What’s That? Metabolic Disorders Driving Hearing Loss

By Christine Bahls

Peer-reviewed work revealing that some metabolic syndrome elements could affect normal hearing goes back decades. In 1986, an article observed that “As more Americans live — and work — longer, the collective burden of urban din, hypertension, and high cholesterol diets may disrupt [their ability] to hear the world around them.”

A few studies make the point: A 2023 meta-analysis of 28 observational studies found the odds ratio of having prevalent hearing loss was 4.22 for metabolic syndrome; a 2021 cross-sectional study of 157 patients with diabetes found that “the most important factors associated with hearing loss [were] the duration of disease, poor glycemic control, and hypertension”; and in 2022, a study using NHANES data found that people with tinnitus aged between 20 and 39 years were “significantly more likely” (odds ratio, 2.49) to have a hypertension diagnosis.

Just why this damage might occur: Persistent hyperglycemia can alter microvascular and macrovascular structures. In the ear, microcirculatory changes affect blood flow and nutrient delivery to the inner ear where the cochlea, with its sensory hair cells, lives. In time, these hair cells deteriorate, resulting in sensorineural hearing loss.

With diabetes, the assault on hearing could come from multiple vantage points; some diabetes-related drugs are linked with tinnitus and hearing loss. A 2020 review in Pharmacotherapy found that 19 antihypertensive and antiarrhythmic therapies and 7 diuretics, when taken systemically, were associated with ototoxicity. Then a study published last year based on 90,271 patients with hyperlipidemia found that statins, as a class, were associated with sensorineural hearing loss and tinnitus after prolonged use.

Insulin analogues apparently can lead to hearing loss as well. “Synthetic insulin’s potential ototoxicity might result from additives, preservatives or insulin fluctuations,” wrote the authors of an October 2025 article in the Australian Journal of General Practice.

We turned to Danielle S. Powell, AuD, PhD, audiologist and epidemiologist, assistant professor, Department of Hearing and Speech Sciences, University of Maryland, College Park, to help sort this all out. Last year, Powell provided published strategies and methods for physicians who manage patients with diabetes and possible hearing loss.

Is there an overall statement that allows some insight into why the drugs used for metabolic syndrome could affect hearing?

No, there isn’t. Each of these (drug classes) has a different mechanism for how they work. The loop diuretics, for example, are linked to mitochondrial dysfunction in some renal cells. Whether the drug class is designed for the vascular or metabolic system, they seem to affect key hearing parts in the ear, especially the cochlea.

The cochlea is essential for the conversion of sound energy and is very susceptible to metabolic and vascular changes. The stria vascularis, a highly vascularized tissue, lines one wall of the cochlea. It is responsible for homeostasis of the cochlear fluid. At this point, the damage isn’t reversible.

But these are all theories. The treat-to-target trials, including Diabetes Control and Complications Trial and Action to Control Cardiovascular Risk in Diabetes, did not examine how glucose-lowering affected hearing health.

How long before damage could occur?

I do not think it is instantaneous, but again, we don’t know whether it’s a few months or few years, especially if we are talking about the microvascular and cardiovascular connection.

Please discuss tinnitus.

Tinnitus, that ringing, buzzing, and humming in the ears, is a known factor for hearing loss itself. It could get worse the longer people are on diabetes-related medications. Stress, poor sleep, and certain drugs can affect it. It can produce anxiety; the more you fixate on it, the worse it can get. It is worth asking patients about it. It seems that hearing loss is only discussed if there is a noticeable difference in the patient.

What are the challenges here for primary care physicians (PCPs)?

I can only give recommendations, as we did in our paper. I think part of the challenge is that hearing is not something that physicians have been trained to check every year. Hearing loss is more ambiguous than, say, hypertension. And hearing aids are expensive.

But I also think, as we pointed out in our paper, that if patients cannot hear what someone, such as their physician, is saying to them, they could find that managing their diabetes in an effective manner might be difficult.

What advice can you give on hearing-loss management?

Physicians should know that these drugs are not outliers in terms of the damage they can do to a patient’s hearing. Other drug classes do as well. It is worth a conversation to see if the patient is okay with taking them.

In the case of tinnitus, we cannot get rid of it at this point but can help them manage it so it is less impactful to their lives. An audiologist most commonly manages tinnitus. If the case is particularly bad, a behavioral therapist can help the patient become desensitized to the noise.

What quick tips can you give to PCPs?

Ask the person how they are doing every day with hearing deficiency and communication and if they are having a hard time doing things. If yes, that is worth monitoring. The patient’s daily life management capabilities can change gradually, as the person is trying to figure out how to cope. We would recommend a hearing test follow-up every 1-2 years.

Also avoid asking whether the patient is having serious trouble hearing because you will miss a lot of those patients who have more mild-to-moderate hearing loss. People with mild-to-moderate loss can function but with difficulty depending on how they engage with the world around them. There are apps, such as the Know Your Hearing app, that can give patients a numerical idea of how well they are hearing. It was devised by hearing professionals. It is a place to start.

Please discuss why hearing aids are important.

People with hearing loss withdraw socially and have depression. The sooner people act they can incorporate a hearing aid into their lifestyle. The brain adapts to the sound it receives, so hearing aids keep the wrong signals from entering the brain, as in the case of tinnitus.

The interconnection between hearing loss, diabetes, and cognitive decline is under discussion. Would you please comment?

We know that hearing loss affects patients in different ways, depending on lifestyle and so on. We should be looking at the patient’s full picture.

What audiologists haven’t done well is acknowledge how busy PCPs are and what is going to work in incorporating hearing plan conversations with their patients during a regular visit to the clinic. We are trying to do a better job going forward with care coordination and interprofessional connections.

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