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We live get kamagra online in unprecedented times. But what makes them without parallel is not the current kamagra crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for the get kamagra online first time, the problems of accessibility, rights and freedoms are now invading privileged spaces.

There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals. For many, the world is not suddenly on fire. €¦IntroductionMinecraft is a computer game with get kamagra online no specific goals to accomplish.

The gameworld consists of three-dimensional (3D) cubes and objects which the player (Steve) can mine and build into infinitely complex (and logically impossible) structures. Steve sometimes encounters other characters (‘mobs’), such as animals and get kamagra online hostile creatures. He can ‘spawn’ and destroy them.

While it looks like a harmless game of logical construction, it conveys some worryingly delusive ideas about the real world. The difference between real and imagined structures is at the heart of the age-old debate around categorising mental disorders.Classification in mental health has had get kamagra online various forms throughout history. Mack and colleagues set out a history of psychiatric classification beginning in 2600 BC with Egyptian references to melancholia and hysteria.

Through the Ancient Greeks with get kamagra online Hippocrates’ phrenitis, mania, melancholia, epilepsy, hysteria and Scythian disease. Through the Renaissance period. Through to 19th-century psychiatry featuring Pinel (known as the first psychiatrist), Kraepelin (known for observational classification) and Freud (known for classifying neurosis and psychosis).1Although the history of psychiatric classification identifies some common trends such as the labels ‘melancholia’ and ‘hysteria’ which have survived millennia, the label ‘depression’ is relatively new.

The earliest usage noted by Snaith is get kamagra online from 1899. €˜in simple pathological depression…the patient exhibits a growing indifference to his former pursuits…’.2 Snaith noted that early 20th-century psychiatrists like Adolf Meyer hoped that ‘depression’ would come to encompass a broad category under which descriptions of subtypes would emerge. This did not happen until the middle of get kamagra online the 20th century.

With the publication of the sixth International Classification of Diseases (ICD) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and their subsequent revisions, the latter half of the 20th century has seen depression subtype labels proliferate. In their study of the social determinants of diagnostic labels in depression, McPherson and Armstrong illustrate how the codification of depression subtypes in the latter half of the 20th century has been shaped by the evolving context of psychiatry, including power struggles within the profession, a move to community care and the development of psychopharmacology.3During this period, McPherson and Armstrong describe how subsequent versions of the DSM served as battlegrounds for professional disputes and philosophical quarrels around categorisation of mental disorders. DSM I and DSM II have been described as products of an American Psychiatric get kamagra online Association dominated by psychoanalytic psychiatrists.4 DSM III and DSM III-R have been described as a radical rejection of psychoanalytic thinking, a ‘neo-Kraepelinian revolution’, a reference to the observational descriptive techniques of 19th-century psychiatrist Emil Kraepelin who classified mental disorders into two broad categories.

€˜dementia praecox’ and ‘manic-depression’.5 DSM III was seen by some as a turning point in the use of the medical model of mental illness, through provision of specific inclusion and exclusion criteria, and use of field trials and a multiaxial system.6 These latter technocratic additions to psychiatric labelling served to engender a much closer alignment between psychiatry, science and medicine.The codification of mental disorders in manuals has been described by Thomas Schacht as intrinsic to the relationship between science and politics and the way in which psychiatrists gain significant social power by aligning themselves to science.7 His argument drew on Szasz, who saw the mental health establishment as a therapeutic state. Zimbardo, who described get kamagra online psychiatric care as a controlling force. And Foucault, who described the categorisation of the mentally ill as a force for isolating ‘the other’.

Diagnostic critique has been further developed through a cultural relativist lens in that what Western psychiatrists classify as a depression is constructed differently in other cultures.8 Considering these limitations, some critics have gone so far as to argue that psychiatric diagnostic systems should be abolished.9Yet architects of DSM manuals have worked hard to ensure the technology of classification is regarded as genuine scientific activity with sound roots in philosophy of science. In their philosophical defence of DSM IV, Allen Frances and colleagues address their critics under the headings ‘nominalism vs realism’, ‘empiricism vs rationalism’ and ‘categorical vs dimensional’.10 The implication is that there are opposing stances in which a choice must be made or a middle ground forged by those reasonable enough to recognise the need for pragmatism in the service of clinical get kamagra online utility. The nominalism–realism debate is illustrated using as metaphor three different stances a cricket umpire might take on calling strikes and balls.

The discussion sets out two get kamagra online of these as extreme views. €˜at one extreme…those who take a reductionistically realistic view of the world’ versus ‘the solipsistic nominalists…might content that nothing exists’. Szasz, who is characterised as holding particularly extreme views, is named as an archetypal solipsist.

There is get kamagra online implied to be a degree of arrogance associated with this view in the illustrative example in which the umpire states ‘there are no balls and there are no strikes until I call them’. Frances therefore sets up a means of grouping two kinds of people as philosophical extremists who can be dismissed, while avoiding addressing the philosophical problems they pose.Frances provides little if any justification for the middle ground stance, ‘There are balls and there are strikes and I call them as I see them’, other than to focus on its clinical utility and the lack of clinical utility in the alternatives ‘naïve realism’ and ‘heuristically barren solipsism’. The natural conclusion the reader is invited to reach is that a middle ground of a heuristic concept is naturally right because it is not extreme and is naturally useful clinically, without specifying in what way this stance is coherent, resolves the two alternatives, and in what way a heuristic construct that is get kamagra online not ‘real’ can be subject to scientific testing.Similarly, in discussing the ‘categorical vs dimensional’, Frances promotes the ‘prototype approach’.

