Prasansuk Suchitra, Siriyananda Chana, Nakorn Apinan Na, Atipas Suvajana, Chongvisal Samut
Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
J Med Assoc Thai. 2004 Oct;87(10):1225-33.
Symptoms of balance disorders including 'unsteadiness', 'dizziness and vertigo' are common in the elderly and commonly found in general practice in medicine. There are many causes of balance disorders and vary from one person to another. Disorder of the internal ear or vestibular end-organ type is one cause. Unsteadiness of somato-sensory or proprioception is common in the elderly so is degenerative disorder of central control in brain. The elderly are prone to many chronic illnesses or disorders which are causes of balance disorder or give rise to more rapid degeneration of the central nervous system i.e. high blood pressure, diabetes mellitus, heart disease, proprioception and joint problems, arthritis and muscular weakness due to lack of good health and exercise. The objectives of this research study were to find the etiologies of balance disorders and how Balance Exercises and the 'National Health Service' can be of benefit in helping to prevent them. 1565 elderly inhabitants (age > or = 60 years) of 20 communities adjacent to Siriraj Hospital were selected for study. Among these, 625 persons had a history of balance disorders. Among those, 256 had symptoms during the week selected for examination. The average age was 66 years old, women outnumbered men with a ratio of 2.4:1. The common underlying causes were hypertension in 32.4%, diabetes mellitus 13.8%, arthritis 8.1%, and heart disease 4.4% respectively. All are still taking one or more types of drug. The subjects were randomly divided into two groups for the study purpose of effectiveness of balance exercise. Group 1 did not perform the head balance exercise and Group 2 performed the head balance exercise. Audiometric testing showed impaired hearing in 90% of the subjects. The majority slowed hearing loss in high frequencies. Testing of middle ear function found 75% of Group 1 to have normal middle ear function 77% of Group 2. Brainstem Electrical Response Audiometry (BERA) showed normal response latencies of in 96% of group 1 and 94% of Group 2. Poor morphology of waveform was found in 12% of Group 1 and 16% of Group 2. Doppler sonography for intra-cranial blood flow measurement showed abnormal flow of the ICA in 17.6% of group 1 and 20.16% of group 2. Basilar arterial abnormal flow was found in 77.6% of Group 1 and 80.6% of Group 2 respectively. The flow of ICA was improved after 8 weeks in both groups. The measurement of balance by Posturography showed 86.7% abnormality in Group 1 and 83.5% abnormality in Group 2 (and the majority due to inner ear problems but many cases had a mixture of joints and CNS problems too). Results of the self-evaluation (by questionaires) showed the elderly to have symptoms of light headedness in 51% and loss of balance in 29%, Vertigo with rotation occurred in 23.6%. 49% of the symptoms were intermittent, 56.4% experienced a 'fall". On questioning about the benefit and performance of Head and Neck Exercises, 82.8% found the exercises were easy to perform, 56.4% said the results were very beneficial.
平衡失调的症状，包括“不稳定感”、“头晕和眩晕”，在老年人中很常见，在普通医学实践中也经常出现。平衡失调有多种原因，因人而异。内耳或前庭终器型失调是其中一个原因。躯体感觉或本体感觉的不稳定在老年人中很常见，大脑中枢控制的退行性失调也是如此。老年人容易患许多慢性疾病或失调，这些都是平衡失调的原因，或者会导致中枢神经系统更快地退化，即高血压、糖尿病、心脏病、本体感觉和关节问题、关节炎以及由于健康状况不佳和缺乏锻炼导致的肌肉无力。本研究的目的是找出平衡失调的病因，以及平衡训练和“国民医疗服务体系”如何有助于预防这些失调。选择了诗里拉吉医院附近20个社区的1565名老年居民（年龄≥60岁）进行研究。其中，625人有平衡失调史。在这些人中，256人在选定的检查周内出现了症状。平均年龄为66岁，女性人数多于男性，比例为2.4:1。常见的潜在病因分别为高血压32.4%、糖尿病13.8%、关节炎8.1%和心脏病4.4%。所有人仍在服用一种或多种药物。为了研究平衡训练的效果，将受试者随机分为两组。第一组不进行头部平衡训练，第二组进行头部平衡训练。听力测试显示90%的受试者听力受损。大多数人高频听力损失减缓。中耳功能测试发现第一组75%的人中耳功能正常，第二组77%的人中耳功能正常。脑干听觉诱发电位（BERA）显示第一组96%的人反应潜伏期正常，第二组94%的人反应潜伏期正常。第一组12%的人和第二组16%的人波形形态不佳。用于测量颅内血流的多普勒超声显示，第一组17.6%的人颈内动脉血流异常，第二组20.16%的人颈内动脉血流异常。基底动脉血流异常分别在第一组77.6%的人和第二组80.6%的人中被发现。两组在8周后颈内动脉血流均有所改善。姿势描记法测量平衡结果显示，第一组异常率为86.7%，第二组异常率为83.5%（大多数是由于内耳问题，但许多病例也同时存在关节和中枢神经系统问题）。自我评估（通过问卷调查）结果显示，老年人中有51%有头晕症状，29%有平衡失调症状，23.6%出现旋转性眩晕。49%的症状是间歇性的，56.4%的人经历过“跌倒”。在询问头部和颈部训练的益处和效果时，82.8%的人认为训练易于进行，56.4%的人表示效果非常有益。
