Smoking, osteoporosis and diabetes can all contribute to the risk of losing your hearing
Knowing your risks for hearing loss may help you mitigate the level of hearing loss you experience in your life. There’s lots of information out there about hearing loss increasing your risks of other health problems but have you considered how life choices and health conditions may be increasing your risk of experiencing hearing loss?
Smoking increases risk of hearing loss by up to 70%
Smoking cigarettes has been shown to contribute to many health problems but have you considered its impact on your hearing?
Research has shown a connection between cigarette smoking and hearing loss that’s a bit astounding. People who smoke regularly can be increasing their risk of hearing loss, particularly in the high frequencies, by up to 70%. It’s an ‘up to’ because the risk appears to increase based on how much you smoke.
Teenagers who smoke, or are continuously exposed to second-hand smoke, are 2 – 3 times more likely to have hearing loss than their non-smoking counterparts or those who have little exposure to second-hand smoke.
And for those exposed to second-hand smoke?
People who live with smokers but don’t themselves smoke are a shocking twice as likely to experience hearing loss as they age than those who live in a home of non-smokers.
As noted above, and for those who skipped that part, teenagers exposed to second-hand smoke for hours a day are 2 – 3 time more likely to develop hearing loss.
How does smoking impact hearing?
It’s well known that smoking restricts blood flow and it’s important for blood to circulate well in your ears to keep all its parts functioning well. Smoking is also known to contribute to tinnitus, potentially because of that restricted blood flow.
There are also at least 11 chemicals in cigarette smoke known to be ototoxic (which basically translates to ‘poisoning ear’). They include nicotine, toluene, carbon monoxide, formaldehyde, hydrogen cyanide, the heavy metal cadmium, acetone, acetic acid, ammonia, arsenic and lead.
These chemicals fall into one of these categories:
- Neurotoxicants damage the nerve fibers that interfere with hearing and balance;
- Cochleotoxicants mainly affect the cochlear hair cells, which are the sensory receptors and can impair the ability to hear;
- Vestibulotoxicants affect the hair cells on the spatial orientation and balance organs.
If these chemicals were found in a work environment, they’d be a health and safety hazard. So don’t underestimate their potential to impact your hearing.
What about vaping or cannabis and their impact on hearing?
Science is only just starting to study the impact of vaping on hearing. What is known is if you’re vaping product containing nicotine – a known oxotoxic substance – then an increased risk of hearing loss exists. Additionally, many of the flavoured vape fluids contain propylene glycol, another oxotoxic chemical.
The research into both the good and bad of cannabis has been underway in Canada since its legalization in 2018. Prior to that, research was sporadic and of varying quality because it was difficult to research an illegal substance.
What has been found however is cannabis promotes changes in the auditory pathway and in the function of outer hair cells of the ear.
Choices
Hearing is how we connect with people. If there are lifestyle choices that could be putting your hearing at risk, it’s good to know about them so you can make an informed decision.
No bones about it – osteoporosis puts your hearing at risk
Osteoporosis is associated with aging and so is hearing loss. Is there a relationship between the two or is it just by chance that aging is part of both? Research has tried to determine whether osteoporosis causes hearing loss or if it’s just a relationship because both appear in aging populations. Whether it’s one or the other, research has found a 76% increased risk of hearing loss, particularly sudden hearing loss, in people with osteoporosis. For women with osteoporosis, that risk increases to 87%.
If you have sudden hearing loss, get medical attention immediately.
What’s osteoporosis and why does it affect hearing?
Osteoporosis is a bone disease. It reduces the density of your bones and your bone mass decreases. Your bones become fragile and porous. The fragility it creates in your bone structure can cause fractures much more easily. Most people don’t know they have osteoporosis until they’re getting medical care for a surprise fracture.
Did you know the smallest bones in your body are found in your ears? It stands to reason since there are bones in your ears that those bones would also be victims of osteoporosis. Sudden noises, a serious fall, a head injury could all break the tiny bones in your ears if you have osteoporosis.
Research has also discussed that both the auditory system and your skeleton have some needs in common: calcium and good blood flow. For this reason, the changes in bones from osteoporosis may be a mirror of changes in the inner ear that affect hearing. These changes may influence the stability of the temporal bone protecting the nerves and other structures in your ears and may even change the metabolism of fluid in the cochlea, the shell shaped structure in your ear that is the main instrument of hearing.
Diabetes, even prediabetes, increases risk of hearing loss
Despite loads of research showing a strong and consistent link between diabetes and hearing loss, getting a hearing test is not a standard in the care regime for diabetics. If you have diabetes, or are even prediabetic, it might be a good idea to add this to your routine.
How does diabetes affect hearing?
Diabetics are twice as likely to have hearing loss than those without diabetes. For prediabetics, there’s a 30% increase in the risk of hearing loss. Some research has shown more than half of diabetics have some level of measurable hearing loss. Importantly, the same research that found the doubled likelihood of hearing loss for diabetics also discovered the strongest association between diabetes and hearing loss in the participants between the ages of 20 and 48.
Diabetes can change the blood flow and nerves of many parts of the body and some research suggests this may be what’s happening in the ear as well. Research (through doing autopsies as you can’t see these parts just by in-office medical examination) has found stiffening of the internal auditory artery, thickened capillaries (the wee tiny blood vessels) of some areas of the cochlea (the main engineer of hearing in your ears), a wasting away of some of the nerve cells in the cochlea and some loss of the wall around the nerve cells.