Those holding opposing views are labelled as ‘dualists’ or ‘dichotomisers’. The prototypical approach is again put forward as a clinically useful middle ground. Illustrations are get kamagra online drawn from natural science.

€˜a triangle and a square are never the same’, inciting the reader to consider science as value-free. The prototypical approach emerges as a natural solution, yet the authors do not address how get kamagra online a diagnostic prototype resolves the issues posed by the two alternatives, nor how a prototype can be subjected to natural science methods.The argument presented here is not a defence of solipsism or dualism. Rather it aims to illustrate that if for pragmatic purposes clinicians and policymakers choose to gloss over the philosophical flaws in classification practices, it is then risky to move beyond the heuristic and apply natural science methods to these constructs adding multiple layers of technocratic subclassification.

Doing so is more like playing Minecraft than cricket. The National Institute for Health and Care Excellence (NICE) guideline for depression is taken as an example of the philosophical errors that can follow from get kamagra online playing Minecraft with unsound heuristic devices, specifically subcategories of persistent forms of depression. As well as serving a clinical purpose, diagnosis in medicine is a way of allocating resources for insurance companies and constructing clinical guidelines, which in turn determine rationing within the National Health Service.

The consequences get kamagra online for recipients of healthcare are therefore significant. Clinical utility is arguably not being served at all and patients are left at risk of poor-quality care.Heterogeneity of persistent depressionAndrea Jobst and colleagues note that ‘because of their chronic clinical course, approximately 40% of CD [chronic depression] patients also fulfil criteria for TRD [treatment resistant depression]…usually defined by the number of non-successful biological treatments’.11 This position is reflected in the DSM VAmerican Psychiatric Association (2013), the European Psychiatric Association (EPA) guidance and the ICD-11(World Health Organisation, 2018), which all use a ‘persistent’ depression category, acknowledging a loosely defined mixed group of long-term, difficult-to-treat depressive conditions, often associated with dysthymia and comorbid common mental disorders, various personality traits and psychosocial disability.In contrast, the NICE 2018 draft guideline separates treatments into those for ‘new episodes’ of depression. €˜further-line’ treatment of depression (equivalent to TRD), CD and ‘depression with co-morbidities’.

The latter is subdivided get kamagra online into treatments for ‘complex depression’ and ‘psychotic depression’. These categories and subcategories introduce an unfortunate sense of certainty as though these labels represent real things. An analysis follows get kamagra online of how these definitions play out in terms of grouping of randomised controlled trials in the NICE evidence review.

Specifically, the analysis reveals the overlap between populations in trials which have been separated into discrete categories, revealing significant limitations to the utility of the category labels.The NICE definition of CD requires trial samples to meet the criteria for major depressive disorder (MDD) for 2 years. Dysthymia and double depression (MDD superimposed on dysthymia) were included. If 75% of the trial population met these criteria, the trial was reviewed in the CD category.12 The definition of TRD (or get kamagra online ‘further-line treatments’) required that the trial sample had demonstrated a ‘limited response to previous treatment’ and randomised to the further-line treatment at this point.

If 80% of the trial participants met these criteria, it was reviewed in the TRD category.13 Complex depression was defined as ‘depression co-existing with personality disorder’. To be classed as complex, 51% of trial participants had to have personality disorder (PD).14It is immediately clear from these definitions that there is a potential problem with attempting to categorise trial populations into just one of these get kamagra online categories. These populations are likely to overlap, whether or not a trial protocol sets out to explicitly record all of this information.

The analysis below will illustrate this using examples from within the NICE review.Cataloguing complexity in trial populationsWithin the category of further-line treatments (TRD), 64 trials were reviewed. Comparisons within these trials were further subcategorised into ‘dose escalation strategies’, get kamagra online ‘augmentation strategies’ and ‘switching strategies’. In drilling down by way of illustration, this analysis considers the 51 trials in the augmentation strategy evidence review.

Of these, two were classified by the reviewers as also fulfilling the criteria for CD but were not analysed in the CD category (Study IDs. Fonagy 2015 and get kamagra online Kocsis 200915). About half of the trials (23/51) did not report the mean duration of episode, meaning that it is not possible to know what percentage of participants also met the criteria for CD.

Of trials that did report episode duration, 17 reported a mean duration longer than 24 months get kamagra online. While the standard deviations varied in size or were unreported, the mean indicates a good likelihood that a significant proportion of the participants across these 51 trials met the criteria for CD.Details of baseline employment, trauma history, suicidality, physical comorbidity, axis I comorbidity and PD (all clinical indicators of complexity, severity and chronicity) were not collated by NICE. For the present analysis, all 51 publications were examined and data compiled concerning clinical complexity in the trial populations.

Only 14 of 51 trials report get kamagra online employment data. Of those that do, unemployment ranges from 12% to 56% across trial samples. None of the trials get kamagra online report trauma history.

