Auditory effects of chronic alcoholism

Acute Alcoholic Hallucinosis: A Review

Acute alcoholic hallucinosis is a psychotic disorder characterized by a predominance of auditory hallucinations with delusions and affective symptoms in the clinical picture. Classically, it develops as part of the alcohol withdrawal syndrome. The prevalence of acute alcoholic hallucinosis ranks second among alcohol-related psychoses after alcohol delirium. The study aimed to systematize the scientific data on the history of alcoholic hallucinosis, its pathogenesis, clinical presentation, and treatment approaches. A literature search was performed in PubMed, Scopus, Google Scholar, and eLibrary. The following words and combinations were used as search strings: (alcoholic hallucinosis OR alcoholic psychosis OR alcohol-related psychosis OR alcohol-induced psychosis OR alcohol-induced psychotic disorder OR complicated alcohol withdrawal syndrome) NOT (animal OR rat OR mouse). The relevant information concerning the history of acute alcoholic hallucinosis, its pathogenesis, clinical picture, and treatment approaches was systematized and summarized. This review presents relevant findings regarding acute alcoholic hallucinosis. Limitations of the review include the use of heterogeneous and mostly descriptive studies and studies on small cohorts of patients.

Gender Differences in the Association between Moderate Alcohol Consumption and Hearing Threshold Shifts

Hearing loss is a global public health problem with a high prevalence, significantly impairing communication and leading to a decrease in the quality of life. The association between moderate alcohol consumption (MAC) and hearing impairment has been addressed in several studies with inconsistent results. The intent of our study is to clarify the correlation between MAC and the hearing threshold and further investigate the interplay between MAC and the hearing threshold categorized by gender. The study included 4,075 participants aged 20–69 years from the 1999–2004 data of National Health and Nutrition Examination Survey (NHANES). The associations among MAC, gender differences, and high-frequency and low-frequency hearing thresholds were analyzed. We found that current female drinkers with MAC tended to have lower hearing thresholds. There is a significant protective effect of MAC on hearing threshold shifts in the US adult population, especially in females. Our research was the first study to further indicate that there is a gender difference in the association between MAC and hearing impairment. In accordance with our results, if people drink, they should consume moderate rather than higher amounts, especially in women, which may result in a reduced risk of hearing loss.

Alcohol-induced psychotic disorder: a review

While alcohol-induced psychotic disorder (AIPD) is well recognised, relatively little is known about the condition. We undertook a review of the literature to identify studies on the epidemiology, clinical manifestations, underlying neurobiology and treatment of AIPD. Few prospective studies have been conducted on AIPD. Recent advances have focussed on epidemiological, phenomenological, neuro-imaging, treatment and outcome issues. Current evidence suggests AIPD can be clinically distinguished from alcohol-withdrawal delirium and schizophrenia. The disorder may be more common than previously recognised depending on the inclusion criteria applied. AIPD is associated with high co-morbidity with other psychiatric disorders, high re-hospitalization and mortality rates and suicidal behaviour. Concurrent dysregulation of several neurotransmitter systems may be involved in the pathogenesis of hallucinations in alcohol dependence, and neuro-imaging studies suggest perfusion abnormalities to various brain regions. Antipsychotic treatment remains the preferred treatment for AIPD. The prognosis appears less favourable than previously believed, yet usually good when abstinence can be maintained.

