Balance assessment in alcoholic subjects

Braz J Otorhinolaryngol. 2010;76(2):148-55. ORIGINAL ARTICLE Balance assessment in alcoholic subjects Paula Michele da Silva Schmidt 1, Aline Marques Giordani 2, Angela Garcia Rossi 3, Pedro Luiz Cóser 4 Keywords: alcoholism, labyrinth diseases, dizziness. Summary A lcoholism is a chronic condition, consisting on a state of intoxication caused by the consumption of alcohol beverages. Frequently found signs and symptoms are: gait instability, dizziness and lack of psychomotor coordination, among others. Aim: to study the influence of alcoholism on postural balance. Materials and Methods: this is a prospective study. The sample comprehended 32 individuals in the experimental group, members of the Alcoholic Anonymous Group of the city of Santa Maria-RS and 32 non-alcoholic individuals making up the control group. The individuals were submitted to an otorhinolaryngological evaluation, static and dynamic balance study and cerebellar tests, vecto-electronystagmographic evaluation and dynamic posturography. Results: we noticed that the vectoelectronystagmography was normal for most of the individuals in the experimental group, indicating that the labyrinth and the oculomotor-vestibular pathways were normal and that the balance disorder they presented would stem from the dysfunction in other areas of the central or peripheral nervous system. In the dynamic posturography we noticed that alcoholics who were not drinking presented significant alterations in their postural balance when compared to non-alcoholic individuals. Conclusion: alcoholic beverages have a deleterious influence on body balance. MSc in Human Communication Disorders, Speech and Hearing Therapist. MSc in Human Communication Disorders, Speech and Hearing Therapist. 3 PhD in Human Communication Disorders, Speech and Hearing Therapist, Professor. 4 PhD in Human Communication Disorders, Otorhinolaryngologist. Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on January 26, 2009; and accepted on July 27, 2009. cod. 6224 1 2 Brazilian Journal of Otorhinolaryngology 76 (2) March/April 2010 http://www.bjorl.org / e-mail: 148 INTRODUCTION Among the individuals evaluated those who abused drugs other than alcohol and also those who had any ear, nose and/or throat problems were taken off the study. The first study activity was to give the study individuals the Informed Consent Term, which explained the study’s goal, as well as the procedures involved in all the evaluations; and it requested the person’s authorization by means of his/her signature in order to participate in the study. The individuals were submitted to otolaryngological exam, interview, dynamic and static balance tests, dynamic posturography test and vector electro-nystagmography. All 32 individuals from the experimental group underwent full ENT exam, interview and dynamic posturography evaluation. For static and dynamic balance tests and vector electronystagmography, only 29 individuals from the experimental group participated, that is, 3 individuals did not come to the clinic in order to undergo the tests. During the interview we collected information regarding the use of alcohol and the vestibulo-cochlear system of the individuals. It was carried out in order to place the individual as an alcoholic and also to rule out any interference on the vestibulo-cochlear system other than alcohol. The individuals from the control group were interviewed only regarding the issues associated with the cochleovestibular apparatus. The ENT evaluation was done by an otolaryngologist, with the goal of ruling out any ear, nose and/or throat disorder. To look for exclusion criterion, and also for middle ear evaluation, the individuals were submitted to basic audiologic evaluation in a sound booth, made up of Threshold Tonal Audiometry, Speech Recognition Threshold (SRT), Speech Recognition Index (SRI) and Acoustic Immittance Measures. As far as the hearing evaluation goes, we used the following equipment: a Fonix FA12 audiometer, TDH-39 phones and MX-41 pad, a SONY D-11 CD Player SN 9161852 coupled to the audiometer and an Interacoustic AZ7 middle ear analyzer, with a TDH-39 head phone and MX-41 pad, with a 220 Hz sound at 70 dB, both calibrated according to ISO 389-1991 standard. In order to assess the static and dynamic balance and cerebellar function, we used the following tests described by Mangabeira-Albernaz & Ganança (1976): Gait Test, Romberg and Romberg-Barré, Unterberger test, Extended Arms Test, diadochokinesia and dysmetria tests. Dynamic posturography (DP) was carried out through the Foam-Laser Dynamic Posturography (FLP) method, proposed by Castagno12. It is based on a very simple technique to assess the individual’s sensory organization - SOT (Sensorial Organization Test). The patient is put within a 1m²x2m-high booth, and with a visual image made up of blue and beige 10cm stripes. This visual image with stripes aims at creating a visual conflict. At the patient’s side, at Alcoholism or alcohol dependence is a chronic disease acknowledged by the World Health Organization (WHO). It consists of a state of intoxication caused by alcohol consumption. It affects different people at different rates, according to the person’s physical, emotional and psychological characteristics, degree of tolerance to alcohol and type of beverage ingested. Many authors report that ototoxic agents, such as alcohol, have a negative effect on the balance organs causing dizziness and vertigo1-4. Body balance is the capacity each human being has to keep oneself standing up or performing body rotation and movement acceleration without oscillation, deviations or falling. In order to have static and dynamic spatial orientation; in other words, balance, we depend on integrations (vestibular, brainstem and cerebellum areas) which allow the Central Nervous System to recognize head movements and positions in relation to body and space. Changes in body balance maintenance can cause symptoms such as vertigo, dizziness and unbalance5. Dizziness can be a very uncomfortable symptom, which drastically impacts all daily activities and does impair quality of life. It is among the most frequent symptoms in the world and it stems from the labyrinth in approximately 85% of the cases6. Studies state that many drugs, including alcohol, cause dizziness as a side effect, negatively impacting motor skills, including tasks with simple reaction time, coordination skills, balance and eye-hand coordination7-10. Signs and symptoms which are frequently found in alcoholism are anorexia, instability and dizziness, nausea, vomiting, weight loss, fever and abdominal pain, among others7. Some authors report that alcoholism causes premature aging of neuropsychological functions and possible that of the brain11. Considering the little information present in the literature about the relationship between balance and alcoholism, the goal of the prese (...truncated)