About half of the trials (26/51) excluded people who were considered a suicide risk. The others did not.A large proportion of trials (30/51) did not provide any data on axis 1 comorbidity. Of these, 18 did not exclude any diagnoses, while 12 excluded some (but not all) disorders get kamagra online.

The most common diagnoses excluded were psychotic disorders, substance or alcohol abuse, and bipolar disorder (excluded in 26, 25 and 23 trials, respectively). Only 7 of 51 trials clearly stated that all axis 1 diagnoses were excluded get kamagra online. This leaves only 13 studies providing any data about comorbidity.

Of these, 9 gave partial data on one or two conditions, while 4 reported either the mean number of disorders (range 1.96–2.9) or the percentage of participants (range 68.1–96.7) with any comorbid diagnosis (Nierenberg 2003a, Nierenberg 2006, Watkins 2011a, Town 201715).The majority of trials (46/51) did not report the prevalence of PD. Many stated PD as an exclusion criterion but without defining a get kamagra online threshold for exclusion. For example, PD could be excluded if it ‘impacted’ the depression, if it was ‘significant’, ‘severe’ or ‘persistent’.

Some excluded certain PDs (such as antisocial or borderline) and not others but without reporting the get kamagra online prevalence of those not excluded. In the five trials where prevalence was clear, prevalence ranged from 0% (Ravindran 2008a15), where all PDs were excluded, to 87.5% of the sample (Town 201715). Two studies reported the mean number of PDs.

2.0 (Nierenberg get kamagra online 2003a) and 0.85 (Watkins 2011a15).The majority of trials (43/51) did not report the prevalence of physical illness. Many stated illness as an exclusion criterion, but the definitions and thresholds were vague and could be interpreted in different ways. For example, illness could get kamagra online be excluded if it was ‘unstable’, ‘serious’, ‘significant’, ‘relevant’, or would ‘contraindicate’ or ‘impact’ the medication.

Of the eight trials reporting information about physical health, there was a wide variation. Four reported prevalence varying from 7.6% having a disability (Eisendrath 201615) to 90.9% having an illness or disability (Town 201715). Four used scales of physical get kamagra online health.

Two indicating mild problems (Nierenberg 2006, Lavretsky 201115) and two indicating moderately high levels of illness (Thase 2007, Fang 201015).The NICE review also divided trial populations into a dichotomy of ‘more severe’ and ‘less severe’ on the grounds that this would be a clinically useful classification for general practitioners. NICE applied a bespoke methodology for creating this dichotomy, abandoning validated measure thresholds in order first to generate two ‘homogeneous’ groups to ‘facilitate get kamagra online analysis’, and second to create an algorithm to ‘read across’ different measures (such as the Beck Depression Inventory, the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale).16 Examining trials which use more than one of these measures reveals problems in the algorithm. Of the 51 trials, there are 6 instances in which the study population falls into NICE’s more severe category according to one measure and into the less severe category according to another.

In four of these trials, NICE chose the less severe category (Souza 2016, Watkins 2011a, Fonagy 2015, Town 201715). The other two trials were designated more severe (Barbee 2011, get kamagra online Dunner 200715). Only 17 of 51 trials reported two or more depression scale measures, leaving much unknown about whether other study populations could count as both more severe and less severe.Absence of knowledge or knowledge of absence?.

A key philosophical error in science get kamagra online is to confuse an absence of knowledge with knowledge of absence. It is likely that some of the study populations deemed lacking in complexity or severity could actually have high degrees of complexity and/or severity. Data to demonstrate this may either fall foul of a guideline committee decision to prioritise certain information over other conflicting information (as in the severity algorithm).

The information may be non-existent as it was not get kamagra online collected. It may be somewhere in the publication pipeline. Or it may be sitting in a database with a research team that has run out of funds for supplementary get kamagra online analyses.

Wherever those data are or are not, their absence from published articles does not define the phenomenology of depression for the patients who took part. As a case in point, data from the Fonagy 2015 trial presented at conferences but not published reveal that PD prevalence data would place the trial well within the NICE complex depression category, and that the sample had high levels of past trauma and physical condition comorbidity. The trial also meets the guideline criteria for CD according to the guideline’s own appendices.17 Reported axis 1 comorbidity was high (75.2% had anxiety disorder, 18.6% had substance abuse disorder, 13.2% had eating disorder).18 The mean depression get kamagra online scores at baseline were 36.5 on the Beck Depression Inventory and 20.1 on the HRSD (severe and very severe, respectively, according to published cut-off scores).

NICE categorised this population as less severe TRD, not CD and not complex.Notes1. Avram H get kamagra online. Mack et al.

(1994), “A Brief History of Psychiatric Classification. From the Ancients to DSM-IV,” Psychiatric get kamagra online Clinics 17, no. 3.

Snaith (1987), “The Concepts of Mild Depression,” British Journal of Psychiatry 150, no. 3. 387.3.

Susan McPherson and David Armstrong (2006), “Social Determinants of Diagnostic Labels in Depression,” Social Science &. Medicine 62, no. 1.

52–7.4. Gerald N. Grob (1991), “Origins of DSM-I.

A Study in Appearance and Reality,” The American Journal of Psychiatry. 421–31.5. Wilson M.

Compton and Samuel B. Guze (1995), “The Neo-Kraepelinian Revolution in Psychiatric Diagnosis,” European Archives of Psychiatry and Clinical Neuroscience 245, no. 4.