In other words, diabetes may damage the small blood vessels and nerves in your ears. Similar to concerns for other parts of the body.
But is it high blood pressure rather than diabetes?
More than 70% of people with diabetes over the age of 18 are found to have hypertension, otherwise known as high blood pressure. When blood pressure is high, blood moves much faster and fatty bits can build up on blood vessels that have been damaged by the speed and pressure of the blood flow. If this happens in the blood vessels of the ear, it can lead to hearing loss.
High blood pressure may also cause haemorrhaging in the arteries that support the function of the inner ear, which could cause either sudden or gradual hearing loss. (Again, if you have sudden hearing loss, get medical attention right away.) Additionally, if the thickness of the blood increases, it may reduce the blood’s ability to get oxygen to the important bits of your ears causing damage.
Some researchers point to high blood pressure as the factor that increases the risk for people with diabetes. Because we can’t see the damage in a diabetic’s ears when they are alive, it will likely remain a guessing game for a while.
What to do, what to do
If any of these lifestyle choices or diseases are part of your life, get your hearing checked. It’s important to know where you stand. Hearing tests are painless and at Hear Well Be Well hearing tests are free.
Sources:
Cruickshanks KJ, et al. Cigarette Smoking and Hearing Loss: The Epidemiology of Hearing Loss Study. JAMA. 1998;279(21):1715–1719.
Katbamna B. Effects of Smoking on the Auditory System. Audiology Online. October 2008, article 899.
Pezzoli M, et al. Effects of Smoking on Eustachian Tube and Hearing. Int Tinnitus J. 2017;21(2):98–103.
Lalwani AK, Liu YH, Weitzman M. Secondhand smoke and sensorineural hearing loss in adolescents. Arch Otolaryngol Head Neck Surg. 2011 Jul;137(7):655-62. doi: 10.1001/archoto.2011.109. PMID: 21768409; PMCID: PMC4117391.
Johnson, A.C. and T.C. Morata. Occupational exposure to chemicals and hearing impairment, in Arbete och Hälsa, The Nordic Expert Group, Editor. 2010: Gothenburg. p. 1.
Song JJ, Go YY, Mun JY, Lee S, Im GJ, Kim YY, et al. Effect of electronic cigarettes on human middle ear. Int J Pediatr Otorhinolaryngol. 2018;109:67–71.
Phulka, J.S., Howlett, J.W. & Hu, A. Cannabis related side effects in otolaryngology: a scoping review. J of Otolaryngol – Head & Neck Surg 50, 56 (2021).
Mei-Chen Yeh, Shih-Feng Weng, Yuan-Chi Shen, Chien-Wen Chou, Chwen-Yi Yang, Jhi-Joung Wang, Kai-Jen Tien. Increased Risk of Sudden Sensorineural Hearing Loss in Patients With Osteoporosis: A Population-based, Propensity Score-matched, Longitudinal Follow-Up Study, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 6, 1 June 2015, Pages 2413–2419.
Sharon G. Curhan, Konstantina Stankovic, Christopher Halpin, Molin Wang, Roland D. Eavey, Julie M. Paik, Gary C. Curhan. Osteoporosis, bisphosphonate use, and risk of moderate or worse hearing loss in women. Journal of the American Geriatrics Society, 2021.
Wei X. Dietary magnesium and calcium intake is associated with lower risk of hearing loss in older adults: A cross-sectional study of NHANES. Front Nutr. 2023 Mar 14;10:1101764. doi: 10.3389/fnut.2023.1101764. PMID: 36998904; PMCID: PMC10043168.
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 Jul 1;149(1):1-10. doi: 10.7326/0003-4819-149-1-200807010-00231. Epub 2008 Jun 16. PMID: 18559825; PMCID: PMC2803029.
Asghar S, Ali Z, Abdullah A, et al Sensorineural hearing loss among type 2 diabetic patients and its association with peripheral neuropathy: a cross-sectional study from a lower middle-income country BMJ Open 2024;14:e081035. doi: 10.1136/bmjopen-2023-081035.
Makishima K, Tanaka K. Pathological changes of the inner ear and central auditory pathway in diabetics. Ann Otol Rhinol Laryngol. 1971;80:218-28.
Jorgensen MB. The inner ear in diabetes mellitus. Histologic studies. Arch Otolaryngol. 1961;74:373-81.
Agarwal S, Mishra A, Jagade M, Kasbekar V, Nagle SK. Effects of hypertension on hearing. Indian J Otolaryngol Head Neck Surg. 2013 Dec;65(Suppl 3):614-8. doi: 10.1007/s12070-013-0630-1. Epub 2013 Feb 17. PMID: 24427724; PMCID: PMC3889339.
Naha S, Gardner MJ, Khangura D, et al. Hypertension in Diabetes. [Updated 2021 Aug 7].
Ohinata Y, Makimoto K, Kawakami M, Takahashi H. Blood viscosity and plasma viscosity in patients sudden deafness. Acta Otolaryngol. 1994;114(6):601–607. doi: 10.3109/00016489409126112.