Background: Type 2 diabetes mellitus (T2DM) is growing rapidly around the world and has increasingly been identified as a risk factor for sensorineural hearing loss (SNHL). However, despite considerable growing evidence worldwide, only limited studies have been conducted on this association in the general population of Iraq. 
Aims: To determine the prevalence of SNHL in patients with T2DM compared with non-diabetic controls and differentiate the clinical and metabolic characteristics of patients having SNHL compared to those without. 
Methods: We performed a case-control study at Al-Hussein Teaching Hospital in Samawa, Al-Muthanna Governorate, Iraq, from January 2020 until December 2022. Two hundred and forty total participants (120 with T2DM and 120 control participants who were age- and sex-matched) were enrolled. Each participant underwent standard tests such as pure-tone audiometry, tympanometry, and speech discrimination testing to determine hearing loss. Also, we obtained fasting blood glucose values, glycated hemoglobin (HbA1c), lipid profile, and renal function tests to evaluate metabolic and clinical factors. We performed analyses using chi-square, Pearson’s correlation coefficient, and Cox regression analysis. 
Results: Of the diabetic participants, 74 were determined to have SNHL compared to the control participants (p < 0.001, odds ratio [OR]=7.08; 95% confidence interval [CI]: 3.92–12.78). High frequency (4-8 kHz) SNHL was the most common type of hearing loss present in 68 of the diabetic patients (56.7%). In the diabetic cohort, >10 year duration of T2DM (OR=6.30, p<0.001), HbA1c levels ≥ 9.0% (OR=4.31, p<0.001), and age ≥55 years (OR=3.56; p=0.002) were independent risk factors for developing SNHL, as well as hypertension (OR=2.75, p=0.019). Furthermore, the severity of SNHL was moderately correlated with the duration of diabetes (r=0.61; p<0.001) and HbA1c level (r=0.52; p<0.001). 
Conclusion: This study demonstrates the significant association of T2DM and SNHL in the general population of Iraq, with the high frequency of hearing loss being the most commonly found audiological manifestation of the association. Our data suggest that poor glycemic control and prolonged presence of T2DM are the two most significant modifiable risk factors for developing SNHL. It is critical that standard diabetic care providers include routine audiologic evaluation as a component of diabetic screening in Iraq.