198–9.6. Gerald L. Klerman (1984), “A Debate on DSM-III.

The Advantages of DSM-III,” The American Journal of Psychiatry. 539–42.7. Thomas E.

Schacht (1985), “DSM-III and the Politics of Truth,” American Psychologist. 513–5.8. Daniel F.

Hartner and Kari L. Theurer (2018), “Psychiatry Should Not Seek Mechanisms of Disorder,” Journal of Theoretical and Philosophical Psychology 38, no. 4.

189–204.9. Sami Timimi (2014), “No More Psychiatric Labels. Why Formal Psychiatric Diagnostic Systems Should Be Abolished,” Journal of Clinical and Health Psychology 14, no.

(1994), “DSM-IV Meets Philosophy,” The Journal of Medicine and Philosophy. A Forum for Bioethics and Philosophy of Medicine 19, no. 3.

207–18.11. Andrea Jobst et al. (2016), “European Psychiatric Association Guidance on Psychotherapy in Chronic Depression Across Europe,” European Psychiatry 33.

20.12. National Institute for Health and Care Excellence (2018), Depression in Adults. Treatment and Management.

Draft for Consultation, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/full-guideline-updated, 507.13. Ibid., 351–62.14. Ibid., 597.15.

Note that in order to refer to specific trials reviewed in the guideline, rather than the full citation, the Study IDs from column A in appendix J5 have been used. See www.nice.org.uk/guidance/gid-cgwave0725/documents/addendum-appendix-9 for details and full references.16. National Institute for Health and Care Excellence (2018), Depression in Adults.

Treatment and Management. Second Consultation on Draft Guideline – Stakeholder Comments Table, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/consultation-comments-and-responses-2, 420–1.17. National Institute for Health and Care Excellence (2018), Depression in Adults, appendix J5.18.

Peter Fonagy et al. (2015), “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression. The Tavistock Adult Depression Study (TADS),” World Psychiatry 14, no.

3. 312–21.19. American Psychological Association (2018), Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults.

Draft.20. Jacqui Thornton (2018), “Depression in Adults. Campaigners and Doctors Demand Full Revision of NICE Guidance,” BMJ 361.

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Binary gender policies may worsen inequalities and marginalisation of transgender subjects potentially increasing the risk of morbidity and mortality.As with the general population, during the lockdown, the Internet and social media were useful in reducing isolation and, in this particular population, were also relevant for keeping in touch with associations and healthcare facilities with the support of telemedicine services.4 Addressing the role of the telemedicine in the transpopulation, between May and June 2020 we conducted an anonymous web-based survey among transgenders living in Italy (ClinicalTrials.gov Identifier NCT04448418). Among the 108 respondents, with a mean age of 34.3±11.7 years, 73.1% were transmen and 26.9% transwomen where to buy kamagra online and 88.9% were undergoing gender-affirming hormonal treatment (GAHT). One in four subjects (24.1%) presented a moderate-to-severe impact where to buy kamagra online of the kamagra event (Impact of Event Scale score ≥26). The availability of telematic endocrinological visit was associated with better Mental Health Scores in the 12-items Short Form Health Survey(SF-12) (p=0.030) and better IES (p=0.006).Our survey suggests a positive where to buy kamagra online effect of telemedicine as the availability of telematic endocrinological consultations may have relieved the distress caused by the kamagra by offering the opportunity to avoid halting GAHT.

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A new analysis of health insurers’ financial data suggests that they remained profitable across markets in 2020 due click for more in part to an unprecedented decrease in health spending and utilization in the spring as the erectile dysfunction treatment kamagra led to get kamagra online massive shutdowns.The analysis examines insurers’ 2020 data for four distinct markets. Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer). Across the four markets, insurers showed higher gross margins per enrollee per month in 2020 than the previous year, ranging from an average of $188 for Medicare Advantage plans to an average $71 for Medicaid managed care.

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If radiation is needed anywhere in the head and neck, it can potentially lead to two types of cheap kamagra uk next day delivery hearing loss. Conductive hearing loss, a type of hearing loss that happens when sound doesn’t make its way to the inner ear, may occur. This is due to the ear canal being narrowed, the eardrum thickening, or other ear changes caused by radiation, according to a 2019 article published in the Journal of Neurologic Surgery. A condition called otitis media with effusion (OME), where fluid collects in the middle ear, occurs in nearly half of people cheap kamagra uk next day delivery who have radiation therapy in the head and neck, per the article.

Sensorineural hearing loss, which arises with damage to the inner ear or auditory nerve, can also occur as a result of radiation. Higher doses of radiation are more likely to cause hearing loss, according to the journal article. People under age 3 and over age 50 are at a higher risk for this type of cheap kamagra uk next day delivery hearing loss, as are people being treated with the chemotherapy treatment cisplatin (more on that in a moment). This type of hearing loss is permanent.

Chemotherapy and hearing loss Chemotherapy refers to the use of powerful chemicals that are capable of killing cancer cells. In some cases, chemotherapy drugs can be cheap kamagra uk next day delivery "ototoxic," which means they are harmful to hearing. About half of all patients who receive the chemotherapy drug cisplatin develop hearing-related side effects including hearing loss, tinnitus and vertigo. This is known as ototoxicity.