The impact of tinnitus on sufferers in Indian population

Tinnitus is a very common complain and affects 7% of population and has been associated with a range of physical and emotional disorders (Hallam et al. in Br J Clin Psychol 27:213-222, 1988). Hence to understand the distress caused by tinnitus and its relationship with the nature of tinnitus so as to suggest the appropriate treatment, there is the need to study the impact of tinnitus of a group of tinnitus sufferers. This study could be done on the basis of verbal description of tinnitus, Audiological measurement of tinnitus and psychological characteristics of tinnitus in terms of distress, anxiety, depression and disturbance of personality, to understand the impact of tinnitus on sufferers. Fifty adults in the age range of 18-60 years with subjective tinnitus with bilateral normal hearing or pure SNHL ranging from mild to moderately severe were selected. An audiological profile of each subject was prepared on the basis of brief case history of subject, otoscopic examination, pure tone audiometry, impedance audiometry, frequency (pitch) and intensity (loudness) of tinnitus. A psychometric profile was developed by using Tinnitus Reaction Questionnaire and Nature of Tinnitus Questionnaire. These questionnaires were translated and adopted in Hindi and Bengali language after appropriate standardization procedure. 60% reported that they do not have any idea regarding probable cause of their tinnitus. 74% subjects of this study reported that there is no fluctuation in the pitch of their tinnitus. However, 68% reported loudness of tinnitus is fluctuating. A weak co-relation has been seen between traditional audiological measures like pitch matching, loudness matching and subject's description of pitch and loudness of tinnitus. There was a significant correlation between the impact of tinnitus and disturbance of sleep caused by it with increase in depression and anger (0.483). However, no significant co-relation was seen between distressed caused by tinnitus and duration of tinnitus (-0.034). The multiple nature/sounds of tinnitus had far more devastating effects or serious impact on 'tinnitus sufferers' than the single sound/nature. Gender differences were also found among tinnitus sufferers while assessing the audiological and psychological measures of tinnitus. Female subjects also reported a higher level of emotional reaction with a mean of 35.9 to their tinnitus as compared to males with a mean of 31.7. Tinnitus has resulted in multifold effects/impacts on tinnitus sufferers where it has made them feel unhappy, tense, irritable, depressed, annoyed, distressed and frustrated. It has interfered with their enjoyment, their relaxation, their sleep, and forced them to avoid quiet environmental and social situations. These findings should further help in the overall management of the patient suffering from tinnitus.

Experimental and clinical usefulness of crossmodal paradigms in psychiatry: an illustration from emotional processing in alcohol-dependence

Crossmodal processing (i.e., the construction of a unified representation stemming from distinct sensorial modalities inputs) constitutes a crucial ability in humans' everyday life. It has been extensively explored at cognitive and cerebral levels during the last decade among healthy controls. Paradoxically however, and while difficulties to perform this integrative process have been suggested in a large range of psychopathological states (e.g., schizophrenia and autism), these crossmodal paradigms have been very rarely used in the exploration of psychiatric populations. The main aim of the present paper is thus to underline the experimental and clinical usefulness of exploring crossmodal processes in psychiatry. We will illustrate this proposal by means of the recent data obtained in the crossmodal exploration of emotional alterations in alcohol-dependence. Indeed, emotional decoding impairments might have a role in the development and maintenance of alcohol-dependence, and have been extensively investigated by means of experiments using separated visual or auditory stimulations. Besides these unimodal explorations, we have recently conducted several studies using audio-visual crossmodal paradigms, which has allowed us to improve the ecological validity of the unimodal experimental designs and to offer new insights on the emotional alterations among alcohol-dependent individuals. We will show how these preliminary results can be extended to develop a coherent and ambitious research program using crossmodal designs in various psychiatric populations and sensory modalities. We will finally end the paper by underlining the various potential clinical applications and the fundamental implications that can be raised by this emerging project.

Auditory assessment of alcoholics in abstinence

Alcoholism is considered the most relevant addiction in the international arena and few investigations have examined the association between sensorineural hearing loss and alcohol abuse, with conflicting results.

AIM

To analyze the effects of alcohol abuse on the auditory system of alcoholics in abstinence taking into account the duration of alcohol abuse and associated noise exposure.

METHOD

our series comprehended 75 individuals, divided into two groups: trial and control. The audiological assessment was made by means of: pure-tone audiometry, transient evoked otoacoustic emissions, tympanometry. The Wilcoxon and Mann-Whitney tests were used in the statistical analysis of the data.

RESULTS

the groups of patients who had been alcoholics evidenced a statistically significant worse performance in the audiological assessment. The combined exposure to alcohol and noise was not synergic on the auditory system.

CONCLUSION

long-term alcohol abuse can damage the cochlear function, specifically the outer hair cells.

The crossmodal facilitation effect is disrupted in alcoholism: a study with emotional stimuli

AIMS

Chronic alcoholism is classically associated with major deficits in the visual and auditory processing of emotions. However, the crossmodal (auditory-visual) processing of emotional stimuli, which occurs most frequently in everyday life, has not yet been explored. The aim of this study was to explore crossmodal processing in alcoholism, and specifically the auditory-visual facilitation effect.

