Hearing and Vestibular Loss with Misuse of Opioids and Illicit Drugs: A Review of the Literature

Background: The purpose of this review was to summarize the literature regarding the effects of opioids and illicit drugs on the auditory and vestibular systems. Methods: Data were sourced from published papers reporting hearing loss (HL) and/or vestibular loss (VL) following misuse or overdose of opioids or illicit drugs. Most papers consisted of retrospective single-case reports, with few retrospective reviews or prospective cohort studies. Search terms included variations of HL, VL, opioids, and illicit drugs. Search results yielded 51 articles published between 1976 and 2021. A total of 44 articles were reviewed after excluding studies that were not available in English (n = 3), only described acute effects in healthy cohorts (n = 3) or only described general health aspects in a group on methadone maintenance (n = 1). Results: Sixteen studies reported ototoxicity from illicit drugs, 27 from prescription opioids, and 1 was unspecified. This review shows that HL associated with amphetamines and cocaine was typically sudden, bilateral, and temporary. HL from cocaine/ crack and heroin often presented with greatest losses in the mid-frequency range. HL associated with opioids was typically sudden, bilateral, moderately severe to profound, and in most cases permanent. The literature is sparse regarding VL from illicit drugs and opioids. Conclusion: Practitioners who see patients for sudden or rapidly progressive HL or VL with no apparent cause should inquire about misuse of illicit drugs and opioids, particularly when the HL does not respond to steroid treatment

A lifecourse approach in examining the association between accumulation of adversity and mental health in older adulthood

BACKGROUND: There is evidence for a cumulative effect of adversities on mental health, however, less is known on the accumulating duration of exposure to adversity across the lifecourse on mental health in older adults. METHODS: Using data from the 1946 British birth cohort study (N = 2745), we examined associations between the accumulation of adversity (birth-63 years) and mental health (emotional symptom, life satisfaction, affective wellbeing) in older adults (63-69 years). Accumulation of adversity was assessed as the number of adversities and duration of exposure (number of lifecourse stages exposed to any, economic, psychosocial, or physical adversity). Linear regression tested their association with mental health, adjusted for sex, childhood cognition and emotional problems, and educational attainment. RESULTS: Increased number of adversities was associated with increased emotional symptoms (β = 0.08 [0.06, 0.10]), decreased life satisfaction (β = -0.14 [-0.16, -0.12]) and decreased affective wellbeing (β = -0.08 [-0.10, -0.06]). Each additional duration of exposure was associated with a 0.38 [0.12, 0.65] standard deviation (SD) increase in emotional symptoms, and a - 0.68 [-0.96, -0.39] and -0.43 SD [-0.68, -0.18] decrease in life satisfaction and affective wellbeing, respectively. Life satisfaction showed stronger associations with economic and psychosocial compared to physical adversity. LIMITATIONS: Some limitations include selective drop-out and lack of ethnic diversity. CONCLUSIONS: Efforts to improve mental health in older adults should focus on reducing the number of adversities, as well as considering previous exposure across different lifecourse stages, to prevent adversities from becoming chronic. Future research should also consider the clustering and co-occurrence of different adversities across the lifecourse

Seasonal variation of hip fractures in patients with Benign Paroxysmal Positional Vertigo

Introduction: Seasonal variation of benign paroxysmal positional vertigo (BPPV) presentation has been reported, with higher rates of presentation in months associated with times of lower serum vitamin D levels. The purpose of this study was to examine the association between the timing of hip fracture in patients with BPPV. Methods: A retrospective review (2013 to 2019) of adult patients was performed at a tertiary care academic center to identify patients with hip fracture due to ground level fall (ICD-10 code S72) and a previously established diagnosis of vestibular disorder (ICD-10 codes H81-83, A88.1, and R42). Included patients were matched by age and sex to control for patients who had hip fracture without a vestibular diagnosis. Patient charts were reviewed, and demographic and clinical data were extracted related to hip fracture and prior vestibular diagnosis. Groups were subdivided based on whether patients had a hip fracture from January to June versus July to December. Fisher’s exact test was used to evaluate for a difference in seasonal variation between groups. Results: There were 201 patients with vestibular disorders of whom 27 patients carried the diagnosis of BPPV, with a mean age of 80.4 years. The rates of hip fracture among patients with BPPV was higher in the period extending from January to June (63.0%) versus July to December (37.0%), [odds ratio 1.59, 95% CI 0.66-4.00]. The rate of hip fracture was not significantly different between these time periods for the control group (51.7% versus 48.3%) or the vestibular group (53.2% versus 46.8%). Conclusion: These results offer preliminary evidence that, in addition to an increased presentation for BPPV during months associated with decreased serum vitamin D, injuries due to BPPV may be increased as well. The present study is limited by the statistical power afforded by the small number of patients with BPPV and hip fracture that were identified