Platinum-based chemotherapy (cisplatin) This is especially the case for chemotherapy known as platinum-based therapy (that is, chemo meds containing the element platinum) cheap kamagra uk next day delivery. The most ototoxic platinum-based chemotherapy is cisplatin, according to a review article in Cancer Chemotherapy and Pharmacology. This medication is used to treat bladder, testicular, and ovarian cancer, according to the National Cancer Center. "Not only hearing loss, but also tinnitus and imbalance are cheap kamagra uk next day delivery common in patients who receive platinum-based chemotherapy, and can cause debilitating effects upon quality of life," the review article states.

Hearing-related side effects to this medication appear fairly common. Permanent hearing loss occurs in about half of all patients who take cisplatin, ASHA notes. It usually causes high-frequency hearing cheap kamagra uk next day delivery loss. Scientists are still working to understand why cisplatin damages hearing—it may be because it easily enters the inner ear (while other drugs are blocked) but doesn’t seem to exit it, according to ASHA.

Once in the inner ear, the medications may cause damage to hair cells, which are vital to the hearing process. Other platinum-based chemotherapies that treat solid tumors, such as carboplatin and oxaliplatin, are less likely to damage hearing, although they can still cause issues cheap kamagra uk next day delivery. For instance, carboplatin can cause ringing in the ears (tinnitus), notes the Mayo Clinic. Other chemo drugs There are other chemotherapies that don’t fall into the platinum-based category that can still cause hearing problems or tinnitus.

They include cheap kamagra uk next day delivery vincristine, doxorubicin, gemcitabine, cyclophosphamide, oxaliplatin, and farmorubicin, notes a 2016 study published in the Brazilian Journal of Otorhinolaryngology. Radiation treatment combined with these ototoxic chemotherapy medications increases the risk for hearing-related issues. With higher doses of chemo meds, there’s a greater risk for hearing problems, according to CCS. Non-cancer drugs can also cause problems Keep in mind, other medications besides chemotherapy taken during cancer treatment—such as pain medications, anti-nausea meds, or antibiotics—can also lead to cheap kamagra uk next day delivery hearing problems.

There are at least 200 medications linked to hearing loss, including over-the-counter medications like aspirin. Hearing loss more likely among kids Seventy-five per cent of patients five years old and younger had cisplatin-related hearing loss three years after starting therapy, a 2021 University of British Columbia study shows. “Young children [are] particularly vulnerable to the ototoxic effects of cheap kamagra uk next day delivery cancer therapies,” affirms a 2016 review article in the journal Cancer. This is because the brain and ears are still forming in young childhood, the article notes.

Not only is hearing loss more common in children who take cisplatin, but it’s also more severe, per ASHA. Plus, even small amounts of hearing loss in high frequencies are a big deal to younger children acquiring cheap kamagra uk next day delivery language. How to weigh the risks Regular hearing check-ups are importantfor current and former cancer patients whoreceived treatment linked to hearing loss. Cancer is a life-threatening disease, which is why doctors use powerful treatment methods, despite the host of known side effects.

Knowing the potential risks is helpful, since it can help cheap kamagra uk next day delivery you assess if the risk is worth it to you personally. Talk to your doctor about the drug's side effects and if there are any alternatives. ASHA recommends following these steps if you are taking known ototoxic medications. Check cheap kamagra uk next day delivery your hearing.

Ideally, do this before the treatment to have a baseline record of your hearing. Track changes. An audiologist can help you cheap kamagra uk next day delivery monitor hearing and balance during treatment, so that you can catch any issues quickly—it’s not always possible, but you may be able to pause or switch treatments. Get check-ups.

Even after cancer treatment ends, it's a good idea to get regular hearing checkups, especially in pediatric cases. Can anything cheap kamagra uk next day delivery prevent treatment-related hearing loss?. Sometimes, an alternative therapy can be given if you're particularly concerned about hearing loss or tinnitus. It's very important to talk to your oncologist about the benefits and risks of the treatments you're receiving.

Researchers are also looking at "otoprotective agents"—drugs that cheap kamagra uk next day delivery can protect hearing when given as the same time as harmful drugs, according to Research Outreach. For instance, ASHA points out that administering sodium thiosulfate (which is typically used to treat cyanide poisoning) may limit hearing loss from cisplatin in children. The trick is figuring out how to give patients otoprotective medications while still allowing chemotherapy medications to be effective. Treating the hearing cheap kamagra uk next day delivery loss If you've received cancer treatment and have permanent hearing loss, it's important to see a hearing care provider for expert help.

You may be a good candidate for hearing aids, cochlear implants, or assistive listening devices. Treating hearing loss not only helps you hear better, it’s also linked health benefits, including a reduced risk of depression and injury-causing falls.Pause to think about it, and our body’s ability to translate noise into sound is incredible. €œIt's quite a complex and intricate system,” Omid Mehdizadeh, MD, an otolaryngologist (ENT) cheap kamagra uk next day delivery at Providence Saint John’s Health Center in Santa Monica, Calif., tells Healthy Hearing. But how exactly does this process unfold?.

We've put together a step-by-step explanation of how people hear—from the moment sound waves arrive to the outer ear, then travel through the middle and inner ear and transform into meaningful signals sent on to the brain. Our brain uses cheap kamagra uk next day delivery these signals to organize and communicate with the external world. How humans hear Step 1. Sound waves enter the ear.

