Comparison of the safety and efficacy of the on-demand use of sertraline,dapoxetine, and daily use of sertraline in the treatment of patients with lifelong premature ejaculation: A prospective randomised study

This study compared the safety and efficacy of the on-demand (OD) use of sertraline (50 mg), sertraline (100 mg) and dapoxetine (30 mg), and the daily use of sertraline (50 mg) in the treatment of patients with premature ejaculation (PE). This prospective randomised study involved 120 lifelong PE patients (intravaginal ejaculatory latency time [IELT]: <1 min; Arabic Index of Premature Ejaculation [AIPE] score: < 30) without secondary causes of PE, identified between March 2018 and May 2020. Patients were divided into 4 groups (30 patients per group) and treated for 8 weeks. Assessments were conducted using the AIPE form as a diagnostic tool. Sertraline (50 mg, daily; 196.7 ± 115.5 s) and sertraline (100 mg, OD; 173.3 ± 97.0 s) had similar IELT and AIPE scores. The latter groups had better results in comparison with sertraline (50 mg, OD; 100.5 ± 54.4 s) and dapoxetine (93.7 ± 53.5 s; p < 0.01). Sertraline (100 mg, OD) had a similar efficacy to that of sertraline (50 mg, daily) and was more effective than sertraline (50 mg, OD) and dapoxetine (30 mg, OD). Sertraline (100 mg, OD) can be considered in the treatment of lifelong PE treatment, having tolerable side effects.     

Impact of intra-operative doppler ultrasound assistance during microsurgical varicocelectomy on operative outcome and sperm parameters

The microsurgical varicocelectomy is the gold standard treatment with a low recurrence rate and less postoperative complications. We compared the surgical outcomes and difficulty in intra-operative vascular Doppler ultrasound-assisted microscopic varicocelectomy (IVDU-MV) with MV in primary and recurrent varicocele. A total of 228 infertile patients with clinically palpable varicocele were included in the study. One hundred fifteen patients were operated on with the standard MV approach, whereas the other 113 patients were operated on with IVDU-MV. Perioperative outcomes, sperm parameters and operative difficulty of the procedure were evaluated. The operative times were significantly shorter for the IVDU-MV group for primary and recurrent varicocele (p = .001). Mean number of veins ligated for primary and recurrent varicocele was significantly higher in the IVDU-MV group than in the MV group (6 ± 1.4 vs. 4.8 ± 1.8 and 3.7 ± 0.9 vs. 2.9 ± 1.2; p < .01). The increase in mean sperm motility was significantly higher in the IVDU-MV group for both primary and recurrent varicocelectomy patients (p < .05). A significant number of IVDU-MV procedures were described as easy in both primary and recurrent varicocelectomy procedures (p = .006). The use of Doppler ultrasound(US) revealed advantages in ligating veins, preserving arteries and improving sperm motility and facilitates the operation for the surgeon, especially during recurrent varicocele repair .     

Tolosa-Hunt syndrome with heterotopic salivary gland tissue and absence of internal carotid artery

Tolosa-Hunt syndrome (THS), heterotopic salivary gland and hypoplasia of internal carotid artery (ICA) are all rare entities. We have reported a case of all these three conditions included in a patient. We have postulated that the heterotopic salivary gland tissue might have caused the hypoplasia of ICA and also triggered the THS.     

The importance of thrombotic risk factors in the development of idiopathic sudden hearing loss

Impaired cochlear blood circulation has been suggested to cause sudden hearing loss. In this study, the role of factor V 1691 G-A (FV 1691 G-A), prothrombin 20210 G-A (PT 20210 G-A), methylene tetrahydrofolate reductase 677 C-T (MTHFR 677 C-T), factor V 4070 A-G (FV 4070 A-G), endothelial cell protein C receptor (EPCR) gene 23-bp insertion, and plasminogen activator inhibitor-1 (PAI-1) 4G/5G mutation was assessed. Fifty-three patients with idiopathic sudden sensorineural hearing loss and 80 individuals comprising the control group were included in this study. The frequency for FV 1691 A was 6.2% in the patient group and 3.7% in the control group, PT 20210 G-A was 1.2% in the patient group and 1.9% in the control group, and FV 4070 A-G was 7.5% in the patient group and 11.3% in the control group. The frequency of MTHFR 677 C-T was significantly higher in the patient group than in the control group, with a P value of .03. PAI-1-675 4G/5G polymorphism was found to be 71.2% and 69.8%, in the control group and the patient group, respectively. The EPCR 23-bp insertion was 0% in the control group and was found in 3 patients (3.7%), which needs further study.     

Transcanal anterior approach for cystic lesions of the petrous apex.

