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The vestibulospinal aspects of vestibular function are commonly neglected in the evaluation of alcohol-induced intoxication. Thus, in the present study the effect of an acute intoxication with a low or moderate quantity of alcohol was examined with respect to the equilibrium in 30 healthy subjects. The blood alcohol concentration (BAC) was measured 30 min after the ingestion of the last alcohol, ranging between 0.22 and 1.59 per thousand. Stability of stance was quantified by static platform posturography in Romberg-test conditions with eyes open and eyes closed. Among other parameters, the average body sway path (SP) and area of body sway (SA) were assessed. Posturography revealed a significant increase in body sway. There was a positive correlation between SA (or SP) and BAC both with eyes open and eyes closed. Multiple group comparisons revealed that the large-alcohol-dose group (BAC > or = 1.0 per thousand) could be clearly differentiated from test cases with BAC lower than 0.8 per thousand. Sway area was the most sensitive parameter for detecting increased body sway after alcohol ingestion. The area increase, present not only with eyes closed but with eyes open, revealed an inadequate compensation of the ethanol-induced ataxia by visual stabilization. The Romberg's quotient, which denotes eyes closed relative to eyes open, remained constant. The increase in sway path with eyes closed showed an omnidirectional sway. A comparison of the sway pattern of subjects after acute ethanol ingestion with the data of patients with permanent cerebellar lesions suggested that the acute effect of alcohol resembles that of a lesion of the spinocerebellum. This finding contrasts with earlier studies, which postulated an acute effect of ethanol resembling that in patients with an atrophy of the anterior lobe of the cerebellum due to chronic alcohol abuse. In seven cases of the lower dose group (BAC < or = 0.8 per thousand), a reduction in body sway after alcohol ingestion was observed. This finding may be consistent with a dose-related biphasic action of alcohol, which - besides its well-known depressant effects with high doses - also shows stimulatory action with small doses.

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Visual orientation is the most important sensory input during locomotion (e.g. walking, driving a car, riding a bicycle). We investigated dynamic visual acuity (DVA) during vertical body-oscillations (amplitude 5 cm; frequency 1.5 Hz) in 12 healthy subjects before and twice after ethanol consumption. During oscillation, vertical eye movements were recorded under two test conditions: with eyes closed (EC) and during DVA testing. A significant increase in vertical eye-amplitude after ethanol ingestion occurred only during EC tests, as a possible sign of vestibular hyperreaction. During vestibular stimulation alone (EC), ethanol did not affect the phase shift between stimulus and eye movements. However, when the subjects were given an additional visual stimulus (DVA), the post-alcohol phase shift rose significantly. Surprisingly, the post-alcohol phase shift values for the two test conditions showed no significant differences. After ethanol ingestion we found no changes in static visual acuity but a significant loss of DVA. Volunteers with a change of DVA threshold (DVAT) showed significantly (P = 0.004) higher post-alcoholic changes in the phase shift. In summary, low doses of ethanol disturbed the visually guided oculomotor response during fixation of an earth-fixed target while the observer was subject to linear vertical acceleration. This effect led to an increasing delay between the beginning of body and eye movements. The consequence was an increasing phase shift and thus a decrease in DVA during whole-body oscillation which was comparable to movements during human locomotion.

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Distortion product otoacoustic emissions (DPOAEs) are probably based on the motile properties of the cochlear outer hair cells (OHCs), which are richly innervated by medial olivo-cochlear efferent nerves (MOCs). DPOAEs provide a stimulating model for functional exploration of the efferent system. The influences of contralateral acoustic stimulation were studied on the amplitude of ipsilateral DPOAEs at the frequency 2f1-f2. Fifteen ears of adults with normal hearing (7 women, 8 men, mean age; 23.1 +/- 4.2 years) were examined. Sound stimulation consisted of exposure to 6 successive series of contralateral pure tones at frequencies between 0.5 and 4.0 kHz and low intensities of 30 dB HL. DP grams were registered with f2 ranging from 708 to 6165 Hz. Contralateral pure tones in the frequency range above 750 Hz and with intensities of 30 dB HL increased the ipsilaterally registered DPOAE amplitudes. The results showed that this increase was frequency specific, at least for frequencies at 1 and 2 kHz. The frequency specificity was especially marked when ipsilateral f2 was near 1 kHz. Contralateral frequencies of 3 and 4 kHz induced a significant, increasing effect, including ipsilateral frequencies around f2 = 3 kHz (or 4 kHz) and also lower frequencies around f2 = 1 kHz. Our results support the concept that the observed increase in DPOAE amplitudes is mediated by the medial olivo-cochlear efferent system. The rule of OHCs as a cochlear amplifier in the presence of contralateral low-intensity sound stimulation is discussed.

The surgeon should be familiar with the diagnosis and management of the rare congenital tumors of the nose to ensure proper therapy and to provide the requisite information for patients, parents, and colleagues.

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