When a cheap kamagra uk next day delivery sound occurs, it enters the outer ear, also referred to as the pinna or auricle. The pinna is the visible portion of your ear, and its funnel-like shape is well-engineered. As sound hits the pinna, it filters and amplifies sound waves, and chutes them along into the ear canal, Dr. Mehdizadeh says cheap kamagra uk next day delivery.

Next, sound waves hit the eardrum, or tympanic membrane, setting it in motion. €œThe eardrum is a paper-thin layer of a membrane that essentially vibrates as soon as sound waves hit it—very similar to a drum,” Dr. Mehdizadeh says. Step cheap kamagra uk next day delivery 2.

Sound moves through the middle ear Behind the eardrum is the middle ear. In this part of the ear's anatomy, sound waves are amplified before they are delivered to the inner ear. Here’s how that cheap kamagra uk next day delivery process unfurls. The eardrum is attached to a chain of three small bones, known as the ossicles.

These three bones are the smallest ones in your body. When the eardrum vibrates in response to sound waves, these bones are cheap kamagra uk next day delivery set into motion as well. The bone directly attached to the eardrum is the malleus (“the hammer”), which is connected at its other end to the incus (“the anvil”). The incus, in turn, is attached to the stapes (the “stirrup” or “footplate”).

The shapes of the ossicles provide inspiration for their cheap kamagra uk next day delivery nicknames. This last bone—the stapes—is connected to the oval window, which is a membrane separating the middle ear from the inner ear. The orientation of the three bones allows them to function as a lever, amplifying the sound energy as it moves from the relatively large tympanic membrane to the relatively small oval window. Step cheap kamagra uk next day delivery 3.

Sound moves through the inner ear (the cochlea) Vibrations from the stapes push on the oval window, and set up pressure waves in the fluid-filled cochlea, the snail-shaped inner ear that contains the organ of Corti. In the organ of Corti, vibrations are finally transformed into electrical energy by cells known as hair cells (stereocilia). The tiny hair cells lining the cochlea are stimulated by different cheap kamagra uk next day delivery frequencies. For example, many people with hearing loss have high-frequency hearing loss, making it harder to hear high-pitched sounds.

This means the hair cells responsible for detecting high frequencies are damaged. (While less common, some people have low-frequency hearing cheap kamagra uk next day delivery loss or mid-range hearing loss.) You’re born with about 16,000 of these hair cells, according to the Centers for Disease Control and Prevention (CDC). These hair cells translate the vibrations from sound waves into electrical impulses that then travel along a complex pathway of nerve fibers to the brain. Note.

Hair cells play a cheap kamagra uk next day delivery vital role in your hearing. They’re also quite fragile. Loud sounds can damage or even destroy them, and once they’re destroyed, they can’t be repaired—and you’ll feel the effects of noise-induced hearing loss. Blasting hair cells with noise is akin to trees in a hurricane, cheap kamagra uk next day delivery struggling to remain standing.

Step 4. Your brain interprets the signal. Once sound is converted to electrical signals cheap kamagra uk next day delivery in the cochlea, these signals travelvia a complex circuit of auditory nerve pathways to the auditory cortex and otherparts of the brain that regulate awareness and sensory perception. (Some of thesepathways shut down to let you sleep at night, for example, even if noise is present).

Sound processing likely occurs in both the cochlea and the brain, Dr. Mehdizadeh says cheap kamagra uk next day delivery. But most of the neurological processing of sound occurs in the brain, he says. Brain cells, known as sensory neurons, transmit the sound information to various areas of the brain, including the thalamus, temporal lobe, and auditory cortex, the National Institutes of Health explains.

These are known as cheap kamagra uk next day delivery the auditory pathways. The auditory pathways process and decode sounds, turning them into something meaningful, like a question, a honking horn, or music. They also help distinguish between nearby, important sounds and less vital background sounds, as well as processing the direction and location of sounds. Many parts of hearing work directly cheap kamagra uk next day delivery in concert with the vestibular, or balance system, which is located nearby, within the semicircular canals of the inner ear.

"There's many different centers in the brain that are interpreting and receiving sounds," Dr. Mehdizadeh says. How exactly your brain works when it comes to sound is still being cheap kamagra uk next day delivery explored by researchers. For example, tinnitus, or ringing in the ears, is still poorly understood, even as common as it is.

Common hearing disorders Given this elaborate, multi-step process that allows humans to hear, it’s no wonder that sometimes things go wrong along the way. Anything that obstructs the transmission of cheap kamagra uk next day delivery sound can lead to issues, Dr. Mehdizadeh says. Here, the types of hearing loss, and where the problem starts within the process.

Conductive hearing loss—this is defined as hearing loss due to sounds not making their way through the cheap kamagra uk next day delivery outer or middle ear, the CDC explains. This can happen due to a number of reasons, including a damaged eardrum, excessive earwax getting stuck in the ear canal, and ear s, according to the American Speech-Language-Hearing Association (ASHA). Medical or surgical treatments can sometimes resolve this type of hearing loss. Sensorineural hearing loss—the most common type of hearing loss, it occurs from damage to those tiny hair cells present in cheap kamagra uk next day delivery the inner ear, and/or to the auditory nerve.

