How to Promote Ear Health for People With Diabetes

5 Actions for Health Care Teams

Doctor looking in a patients ear

We all have a role to play to help people with diabetes live their best life!

Audiologists play a key role in the early detection and treatment of diabetes-related hearing and balance complications, such as hearing loss and an increased risk of falls. These conditions can be avoided or delayed with annual audiological evaluations and treatment if needed.

By working regularly with audiologists as part of a patient’s health care team, primary care providers can help their patients with diabetes reduce the risk of complications that can occur when they don’t hear important medical information. They can also help reduce injuries from unnecessary falls, which in turn can limit patients’ ability to manage their diabetes.

Key Messages to Share With Your Patients

Key Messages to Share With Your Patients

  • Encourage your patients with diabetes to get annual hearing tests, wear ear protection around loud noises, eat a healthy diet, and manage their blood glucose levels.
  • Remind your patients not to clean their ears with swabs, pencils, tweezers, or paper clips.
  • Encourage your patients to monitor their hearing by paying attention to changes, asking loved ones if they’ve noticed hearing changes, and using a self-assessment tool like the Hearing Handicap Inventory Screening.
  • Tell your patients that:
    • An audiologist can screen them for balance-related problems caused by changes to the vestibular system.
    • People with diabetes may be prescribed ototoxic medications, which can contribute to more severe hearing loss than that caused by aging alone.8
    • People with diabetes-related hearing loss may have a reduced quality of life.
  • Share information from CDC’s Take Charge of Your Diabetes: Healthy Ears fact sheet.

Take These 5 Actions to Help Your Patients

1. Know the risks of hearing and balance disorders for people with diabetes.

People with diabetes are at a higher risk for hearing and balance complications, including hearing loss and risk of falls. However, only about 23% of older adults report having an annual audiological evaluation.1
In the United States:

  • About 98 million adults have prediabetes. Hearing loss is 30% higher in adults with prediabetes than in those without this condition.1
  • Studies have consistently shown that hearing loss is twice as common in people with diabetes compared to people without diabetes.2
  • Some studies have found that diabetes has pathological effects on the semicircular canals and otolith organs in the inner ear.3 These effects contribute to problems with the vestibular system, which manages balance.
  • Vestibular dysfunction is 70% higher4 in people with diabetes than in those without the disease, and the incidence of falls is 39% higher.5
  • Diabetes has been shown to reduce cerebral microcirculation, including in the auditory centers of the brain.6 It may also affect cortical auditory processing,7 and both of these conditions can affect hearing.
Common Changes in Ear Health
  • Trouble hearing background noise (e.g., in noisy restaurants or crowds).
  • Frustration when communicating with others (e.g., often responding with “what?” or “huh?”).
  • Falling more often and having trouble with balance.

2. Understand how diabetes can affect hearing and balance and encourage your patients to monitor their ear health.

At each health care visit, tell your patients with diabetes about the signs of hearing and balance problems. This will help them be aware of changes when they start. Make sure your patients understand the information by asking them to repeat back what they heard.

3. Ask your patients questions about their ear health at each health care visit.

For example:

  • Do you have any concerns about your hearing?
  • Do you get a hearing screening, also called an audiological evaluation, every year?
  • Do you know how diabetes can cause hearing loss?
  • Have you fallen recently? Do you have a fear of falling? Do you often feel dizzy or off balance?

You can refer your patients to an audiologist or ask them if they want more information about recommended ear care for people with diabetes. You can base this action on how your patients answer your questions and any other concerns they share during the visit.

4. Remind your patients to keep their blood glucose, blood pressure, and blood lipids within normal levels for optimum hearing health.

Use the following discussion points to help you talk with your patients about their self-care habits and their feelings about managing diabetes:

  • Promote the ABCs of diabetes (A1C, blood pressure, cholesterol, and smoking cessation) and a healthy lifestyle.
  • Ensure that patients have access to health coaches, patient navigators, and community health workers when possible.
  • Ask your patients what other health exams they are getting, including regular ear health checkups.
  • Assess symptoms that might require referral to a specialist.
  • Follow up with your patients to track how well they are managing their diabetes and connecting with their health care team.
  • Assess socioeconomic factors that can affect health, such as food insecurity, housing insecurity or homelessness, financial barriers, and lack of social support. Use this information when you make treatment decisions.
  • Refer patients to local community resources when available.

5. Refer your patients to diabetes self-management education and support (DSMES) services.

DSMES services help people live well with diabetes. Whether a person has just been diagnosed with diabetes or has had it for years, DSMES services will make it possible for them to:

  • Work with a diabetes care and education specialist to set and track goals.
  • Practice how to fit diabetes self-care behaviors, like healthy eating and problem-solving, into all parts of their life.
  • Learn how to use knowledge, skills, and tools to build confidence and emotional strength to manage diabetes.
  • Find ways to get support (in person or online) from family, friends, their community, and their health care team.

Learn more about DSMES and encourage your patients to find a DSMES program that is recognized by the American Diabetes Association or accredited by the Association of Diabetes Care & Education Specialists.


  1. American Diabetes Association. Diabetes and Hearing Loss. Accessed September 21, 2021.
  2. 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):1–10. doi:10.7326/0003-4819-149-1-200807010-00231
  3. D’Silva LJ, Lin J, Staecker H, Whitney SL, Kluding PM. Impact of diabetic complications on balance and falls: contribution of the vestibular system. Phys Ther. 2016;96(3):400–409. doi:10.2522/ptj.20140604
  4. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001–2004 [published correction appears in Arch Intern Med. 2009;169(15):1419]. Arch Intern Med. 2009;169(10):938–944. doi:10.1001/archinternmed.2009.66
  5. Tilling LM, Darawil K, Britton M. Falls as a complication of diabetes mellitus in older people. J Diabetes Complications. 2006;20(3):158–162. doi:10.1016/j.jdiacomp.2005.06.004
  6. Hamed SA. Brain injury with diabetes mellitus: evidence, mechanisms, and treatment implications. Expert Rev Clin Pharmacol. 2017;10(4):409–428.
  7. Konrad-Martin D, Billings CJ, McMillan GP, et al. Diabetes-associated changes in cortical auditory-evoked potentials in relation to normal aging. Ear Hear. 2016;37(3):e173–e187. doi:10.1097/AUD.0000000000000255
  8. Joo Y, Cruickshanks KJ, Klein BEK, Klein R, Hong O, Wallhagen M. Prevalence of ototoxic medication use among older adults in Beaver Dam, Wisconsin. J Am Assoc Nurse Pract. 2018;30(1):27–34. doi:10.1097/JXX.0000000000000011