Diabetes and Vestibular System

In recent years, diabetes has been found to result in an increased risk of hearing loss. Most of what we know regarding the association between the inner ear and diabetes has largely focused on cochlear damage and resulting hearing loss. However, the vestibular system and the cochlea share many of the same physiological mechanisms, potentially impacting balance and resulting in dizziness. 

The vestibular system is located in the inner ear and is connected to our hearing organ – the cochlea. There are 5 main components that comprise the vestibular system: three semicircular canals, the utricle, and the saccule. When we spin, it causes disruptions to the fluid in the semicircular canals. It takes time for the fluid to settle back down and for the dizziness to subside. However, there are a number of vestibular disorders that can also cause a sensation of dizziness when we’re not moving at all. Incidentally, persons with diabetes are at a higher risk (2x than that of an age matched peer without diabetes) of developing hearing loss and associated balance disorders. 

The vestibular system also relies heavily on the input from two reflexes in the body: the VOR (vestibulo-ocular reflex), which allows your eyes to maintain clear visuals while moving, and the VSR (vestibulo-spinal reflex), which allows for you to walk upright by controlling the muscle movements while in motion. For example, let’s say you are going on a hike with your family. In order to maintain balance, what you see with your eyes and what you feel with your feet must match up with the information coming from the vestibular system. If input from any one of these systems is incorrect, you are likely to lose your balance and fall. Two common comorbidities of diabetes are retinopathy and neuropathy of the hands and feet. Retinopathy can impact the function of the VOR and neuropathy can impact the function of the VSR. This causes a mismatch of information within the vestibular system, which may increase the risk of falls and injuries. 

After receiving a diabetes diagnosis, your physician will likely refer you to several specialists for proper monitoring of common comorbidities of diabetes including a cardiologist, an optometrist, and a podiatrist. An audiologist should certainly be on that list. In fact, the American Diabetes Association recently added yearly audiological evaluation to the diabetes management protocol. Not only is an audiologist able to monitor your hearing, but they can also monitor your vestibular system. Audiologists can complete assessments regarding your balance abilities and dizziness symptoms, such as the Dizziness Symptom Profile (DSP), which assesses 8 common vestibular disorders. The provider can also recommend a comprehensive vestibular evaluation if results suggest a possible vestibular disorder. If you or someone you know has diabetes, be sure to encourage them to obtain a comprehensive audiological evaluation to monitor their hearing and balance. 

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