Age-related hearing loss is sensorineural, as is noise-induced hearing loss. Diseases, head trauma, tumors, and certain drugs can also cause sensorineural hearing loss. Sensorineural hearing loss is permanent, and ranges in severity. Mixed hearing loss—as the name indicates, this type of hearing loss is a combination of conductive and sensorineural hearing loss.

It can occur over time, or due to sudden trauma. Auditory disorders—Several types of hearing loss occur within the auditory nerve and brain. People with this kind of hearing loss may not show any problems on standard hearing tests, but still feel like they can't hear. These conditions include auditory processing disorder, hidden hearing loss and auditory neuropathy spectrum disorders.

Essentially, sounds make their way to the inner ear successfully, but don’t transmit properly to the brain, according to the National Institute of Deafness and Other Communication Disorders (NIDCD). This may be due to damage to hair cells or neurons, or potentially to the auditory nerve, according to the NIDCD. Genes may play a role, too. How hearing aids can help—and their limits Hearing aids can be transformative for people with hearing loss.

Fundamentally, they allow you to hear—but hearing aids are associated with other benefits as well, such as overall better health and improved quality of life, reduced loneliness, and even decreased risk of falls. But ask any hearing expert and they’ll note that hearing aids are not like eyeglasses—that is, getting fitted for hearing aids will improve your hearing, but it won’t restore it to its original state, as slipping on eyeglasses does. “People think that ears are invincible,” Dr.

While sometimes these side effects are temporary and get better after treatment get kamagra online ends, often they’re permanent. If you’re about to undergo cancer treatment—or have a child in those circumstances—here’s what you need to know. Cancer treatment typically relies on a trio of treatment options. Radiation, surgery, and chemotherapy, often performed in conjunction—for get kamagra online instance, a person may have surgery followed by a course of radiation and chemotherapy. All three cancer treatment options have the potential to damage hearing, depending on the location of the cancer.

Surgery If you have a form of cancer that requires surgery in the brain, ear, or auditory nerve, hearing problems could occur, according to the Canadian Cancer Society (CCS). Removing a get kamagra online cancerous tumor, for instance, might cause damage to the ear. Radiation During radiation treatment, high-energy waves or particles are used to destroy or damage cancer cells. If radiation is needed anywhere in the head and neck, it can potentially lead to two types of hearing loss. Conductive hearing loss, a type of hearing get kamagra online loss that happens when sound doesn’t make its way to the inner ear, may occur.

This is due to the ear canal being narrowed, the eardrum thickening, or other ear changes caused by radiation, according to a 2019 article published in the Journal of Neurologic Surgery. A condition called otitis media with effusion (OME), where fluid collects in the middle ear, occurs in nearly half of people who have radiation therapy in the head and neck, per the article. Sensorineural hearing loss, which arises with damage to the inner ear or auditory get kamagra online nerve, can also occur as a result of radiation. Higher doses of radiation are more likely to cause hearing loss, according to the journal article. People under age 3 and over age 50 are at a higher risk for this type of hearing loss, as are people being treated with the chemotherapy treatment cisplatin (more on that in a moment).

This type of get kamagra online hearing loss is permanent. Chemotherapy and hearing loss Chemotherapy refers to the use of powerful chemicals that are capable of killing cancer cells. In some cases, chemotherapy drugs can be "ototoxic," which means they are harmful to hearing. About half of get kamagra online all patients who receive the chemotherapy drug cisplatin develop hearing-related side effects including hearing loss, tinnitus and vertigo. This is known as ototoxicity.

Platinum-based chemotherapy (cisplatin) This is especially the case for chemotherapy known as platinum-based therapy (that is, chemo meds containing the element platinum). The most ototoxic platinum-based chemotherapy is cisplatin, according to a review article in Cancer Chemotherapy and get kamagra online Pharmacology. This medication is used to treat bladder, testicular, and ovarian cancer, according to the National Cancer Center. "Not only hearing loss, but also tinnitus and imbalance are common in patients who receive platinum-based chemotherapy, and can cause debilitating effects upon quality of life," the review article states. Hearing-related side effects to this medication appear get kamagra online fairly common.

Permanent hearing loss occurs in about half of all patients who take cisplatin, ASHA notes. It usually causes high-frequency hearing loss. Scientists are still working to understand why cisplatin damages hearing—it may be get kamagra online because it easily enters the inner ear (while other drugs are blocked) but doesn’t seem to exit it, according to ASHA. Once in the inner ear, the medications may cause damage to hair cells, which are vital to the hearing process. Other platinum-based chemotherapies that treat solid tumors, such as carboplatin and oxaliplatin, are less likely to damage hearing, although they can still cause issues.

For instance, get kamagra online carboplatin can cause ringing in the ears (tinnitus), notes the Mayo Clinic. Other chemo drugs There are other chemotherapies that don’t fall into the platinum-based category that can still cause hearing problems or tinnitus. They include vincristine, doxorubicin, gemcitabine, cyclophosphamide, oxaliplatin, and farmorubicin, notes a 2016 study published in the Brazilian Journal of Otorhinolaryngology. Radiation treatment combined with these ototoxic chemotherapy medications increases the risk for get kamagra online hearing-related issues. With higher doses of chemo meds, there’s a greater risk for hearing problems, according to CCS.

