. A recent Japanese study presents evidence that hearing loss may be related to A1c levels. Similar to Diabetic Retinopathy

20 Relationship Between Diabetes and Hearing Loss Factors increasing risks of hearing loss for the diabetes patient Age (>60 years of age increases the prevalence) Duration of diabetes Diabetes is associated with hearing loss and could aggravate the hearing loss related to age. Increased BMI

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36 History Dizzy, unsteady, lightheaded, off-balance, floating, confused, foggy, woozy, drunk, sick in the head, unstable, I ve got inner ear VERTIGO - sense of motion subjective objective Oscillopsia stationary objects moving

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40 The Safety of Seniors Act, S 845 (an inc. in funding for falls prevention) 1 of 3 aged 65 or older falls each year. 30% of these require hospitalization about 16,000 of these die others suffer debilitating injuries, other disabilities & decrease in the quality of life. CDC estimates the cost for preventable falls at over 19 billion annually. 80% of fractures are a result of a fall.

41 History Dizzy, unsteady, lightheaded, off-balance, floating, confused, foggy, woozy, drunk, sick in the head, unstable, I ve got inner ear VERTIGO - sense of motion subjective objective Oscillopsia stationary objects moving

42 Types of Dizziness - Lightheadedness near syncope vascular, carotid stenosis, arrhythmias, postural, meds metabolic - Disequilibrium gait versus global - diabetic neuropathy, neuromuscular, central NPH, cerebellar dysfunction, B-12 deficiency, neck - Psychogenic spacey, disconnected - Chronic dizziness in the elderly - multifactorial

43 Types of hearing loss Conductive Sensorineural Mixed

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45 Sudden Idiopathic Sensorineural Hearing Loss Sudden Deafness Viral not a stroke! Ear Emergency normal exam - Audiogram -use a phone! Prednisone 40mg/wk 20mg/wk Transtympanic Decadron perfusion? Avoid Antivirals vasodilators

46 One sided hearing loss is not normal!

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51 Effects of Untreated Hearing Loss Embarrassment, Fatigue and Irritability Tension/Stress Avoidance of Social Activities Withdrawal from personal relationships Depression, negativism Danger to personal safety Social rejection by others Impaired memory and ability to learn new tasks - Dementia Reduced job performance and earning power Diminished psychological and overall health (Better Hearing Institute, 2009)

52 Hearing Aid Technology They re cool, sleek, discreet and virtually invisible. They cut out background noise so you hear what you want to hear They capture the natural richness and variation of speech, so it s easier to follow the conversation wherever you are.

53 Digital Technology improvement in programmability greater precision in fitting management of loudness discomfort control of acoustic feedback (whistling sounds) noise reduction automatic change in programs longer life span water resistant

54 Innovations - Auditory Deprivation Use It or Lose It!

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57 Hearing Aid Technology

58 Open Fit

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63 Lyric

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67 Cochlear Implants Useful when hearing aids are not effective Bilateral severe to profound sensorineural hearing loss Surgical procedure Send electrical signals directly to auditory nerve FDA approved 12 months and older Illustration courtesy of Cochlear Corporation.

68 Nucleus Profile (CI512) Thin removable magnet For MRI safety Thin receiver stimulator For efficient surgery and more discreet outcome Mirror finish and durable smooth surface Designed to reduce likelihood of infection Flexible antenna coil Follows natural curvature of the head Contour Advance Electrode The only perimodiolar electrode for optimum performance 1 Side by side lead exit Consistency in surgery and more impact protection 1 Holden et al, Ear and Hearing, 2013 Nucleus Profile with Contour Advance Electrode (CI512)

69 Basic Principle of a Cochlear Implant Bypass the damaged cochlear hair cells to stimulate the hearing nerve directly

70 Bimodal use of Wireless Accessories Nucleus 6 Sound Processor Resound Linx

71 Enjoy True Wireless Freedom No Strings Attached Hear better in noisy situations, with our true wireless technology and wireless accessories. 71

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74 How It Works Baha Connect System 1. The sound processor picks up sound vibrations and transfers them through an abutment to the titanium implant. 2. A small implant made of titanium is inserted in the bone behind your ear. 3. The sound vibrations are sent directly through the bone to the inner ear (cochlea) where they are converted into electrical impulses by the tiny hair cells inside the cochlear. These impulses travel to the brain, allowing you to perceive sound.

75 How It Works Baha Attract System 1. The sound processor picks up sound vibrations from the environment. 2. The sound processor passes the sound vibrations to the attached external magnet that attracts to the internal magnet. 3. The sound vibrations are transferred through the magnetic attachment to the small titanium implant inserted in the bone behind the ear. 4. The sound vibrations are then sent directly through the bone to the inner ear (cochlea) where they are converted into electrical impulses by the tiny hair cells inside the cochlear. These impulses travel to the brain, allowing you to perceive sound.

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78 Preventable Hearing Loss Protect Your Hearing!

79 Blindness separates people from things Deafness separates people from people! Helen Keller

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