METHODS

Twenty patients suffering from alcoholism, and 20 matched healthy controls had to detect the emotion (anger or happiness) displayed by auditory, visual or auditory-visual stimuli. The stimuli were designed to elicit a facilitation effect (namely, faster reaction times (RTs) for crossmodal condition than for unimodal ones). RTs and performance were recorded.

RESULTS

While the control subjects elicited a significant facilitation effect, alcoholic individuals did not present this effect, as no significant differences between RTs according to the modality were shown. This lack of facilitation effect is the marker of an impaired auditory-visual processing.

CONCLUSIONS

Crossmodal processing of complex social stimuli (such as faces and voices) is crucial for interpersonal relations. This first evidence for a crossmodal deficit in alcoholism contribute in explaining the contrast observed between experimental results describing, up to now, mild impairments in emotional facial expression (EFE) recognition in alcoholic subjects (e.g. Oscar-Berman et al.,1990), and the many clinical observations suggesting massive problems.

Moderate alcohol consumption and hearing loss: a protective effect

OBJECTIVE

To determine if moderate alcohol consumption is associated inversely with hearing loss in a large population based study of older adults.

DESIGN

Cross-sectional population based cohort study. Data are from the 1993-1995 examinations for the population based Epidemiology of Hearing Loss Study (EHLS) (n = 3571) and the Beaver Dam Eye Study (BDES) (n = 3722).

SETTING

Midwestern community of Beaver Dam, Wisconsin.

PARTICIPANTS

Residents of Beaver Dam aged 43 to 84 in 1987-1988 were eligible for the BDES (examinations in 1988-1990 and 1993-1995). During 1993-1995, this same cohort was eligible to participate in the baseline examination for the EHLS.

MEASUREMENTS

Hearing thresholds were measured by pure tone air and bone conduction audiometry (250-8000 Hz.). History of alcohol consumption in the past year, heavy drinking (ever), medical history, occupation, noise exposure, and other lifestyle factors were ascertained by a questionnaire that was administered as an interview.

RESULTS

In multiple logistic regression analyses controlling for potential confounders, moderate alcohol consumption (>140 grams/week) was inversely associated with hearing loss (PTA(.5,1,2,4 > 25 dB HL); odds ratio [OR] = .71, 95% confidence interval [CI] = .52, .97; where PTA is pure tone average). A similar association was found for moderate hearing loss (PTA(.5,1,2,4 > 40 dB HL); OR = 0.49, 95% CI = 0.32, 0.74). Alcohol consumption was associated inversely with the odds of having a low frequency hearing loss (OR = 0.61) or a high frequency hearing loss (OR = 0.60). These findings did not vary significantly by age or gender. There was an increase in the odds of having a high frequency hearing loss (OR = 1.35, 95% CI = 1.04, 1.75), in those with a history of heavy drinking (> or =4 drinks/day). Including cardiovascular disease or its related factors did not significantly attenuate the protective effect.

CONCLUSIONS

There is evidence of a modest protective association of alcohol consumption and hearing loss in these cross-sectional data. This finding is in agreement with a small body of evidence suggesting that hearing loss is not an inevitable component of the aging process.

PET and SPECT findings in alcohol hallucinosis: case report and super-brief review of the pathophysiology of this syndrome

Alcohol hallucinosis is a rare complication of chronic alcoholism with schizophreniform symptomatology. The pathophysiology is basically unclear. We report the case of a 48-year-old, never-medicated, long-term alcoholic suffering from alcohol hallucinosis with pure acoustic hallucinations for at least six months. Current FDG PET data suggest a hypofrontality and possibly a thalamic hypofunction in alcohol hallucinosis, findings similar to those reported in unmedicated schizophrenics. Current IBZM SPECT data do not support a dopamine receptor dysfunction in alcohol hallucinosis but TRODAT SPECT showed reduced dopamine transporter binding. Possible implications of these findings are discussed.

