The association of diabetes with vision loss is well-known, but a new review suggests that individuals with type 2 diabetes (T2D) also face a significant risk for hearing loss.

Hearing loss in T2D “may be a consequence of subclinical microvascular disease,” study authors Miguel Caballero-Borrego, MD, PhD and Ivan Andujar-Lara, MD, of Hospital Clinic and Universitat de Barcelona in Barcelona, Spain, wrote in their study.

“This fact could potentially serve as an early warning sign, suggesting that closer monitoring is necessary, as well as the adaptation of treatment plans to minimize the occurrence or progression of hearing loss,” they added.

The study was published in November 2025 issue of Otolaryngology-Head and Neck Surgery.

Previous Findings Inconsistent

“Persistent hyperglycemia has been demonstrated to result in damage to both microvascular and macrovascular structure,” the authors noted. Microvascular damage may affect the auditory system because microcirculatory alterations result in changes in the cochlea — ie, the ultrastructure of the inner ear capillaries — potentially leading to thickening of the basilar membrane and atrophy of the stria vascularis.

“There is growing evidence of an association between T2D and hearing loss,” with age and duration of diabetes proposed as potential risk factors, the authors wrote. But clinical studies have not consistently found a positive association between the two.

The researchers, therefore, set out to estimate the prevalence of hearing loss among patients with diabetes; to examine the mean difference in hearing thresholds between T2D patients and control individuals; and to investigate how factors such as duration of diabetes, A1c levels, and sex may be implicated.

They identified over 8000 articles, of which 17 (encompassing 3910 individuals with diabetes and 4084 control individuals) met their inclusion criteria.

Consistent Hearing Loss

The prevalence of hearing loss in people with T2D ranged from 40.6% to 71.9%, which was significantly higher than that in control individuals (odds ratio [OR], 4.19; 95% CI, 1.22-14.37).

Hearing loss in those with T2D occurred particularly at higher frequencies (4000-8000 Hz): The mean pure-tone audiometric thresholds of those with T2D were 3.19 decibels (dB) higher than those of control individuals (95% CI, 1.08-5.19). 

Pure-tone thresholds “indicate the softest sound audible to an individual at least 50% of the time,” explained Joe Walter Kutz Jr, MD, professor of Otolaryngology and Neurological Surgery, UT Southwestern Medical Center, Dallas, and colleagues in a 2023 Medscape Medical News article. Higher scores indicate greater hearing loss. 

The mean pure-tone audiometric thresholds were higher for low frequencies (1.11 dB; 95% CI, 0.62-1.57) as well as for high frequencies, although the high frequency hearing impairment was more severe (2.3 dB; 95% CI, 1.97-2.63).

Patients with moderate and severe-to-profound hearing loss had higher mean A1c levels compared to control individuals. Furthermore, the prevalence of hearing loss was 2.7 times higher among patients who had had a diagnosis of diabetes for more than 10 years. Sex did not appear to impact hearing loss prevalence.

“The results demonstrated a consistent elevation in auditory thresholds across all frequencies in individuals with diabetes compared to nondiabetic controls,” the authors summarized.

Study limitations include heterogeneity in the study populations and not assessing cardiovascular comorbidities. “Recent studies have found a complex association between cardiovascular disease and sensorineural hearing loss,” the authors noted. “Given the high prevalence of cardiovascular disease in diabetic patients, these factors may act as confounders and limit the interpretations of our results.”

Since hearing loss may emerge as a consequence of microangiopathy, “a worsening of preexisting hearing loss, the new onset of hearing loss, or the presence of other microvascular disease in diabetic patients could prompt the initiation or intensification of diabetes management to prevent further deterioration of auditory function,” the authors advised.

Screening and Early Detection Warranted

Commenting on the study for Medscape Medical News, Scott Isaacs, MD, president of the American Association of Clinical Endocrinology, said it “confirms what clinicians have observed for over two centuries: Adults with diabetes have an increased risk of hearing loss.”

He explained that in diabetes, “high blood sugar damages the small blood vessels that supply the inner ear, leading to poor blood flow and nutrient delivery, which causes the delicate hair cells of the cochlea to deteriorate and results in sensorineural hearing loss, especially at higher frequencies.”

An important take-home message of the study is that “hearing loss should be recognized as a microvascular complication of diabetes, for which screening and early detection are warranted as part of comprehensive diabetes care,” Isaacs said.

The study received no funding. The authors and Isaacs disclosed no relevant financial relationships. 

Batya Swift Yasgur MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape Medical News and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).