Sex differences in experiences of multiple traumas and mental health problems in the UK Biobank cohort

PurposeExperiences of reported trauma are common and are associated with a range of mental health problems. Sex differences in how reported traumas are experienced over the life course in relation to mental health require further exploration. Methods157,358 participants contributed data for the UK Biobank Mental Health Questionnaire (MHQ). Stratified Latent Class Analysis (LCA) was used to analyse combinations of reported traumatic experiences in males and females separately, and associations with mental health. ResultsIn females, five trauma classes were identified: a low-risk class (58.6%), a childhood trauma class (13.5%), an intimate partner violence class (12.9%), a sexual violence class (9.1%), and a high-risk class (5.9%). In males, a three-class solution was preferred: a low-risk class (72.6%), a physical and emotional trauma class (21.9%), and a sexual violence class (5.5%). In comparison to the low-risk class in each sex, all trauma classes were associated with increased odds of current depression, anxiety, and hazardous/harmful alcohol use after adjustment for covariates. The high-risk class in females and the sexual violence class in males produced significantly increased odds for recent psychotic experiences. ConclusionThere are sex differences in how reported traumatic experiences co-occur across a lifespan, with females at the greatest risk. However, reporting either sexual violence or multiple types of trauma was associated with increased odds of mental health problems for both males and females. Findings emphasise the public mental health importance of identifying and responding to both men and women’s experiences of trauma, including sexual violence

The influence of obesity on operating room time and perioperative complications in cochlear implantation

Objective: The rising incidence of obesity in the United States is associated with increased healthcare expenditures and resource allocation. Obesity has been associated with prolonged operating times during surgical procedures. The primary objective of this study is to compare body mass index (BMI) to length of surgery during cochlear implantation. Methods: A retrospective case control study from a tertiary academic referral center was performed. Patients included were adults who underwent primary, single-sided cochlear implantation with documented BMI and operating room (OR) times from January 2009 to July 2015. The following data were collected: BMI, total operating room time (TORT), surgical operating room time (SORT), ASA status, perioperative and postoperative complications, age, and gender. Results: Two hundreds and thirty-four patients were included and stratified into obese (BMI >30) and non-obese (BMI < 30) categories. Statistical analysis was performed comparing TORT against the obesity category along with other variables. Independent sample t-test demonstrated that obesity increases TORT and SORT by 16.8 min (P = 0.0002) and 9.3 min (P = 0.03), respectively, compared to the non-obese group. Multivariate linear regression analysis demonstrated no statistically significant impact of gender, or ASA status on total operating or surgical time. Obesity was associated with increased perioperative complications (odds ratio [OR], 6.21; 95% CI, 1.18–32.80; P = 0.03) and postoperative complications (OR, 3.97; 95% CI, 1.29–12.26; P = 0.02). Conclusions: Obesity leads to longer TORT and SORT during primary cochlear implant surgery. Obesity is also associated with increased perioperative and postoperative complications compared to non-obese patients. These data have implications with utilization of operating room resources. Keywords: Cochlear implant, Body mass index, Operating time, Perioperative complication

The management of fluid and wave resistances by whirligig beetles

Whirligig beetles (Coleoptera: Gyrinidae) are semi-aquatic insects with a morphology and propulsion system highly adapted to their life at the air–water interface. When swimming on the water surface, beetles are subject to both fluid resistance and wave resistance