Sudden sensorineural hearing loss associated with vardenafil.

The phosphodiesterase type 5 (PDE-5) inhibitors-sildenafil, vardenafil, and tadalafil-are used primarily in erectile dysfunction, but sildenafil is also indicated for pulmonary hypertension. Common adverse effects of vardenafil include headache, flushing, nasal congestion, dyspepsia, and nausea. Recently, PDE-5 inhibitors have been associated with adverse vision effects, and emerging evidence now indicates that they may also be responsible for hearing changes and hearing loss. We describe a patient who developed unilateral sudden sensorineural hearing loss possibly related to the use of vardenafil for erectile dysfunction. To our knowledge, only one other case of hearing loss related to this drug class has been published. Our patient was a 57-year-old man who came to the emergency department with right-sided mild-to-moderate hearing loss in the 500-3000-Hz range, confirmed by audiogram, that occurred after ingestion of vardenafil. The patient was hospitalized 2 days later for administration of intravenous dexamethasone, followed by oral prednisone. He reported that his hearing had improved on the fourth hospital day and was discharged 3 days later, continuing to taper the prednisone on an outpatient basis. A repeat audiogram after 10 days of corticosteroid therapy confirmed that his hearing in the 500-3000-Hz range was within normal limits. Use of the Naranjo adverse drug reaction probability scale indicated a possible (score of 3) adverse reaction of sudden sensorineural hearing loss associated with vardenafil consumption. We also performed an analysis of hearing loss cases related to PDE-5 inhibitors in the United States Food and Drug Administration's Adverse Event Reporting System database to compare the characteristics of our patient with those of other reported adverse event cases. Based on the temporal relation of the sudden sensorineural hearing loss to this patient's drug consumption, we propose that the vardenafil is a likely cause of the hearing loss. This case provides further evidence that PDE-5 inhibitor consumption should be considered as a possible cause in patients presenting with sudden sensorineural hearing loss.

Post-stroke recovery of high-level cognitive function.

This research explored the post-stroke cognitive ability of a 52-year male, KM, who suffered a left middle cerebral artery stroke. KM received no rehabilitation post-stroke, as clinic assessments suggested that mental functioning had returned to an acceptable level. However, KM believed that his cognitive ability had not returned to pre-stroke levels. Comparisons with pre-stroke data from an unrelated study and additional testing using sensitive cognitive measures supported his observations. This research concludes that patient observations and more sensitive testing of post-stroke cognitive functioning may reveal additional high-level cognitive deficits.

An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder.

OBJECTIVE: To evaluate effectiveness of the Adolescent Coping With Depression (CWD-A) course, a cognitive-behavioral group intervention for depressed adolescents with comorbid conduct disorder. METHOD: Between 1998 and 2001, 93 nonincarcerated adolescents (ages 13-17 years) meeting criteria for major depressive disorder and conduct disorder were recruited from a county juvenile justice department and randomly assigned to the CWD-A or a life skills/tutoring control condition. Participants were assessed post-treatment and at 6- and 12-month follow-up. Dichotomous outcomes were analyzed with logistic regression; dimensional measures were analyzed using random effects regression. RESULTS: Major depressive disorder recovery rates post-treatment were greater in CWD-A (39%) compared with life skills/tutoring control (19%) (odds ratio 2.66, 95% confidence interval = 1.03-6.85). CWD-A participants reported greater reductions in Beck Depression Inventory-II (r2 = 0.055, p =.033) and Hamilton Depression Rating Scale (r2 = 0.047, p =.039) scores and improved social functioning (r2 = 0.064, p =.019) post-treatment. Group differences in major depressive disorder recovery rates at 6- and 12-month follow-up were nonsignificant, as were differences in conduct disorder both post-treatment and during follow-up. CONCLUSIONS: This is the first randomized, controlled trial of a psychosocial intervention with adolescents with major depressive disorder and conduct disorder. Although the CWD-A appears to be an effective acute treatment for depression in adolescents with multiple disorders, findings emphasize the need to improve long-term outcomes for depressed adolescents with psychiatric comorbidity and imply that interventions for comorbid populations focus directly on each specific disorder.

Pilot evaluation of the Coping Course: a cognitive-behavioral intervention to enhance coping skills in incarcerated youth.

OBJECTIVE: To describe the development and initial evaluation of the Coping Course, a cognitive-behavioral group intervention designed to enhance general coping and problem-solving skills among incarcerated youth. METHOD: Between 2001 and 2002, 76 male adolescents incarcerated at a youth correctional facility were assessed by questionnaire and randomly assigned to either the Coping Course (n = 46) or usual care (n = 30). Participants repeated the questionnaire after completion of the intervention. A second correctional facility served as an additional source of control group data (n = 62). RESULTS: Significant condition x time effects were present for seven of the examined measures: Youth Self-Report externalizing scores, three measures from the Life Attitudes Scale, self-esteem, one measure of social adjustment, and cognitive-behavioral therapy knowledge. Age and race/ethnicity did not moderate effects. Comparing control group participants with youth at a separate correctional facility who did not receive the Coping Course indicated that change was uniquely associated with participation in the intervention. CONCLUSIONS: Our goal was to take an efficacious adolescent depression group intervention and modify it for use with youth in correctional facilities. Preliminary findings are promising and provide evidence for future research of cognitive-behavioral group treatments with incarcerated youth.