OBJECTIVE: To investigate the utility of a newly described approach, the transcanal anterior approach that is a modification of the subcochlear approach for the drainage of cystic lesions of the petrous apex. STUDY DESIGN: Prospective temporal bone study. SETTING: Tertiary referral center. MATERIALS: A total of six cadaveric temporal bone specimens (four males) were included. Right ear in four specimens and left ear in two specimens were used. INTERVENTIONS: The approach commenced with postauricular skin incision. After the transsection of the meatal skin, antero-inferior tympanotomy was performed. Anteroinferior canaloplasty localized the carotid canal. As much as 0.5 cm of the vertical segment of the internal carotid artery was skeletonized. After the identification of the artery, petrous apex cells were reached by drilling the cortical bone between the cochlea and the internal carotid artery. An air cell tract was established. Position and length of the tract in two specimens were demonstrated on the 1 mm-cut computerized tomography scans. MAIN OUTCOME MEASURES: Utility of the approach was investigated based on the established criteria: anteroposterior diameter and height of the fenestra of the tract, length of the tract from the cochlea to the deepest point of the tract (depth of the tract), and the injury risk of the internal carotid artery and the cochlea. RESULTS: The mean anteroposterior diameter, the height, and the length were 4.7 +/- 1.05 mm, 3.2 +/- 0.68 mm, and 14.7 +/- 1.1 mm, respectively. Injury did not occur in the cochlea or internal carotid artery in any of the specimens. CONCLUSION: With the subcochlear approach, there is always potential risk of injury to the cochlea, the internal carotid artery, and the jugular bulb. Although this new approach includes a technically challenging stage (exposing the vertical portion of the internal carotid artery), partly exposing the vertical portion of the artery provides a safer approach, which decreases the injury risk for the round window and the jugular bulb. Additionally, measurements show that it is possible to reach a considerable part of the petrous apex cells.     

Acoustic characteristics of reconstructed ear canal after atresia surgery

The acoustic properties of the reconstructed ear canals of 13 patients after atresia surgery were investigated by comparing them with those of contralateral healthy ear canals. In the third post-operative month, resonant frequency, amplitude and bandwith of the ear canals with Q-factor were measured. Probe microphone measurements showed a significant shift in resonant frequency in the direction of the higher frequencies, and a non-significant change in bandwith in the atresia surgery group. The suggested reason may be a change in ear canal curvature, altered vibration pattern and sound-absorption characteristics of the skin graft lining the reconstructed ear canal.     

Saccular cyst in an infant: an unusual cause of life-threatening stridor and its surgical treatment

Saccular cysts in infants are rare lesions of the larynx and may result in respiratory obstruction and severe dyspnea. Herein we present a case of saccular cyst in a three-month-old infant. She was presented with severe stridor and respiratory distress. She had been followed with the diagnosis of tracheomalacia for three months elsewhere. Direct laryngoscopy of the larynx revealed a saccular cyst. Stridor disappeared shortly after surgical excision of the supraglottic saccular cyst under direct laryngoscopy. No complication or recurrence was seen in the 12-month follow-up period. Saccular cysts in infants are rare lesions and should be kept in mind in the differential diagnosis of stridor in infants.     

Vestibular disturbance in patients with large vestibular aqueduct syndrome (LVAS)

Large vestibular aqueduct syndrome (LVAS) is a common inner ear anomaly responsible for some unusual vestibular and audiological symptoms. The gross appearance of CT scan of the inner ear is generally normal. However, precise measurement of the inner ear components reveals abnormal dimensions, which may account for accompanying auditory or vestibular dysfunction. It has been reported that sudden increase in cerebrospinal fluid pressure can cause further deterioration of hearing due to transmission of pressure to the inner ear through the enlarged vestibular aqueduct. However, vestibular function is not often studied. In this report, audiovestibular function of 10 patients with large vestibular aqueducts was analysed and compared with the severity of the radiological deformity. The literature was reviewed and typical findings were discussed to emphasize varying aspects of audiovestibular function. It was found that some patients with LVAS have some spontaneous or provoked vestibular disturbance such as vertigo after watching revolving objects. The mean value of electronystagmographic abnormality in patients with hearing loss is greater than in patients with normal hearing. However, there is no statistical correlation between the level of hearing loss, electronystagmographic abnormality and severity of radiological deformity.     

Impact of tumor size on hearing outcome and facial function with the middle fossa approach for acoustic neuroma: a meta-analytic study

OBJECTIVE: The purpose of this study was to review the English language literature concerning the effect of tumor size on hearing outcome and facial function after the middle fossa approach for acoustic neuroma in a large patient population. MATERIAL AND METHODS: The literature search identified a total of 11 studies reporting hearing outcome and facial function for a given tumor size. There were 1073 and 797 cases available for the analysis of hearing outcome and facial function, respectively. These cases were subdivided based on the way in which tumor size was measured: category 1 considered only the extracanalicular portion of the tumor; and category 2 considered the largest diameter of the tumor. In category 1, hearing and facial results were regrouped based on tumor size as follows: intracanalicular (IC) tumors; 1-9 mm tumors; 10-20 mm tumors; and a combined group of < 0.5 mm tumors, including IC tumors. In category 2, tumors were subdivided into 2 groups: those < 10 mm in diameter; and those 10-20 mm in diameter. In each category, tumor size groups were compared using the chi2 test in terms of the rate of functional hearing preservation and good facial function. RESULTS: In category 1, analysis of the rate of functional hearing preservation showed that IC tumors compared favorably with the 1-9 mm and 10-19 mm tumors (56.9% vs 45.6%, p = 0.016; and 56.9% vs 32.3%, p < 0.001, respectively). The IC tumor group had the best rate of good facial function, followed by the 1-9 mm and 10-19 mm tumors (98.9% vs 93.9%, p = 0.007: and 98.9% vs 85.6%, p < 0.001, respectively). In category 2, rates of functional hearing preservation and good facial function were almost the same for tumors < 10 mm in diameter and those 10-20 mm in diameter (p > 0.05). CONCLUSIONS: The meta-analysis revealed that tumor size is an important variable determining hearing outcome and facial function. Inclusion of the IC portion of a tumor in the tumor size measurement apparently hampered the statistical power of the study, leading to an overestimation of the size of IC tumors.