Venlafaxine

Indication

A new class of antidepressant medications, unrelated to the tricyclic antidepressants, used in the treatment of depression.

Side effects

Anxiety, somnolence, dizziness, dry mouth, nausea, abnormal ejaculation (male), impotence, headache, tremor, blurred vision, asthenia, sweating, nervousness, hypertension, and insomnia have been the most commonly reported. Changes in weight, appetite and allergic reactions have also been reported more infrequently. Other less common effects include infection, chills, chest pain, tachycardia, rash, constipation, abnormal dreams, paraesthesias, depression, urinary retention, twitching, change in taste, and tinnitus.

Interactions and precautions
1. Use with caution and at a reduced dosage in those with, liver impairment.
2. Consider overall risk-benefit in those with hypertension.
3. Do not use with alcohol.
4. Do not use with Mao inhibitors--fatal interaction can result.
5. Potential for interaction with over-the-counter cold remedies, consult you physician before use.
6. Use with cimetidine could potentiate the effects of venlafaxine. A dosage reduction (venlafaxine) may be necessary in some individuals.

Usual dose

Adults: oral, 75 mg per day in two to three dicided doses, taken with food.

Otosclerosis

When there is abnormal growth of the bone of the middle ear, otosclerosis is said to occur. This disease of ear bone degeneration is usually noticed during early adult years. The bones of the ear turn into spongy bone tissue and lead to excessive buildup of bone tissue. This impairs the hearing process since there is a barrier to sound being conducted to the inner ear. The bones are then unable to vibrate and pass the sound into the inner ear. Usually the outer and middle ear are affected, leading to conductive hearing loss. Nerves of the ears may also get affected, leading to senso-neural hearing loss. Otosclerosis is noticed to occur in persons with family history of hearing loss. Hearing may be impaired in one or both ears. This condition affects nearly 10% of the American population. Pregnancy is known to trigger this condition in some women.

One of the most common symptoms of otoscelerosis is tinnitus (noice originating inside the ear). Hearing loss may be gradual, which is why this condition is not often diagnosed at the early stage. Other accompanying symptoms are dizziness and balance problems. In many cases, persons suffering from otoscelerosis are not even aware of their condition and do not seek medical help. An otologist (ear physician) will need to conduct a physical examination and study the history of hearing loss This condition can be diagnosed with the help of audiometric examination and special x-rays. A CT scan of the temporal bone can help in ruling out other causes of hearing loss. The hearing and balance functions will be assessed with various tests and procedures. Audiometry, tympanometry and tuning fork tests are conducted to test the extent of hearing loss.

A hearing aid is used to treat this condition when the hearing loss is mild. You can take the help of an audiologist to choose the one that fits your specific needs best. Doses of oral sodium fluoride are known to improve ostosclerosis. Sodium fluoride aids calcification of new bone and checks further otoscelerotic damage. Fluoride medication along with calcium and Vitamin D are prescribed. A surgical procedure known as stapedectomy is performed to replace the fixed stapes bone in the ear with a prosthetis. This device allows sounds waves to pass to the inner ear. The stapes bone is either completely or partially removed. The laser stapedectomy surgery is usually performed under local anasthesia and is an outpatient procedure. Only one year is operated at a time. In most of the cases, stapedectomy benefits the patient suffering from ostoscelerosis. After surgery, a patient must avoid loud noises and sudden changes in pressure for a few weeks. Rarely are there complications with this surgery leading to total deafness or formation of blood clots in the ear.

Presbycusis

Presbycusis refers to age-related hearing loss. This condition is noticed in about 30% adults over the age of 70 years. Aging results in changes in the inner ear or middle ear of a person. This can lead to gradual loss of hearing. Often the person is not even aware of the diminished hearing. Sometimes heart disease, ciculatory problems, diabetes or hypertension can cause changes in the blood supply to the ear. This may lead to mild or moderate loss of hearing. Heriditary factors and side-effects of medications can also bring about presbycusis.

A patient suffering from presbycusis will find it difficult to comprehend conversations clearly. Hearing loss is greater for high-pitched sounds. A person suffering from presbycusis may find it more difficult to hear a woman's voice. Some sounds may appear too loud and deafening. There may be tinnitus in one or both ears. A patient may be advised to use a hearing aid. The use of ear muffs or ear plugs can help in reducing further hearing loss.