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icterus-not-icarus · 1 hour ago

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there’s absolutely something to be said about ‘booktok’ books being largely wattpad quality written erotica i’m certainly not reading them however having seen a guy on tiktok make a video like ‘all the women in your life are READING PORN’ about a book he picked up and read in his FEMALE FRIEND’S HOUSE in a tone of scandalised horror and disgust i actually don’t think men should be making those criticisms. he said he picked it up expecting a romance and was horrified it was GOONER SHIT he said specifically like ‘who are you getting your pussy wet FOR??’ in a tone of revulsion. idk man im not sure shes the weird one. i kind of wish you were dead

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icterus-not-icarus · 20 hours ago

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Sometimes your bestie is blue, owns cows & casually reveals that he created the universe.

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icterus-not-icarus · 20 hours ago

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Pathophysiology – Meniere disease (MD), characterized by the classic triad of symptoms (episodic vertigo, tinnitus, and hearing loss), is likely caused by endolymphatic hydrops of the labyrinthine system of the inner ear (figure 1).

●Clinical presentation – The course of MD is variable. Some patients experience progressive hearing loss with infrequent vestibular symptoms; some have severe and frequent vertigo with only mild auditory symptoms; and some manifest both auditory and vestibular symptoms in equal measure. Most patients tend to cycle from active symptoms to prolonged remissions.

●Diagnostic criteria – A clinical diagnosis of MD is made based upon the following criteria:

•Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours

•Audiometrically documented low- to mid-frequency sensorineural hearing loss in the affected ear

•Fluctuating aural symptoms (reduced or distorted hearing, tinnitus, or fullness) in the affected ear

•Symptoms not better accounted for by another vestibular diagnosis

Although audiometric testing is a required part of the diagnostic evaluation, there is no specific diagnostic test for MD. Imaging, although not required for diagnosis of MD, is frequently performed to exclude important disorders that can present with similar symptoms.

●Differential diagnosis – A variety of other conditions can present with symptoms similar to MD and are often considered in the differential diagnosis. The conditions include vestibular migraine, vestibular schwannoma, multiple sclerosis (MS), transient ischemic attacks (TIAs), benign paroxysmal positional vertigo, and Cogan syndrome (table 2).

●Dietary and lifestyle modifications for all patients – As initial therapy for all patients with MD, we suggest lifestyle modification, including salt restriction, and limiting caffeine and alcohol consumption (to a maximum of one of each beverage daily) (Grade 2C). If other triggers are identified (eg, nicotine, stress, monosodium glutamate [MSG]), these should also be avoided. Dietary and lifestyle modifications should be continued indefinitely.

●Vestibular rehabilitation for persistent disequilibrium – For patients with MD and persistent disequilibrium symptoms between attacks, we suggest referral for vestibular rehabilitation therapy (Grade 2C). Although vestibular rehabilitation does not reduce the frequency of vertigo attacks, the exercise activities maximize balance and central nervous system (CNS) compensation for disequilibrium symptoms. Vestibular rehabilitation has no role in the treatment of acute vertigo due to MD.

●Pharmacotherapy for refractory symptoms – For all patients with MD with refractory symptoms and poor quality of life despite dietary and lifestyle interventions, we suggest the use of pharmacotherapy rather than no pharmacotherapy (Grade 2C). Betahistine and diuretics are the two options for pharmacologic therapy to reduce the severity and intensity of MD attacks. We suggest treatment with betahistine rather than diuretics, when available (Grade 2C). Betahistine is well tolerated and, unlike diuretics, does not require monitoring of adverse effects such as hypotension, altered kidney function, and electrolyte abnormalities.

For patients who respond to treatment with betahistine or a diuretic, treatment is continued for approximately six months; if symptoms remain well controlled, the medication can be tapered (for betahistine) and discontinued. Pharmacotherapy can be resumed if troublesome symptoms recur.

Acute episodes of vertigo should be managed with vestibular suppressants and antiemetics if necessary (table 3).

●Glucocorticoid therapy (systemic or intratympanic) for persistent symptoms – Among all patients with refractory symptoms severe enough to require further treatment beyond dietary changes, lifestyle adjustment, and first-line pharmacotherapy, there is no widely accepted agreement upon which treatment is preferred. However, we suggest treatment with glucocorticoids rather than other therapies for these patients (Grade 2C).

•For the majority of patients with MD and refractory, disabling vertigo symptoms despite first-line treatments, we treat with a limited course of oral glucocorticoids.

•For patients with MD with disabling vertigo symptoms despite first-line treatments, and in whom oral glucocorticoid therapy is contraindicated, or who through shared decision-making prefer intratympanic therapy, we offer treatment with intratympanic glucocorticoids.

●Additional treatment options for patients refractory to glucocorticoid therapy – For patients with refractory MD symptoms and continued poor quality of life despite treatment with glucocorticoids (systemic or intratympanic), we offer additional treatments. We generally use the degree of labyrinthine function (severity of vertigo attacks and the degree of disequilibrium between attacks) and the level of hearing loss to determine the most appropriate management for an individual patient.

•For MD patients with preserved hearing, we offer treatment with endolymphatic sac procedures (including decompression and/or shunting) or sacculotomy; if this is unsuccessful, we typically then offer treatment with intratympanic gentamycin.

•For patients with MD with complete hearing loss in the affected ear, we suggest treatment with IT gentamycin rather than labyrinthectomy (Grade 2C). Labyrinthectomy is generally reserved for those patients who have disabling symptoms that persist despite treatment with IT gentamicin.

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