Recurrent and Massive Life Threatening Epistaxis due to Nasal Heroin Usage

Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.     

In Vitro and In Vivo Assessment of the Ability of Adeno‐Associated Virus–Brain‐Derived Neurotrophic Factor to Enhance Spiral Ganglion Cell Survival Following Ototoxic Insult

Objectives/Hypothesis Auditory dysfunction following ototoxic insult results from loss of cochlear hair cells. Secondary degeneration of auditory neurons ensues from withdrawal of neurotrophic support from hair cells and can be prevented with administration of neurotrophins. Administration of adeno‐associated virus containing the gene for brain‐derived neurotrophic factor will promote spiral ganglion neuron survival after the destruction of hair cells. Methods Prevention of aminoglycoside‐induced spiral ganglion neuron loss through the expression of brain‐derived neurotrophic factor mediated by means of the adeno‐associated virus was tested in vitro in cochlear explants and in vivo in mammalian cochlea. Results Neuronal survival was significantly enhanced in adeno‐associated virus–brain‐derived neurotrophic factor transfected rat cochlear explants compared with control samples (30% vs. 19%, P <.05) following exposure to aminoglycoside. Following deafening with aminoglycoside and loop diuretic and introduction of adeno‐associated virus–brain‐derived neurotrophic factor through osmotic minipump, the experimental group of animals infused with adeno‐associated virus–brain‐derived neurotrophic factor displayed enhanced spiral ganglion neuron survival in the basal turn of the cochlea when compared with the control group infused with adeno‐associated virus containing green fluorescent protein reporter gene. Conclusions Administration of adeno‐associated virus–brain‐derived neurotrophic factor enhances spiral ganglion neuron survival following ototoxic exposure in vitro and in vivo. These studies lay the groundwork for further exploration of its application as an adjunct therapy for patients undergoing cochlear implantation because the success of implantation depends directly on the population of neurons available for electrical stimulation.