Alcohol, auditory functioning and deafness

This paper reviews studies of alcohol and auditory impairment and the treatment of deaf people with alcohol problems and concludes that: (a) alcohol affects auditory functioning, (b) prenatal exposure to alcohol is a risk factor for hearing impairment in FAS children,

Acute ethanol effects on sensory/motor function in baboons with a history of chronic ethanol ingestion

Baboons with a history of chronic, daily ethanol ingestion were subsequently studied under conditions that assessed the effects of acute oral self-administration of ethanol on auditory and visual threshold functions and reaction times. During the post-chronic experiment reported herein, the animals consumed specific amounts of ethanol twice weekly (0.1, 0.32, 1.0 or 1.3 g/kg), following which they immediately performed psychophysical tests designed to assess ethanol's effects on sensory thresholds and reaction times. Clear, dose-related increases in reaction times were observed following ethanol doses greater than 0.32 g/kg. Trends within individual threshold functions were consistent with systematic changes in auditory and visual threshold sensitivities of 1-3 dB at the high ethanol doses. Reaction time increases ranged from 25 to 180 ms above baseline levels at the highest dose (a 15% average increase). These general findings however, were in contrast to data obtained in the same animals under conditions of daily, chronic ethanol administration which characteristically showed greater sensory/motor effects of up to twice the magnitude of those observed with single doses.

Afferent information processing in patients with chronic alcoholism. An evoked potential study

Visual evoked potentials (VEP), median nerve sensory conduction velocity (SNCV) as well as sensory evoked potentials (SEP), and brainstem acoustic evoked potentials (BAEP) were investigated on both sides in 40 patients with chronic alcoholism (mean age 37 years) without clinical signs of alcohol-induced central nervous system lesions. The results were compared to those obtained in 40 normal controls (mean age 32 years). In both groups, the parameters were analysed by means of both dependence and interdependence statistics. Dependence statistics (ANOVA) revealed significant differences between both groups. In 70% of the patients, at least one pathological parameter (greater than mean +/- 2.5 SD) was found; about 38% of the patients had two or more pathological values. Most pathological parameters were observed with BAEP testing (45% of patients) followed by SNCV (33%), median nerve SEP (30%), and VEP (10%). No significant clustering of pathological parameters was found in certain patients. By means of interdependence statistics, evidence is presented for a disturbance of sensory processing in the brainstem auditory pathways of the patients.

Ethanol's effects on auditory thresholds and reaction times during the acquisition of chronic ethanol self-administration in baboons

Baboons were trained to ingest ethanol at successively higher ethanol concentrations using oral self-administration techniques. Concurrently, animal psychophysical procedures were employed to determine auditory thresholds and reaction times daily. Maximal consumption of ethanol occurred at concentrations of 6-8% (w/v). During the initial period of ethanol self-administration, both auditory reaction times and auditory thresholds became elevated as animals consumed larger amounts of ethanol. For both the threshold and reaction time measures, the degree of elevation was correlated with the amount of ethanol consumed. These correlations decreased, however, with continued ethanol consumption. The elevations in sensory and motor function recovered to near-baseline levels when ethanol was no longer available.

Alcoholic hallucinosis: a psychiatric enigma--1. The development of an idea

This paper outlines the evolution of ideas on the topic of alcoholic hallucinosis. From 1847 to 1987 numerous descriptive case-histories appeared in the literature. Analysis of these demonstrates that there were some phenomenological features of the illness about which authors were agreed. These were the acute onset of the illness, the predominance of auditory hallucinations and a history of heavy drinking. Protagonists of the delirium tremens school of though drew attention to the slight clouding of consciousness, the presence of the physical symptoms which may accompany an acute confusional state and the possibility of other kinds of hallucinations. Those who favoured the idea that it was a schizophrenic-like illness emphasized the chronicity, the predominance of auditory hallucinations and clear consciousness. Enlightening as these case-histories were, it was impossible to conclude the debate on these unsystematic observations alone.

Speech processing ability in alcoholics: a transient impairment and its relation to field dependence

Alcoholic and non-alcoholic subjects received a test of the ability to identify speech presented against competing speech (Synthetic Sentence Identification) and a test of field dependence (Embedded-Figures Test (EFT). Performance on the speech task (which involved auditory figure-ground differentiation) bore no special relationship to performance on the field-dependence test. However, cross-sectional and longitudinal data suggested that recently-drinking alcoholics are temporarily impaired in their speech-processing ability, recovering this ability after several months of alcohol-abstinence. A relationship between chronicity of alcoholism and field dependence was also observed. The latter relationship, along with findings on auditory tests, were discussed in terms of their relevance to the issue of whether field dependence is an antecedent to or a consequence of alcoholism.