Will the poor health of kidneys damage Hearing? Yes, they can work in more ways than one. However, this side effect of chronic kidney disease is not talked about very often.

Sensorineural hearing loss in chronic kidney disease is common. Hearing loss often happens due to the illness itself and sometimes ototoxic drugs needed to treat kidney diseases. It happens from 27% to 77% of people suffering from chronic kidney diseases. The percent varies between countries, depending on the burden of NCDs. Hearing loss is often long-lasting and worsens over time[1]. All CKD patients need regular hearing assessment to guard against this and treat accordingly. Timely intervention can prevent and protect Hearing.

What kind of hearing loss is seen in CKD patients?

Sensorineural hearing loss, moderate to severe involving higher frequencies, is seen in CKD. Its bilateral and symmetrical in most cases.

Tinnitus, a ringing sensation in the ear, may be associated with SNHL. The CKD patients are at three times greater risk of tinnitus than the general population. A patient may also present with Sudden Severe Hearing Loss.

While evaluating hearing loss, a necessary part of the workup includes questions about comorbidities and ototoxic drugs. Non-communicable diseases like hypertension, Diabetes mellitus, individually and together, pose a risk to HearingHearing. Ototoxic drugs are toxic to the ear(oto) but often necessary to treat chronic kidney disease. It is the classic case of side effect where the risks and benefit of treatment are weighed in. Loop diuretics and Aminoglucosides are common drugs that can cause hearing damage.

How does kidney disease affect ears?

Systemic disease can affect every part of the human body. All systems are related, and when it comes to nerves, they are extra sensitive.

Ourkidneys remove waste toxins from our bodies. They also play a role in balancing the electrolytes. The cochlea in our inner ear responsible for Hearing has fine hair cells and a delicate ionic balance which gets disrupted by-

1. Uraemic toxins
2. Distorted ionic balance
3. Ototoxic drugs are used to treat severe kidney infections.
4. Haemodialysis in some instances due to multiple factors.

The effect of all this may be superadded to damage the cochlear hair cells. It may present as a ringing sound in the ear or reduced Hearing.

Your nephrologist will advise about the ototoxic nature of certain drugs and the need for an ear checkup. During early stages of mild hearing loss, you may not realize the problem. However, a tuning fork test and Pure tone audiometry by a registered ENT surgeon will help diagnose it.

When to visit an ENT surgeon if you have CKD?

• Annual Pure tone audiometry needs to be a part of CKD treatment. Get tested on time: at least annual ENTcheckup and Pure tone audiometry for screening.
• In case of a reduced hearing in one or both ears.
• In case of ringing sound in the ear
• If you have a problem with balance.
• In case of change of medicine
• After Haemodialysis

How to prevent further hearing damage?

• Regular hearing assessment
• Better control of Blood urea creatinine, Serum electrolytes.
• Better control of comorbidities.
• Avoid acoustic trauma
• Avoiding ototoxic drugs

What to do in case of hearing loss?

If you suspect you hear less or are a CKD patient's caregiver, visit an ENT surgeon. Your doctor will check the eardrum, do a tuning fork and advise the following tests.

• Pure-tone Audiometry
• SISI(Short increment sensitivity index)
• TDT(tone decay test).

In case of hearing loss, a Hearing Aid trial and suitable Digital Hearing aid are advised.

What other things will your doctor tell you if you have hearing loss with CKD?

• Counseling and family awareness.
• A support system and community to encourage productive habits.
• Avoid topical or systemic Ototoxic drugs(Aminoglycosides, Frusemide).
• Neurovitamins
• The strict control of blood pressure and blood sugar will prevent super added damage.
• Maintain ear hygiene, avoid pond bathing, diving, self-cleaning of the ear, and forceful Valsalva.

The strict control of other non-communicable diseases like hypertension, Diabetes mellitus is essential because they increase nerve damage.

Increasing age and age-related aggravation of sensorineural hearing loss are typical. Like all diseases, prevention is helpful.