Non-cancer drugs can also cause problems Keep in mind, other medications besides chemotherapy taken during cancer treatment—such as pain medications, anti-nausea meds, or antibiotics—can also lead to hearing problems. There are at least 200 medications linked get kamagra online to hearing loss, including over-the-counter medications like aspirin. Hearing loss more likely among kids Seventy-five per cent of patients five years old and younger had cisplatin-related hearing loss three years after starting therapy, a 2021 University of British Columbia study shows. “Young children [are] particularly vulnerable to the ototoxic effects of cancer therapies,” affirms a 2016 review article in the journal Cancer. This is because the brain and ears are still get kamagra online forming in young childhood, the article notes.

Not only is hearing loss more common in children who take cisplatin, but it’s also more severe, per ASHA. Plus, even small amounts of hearing loss in high frequencies are a big deal to younger children acquiring language. How to weigh the risks Regular hearing check-ups are importantfor current and former cancer patients whoreceived treatment linked to hearing loss get kamagra online. Cancer is a life-threatening disease, which is why doctors use powerful treatment methods, despite the host of known side effects. Knowing the potential risks is helpful, since it can help you assess if the risk is worth it to you personally.

Talk to your doctor about the drug's side effects and if there are any alternatives get kamagra online. ASHA recommends following these steps if you are taking known ototoxic medications. Check your hearing. Ideally, do this before the get kamagra online treatment to have a baseline record of your hearing. Track changes.

An audiologist can help you monitor hearing and balance during treatment, so that you can catch any issues quickly—it’s not always possible, but you may be able to pause or switch treatments. Get get kamagra online check-ups. Even after cancer treatment ends, it's a good idea to get regular hearing checkups, especially in pediatric cases. Can anything prevent treatment-related hearing loss?. Sometimes, an alternative get kamagra online therapy can be given if you're particularly concerned about hearing loss or tinnitus.

It's very important to talk to your oncologist about the benefits and risks of the treatments you're receiving. Researchers are also looking at "otoprotective agents"—drugs that can protect hearing when given as the same time as harmful drugs, according to Research Outreach. For instance, ASHA points out that administering sodium thiosulfate (which is typically used to treat cyanide get kamagra online poisoning) may limit hearing loss from cisplatin in children. The trick is figuring out how to give patients otoprotective medications while still allowing chemotherapy medications to be effective. Treating the hearing loss If you've received cancer treatment and have permanent hearing loss, it's important to see a hearing care provider for expert help.

You may be a good get kamagra online candidate for hearing aids, cochlear implants, or assistive listening devices. Treating hearing loss not only helps you hear better, it’s also linked health benefits, including a reduced risk of depression and injury-causing falls.Pause to think about it, and our body’s ability to translate noise into sound is incredible. €œIt's quite a complex and intricate system,” Omid Mehdizadeh, MD, an otolaryngologist (ENT) at Providence Saint John’s Health Center in Santa Monica, Calif., tells Healthy Hearing. But how exactly get kamagra online does this process unfold?. We've put together a step-by-step explanation of how people hear—from the moment sound waves arrive to the outer ear, then travel through the middle and inner ear and transform into meaningful signals sent on to the brain.

Our brain uses these signals to organize and communicate with the external world. How humans hear Step 1. Sound waves enter get kamagra online the ear. When a sound occurs, it enters the outer ear, also referred to as the pinna or auricle. The pinna is the visible portion of your ear, and its funnel-like shape is well-engineered.

As sound hits the pinna, it filters and amplifies sound waves, and chutes get kamagra online them along into the ear canal, Dr. Mehdizadeh says. Next, sound waves hit the eardrum, or tympanic membrane, setting it in motion. €œThe eardrum is a paper-thin layer of a membrane that essentially vibrates as soon get kamagra online as sound waves hit it—very similar to a drum,” Dr. Mehdizadeh says.

Step 2. Sound moves through the middle ear Behind the get kamagra online eardrum is the middle ear. In this part of the ear's anatomy, sound waves are amplified before they are delivered to the inner ear. Here’s how that process unfurls. The eardrum is attached to a chain of three small bones, known as the get kamagra online ossicles.

These three bones are the smallest ones in your body. When the eardrum vibrates in response to sound waves, these bones are set into motion as well. The bone directly attached to the eardrum is the malleus (“the hammer”), which is connected at its other end to the incus get kamagra online (“the anvil”). The incus, in turn, is attached to the stapes (the “stirrup” or “footplate”). The shapes of the ossicles provide inspiration for their nicknames.

This last bone—the get kamagra online stapes—is connected to the oval window, which is a membrane separating the middle ear from the inner ear. The orientation of the three bones allows them to function as a lever, amplifying the sound energy as it moves from the relatively large tympanic membrane to the relatively small oval window. Step 3. Sound moves through the inner ear (the cochlea) Vibrations from the stapes push on the oval window, and set up pressure waves in the fluid-filled cochlea, the snail-shaped inner ear get kamagra online that contains the organ of Corti. In the organ of Corti, vibrations are finally transformed into electrical energy by cells known as hair cells (stereocilia).

The tiny hair cells lining the cochlea are stimulated by different frequencies. For example, many people with hearing loss have high-frequency get kamagra online hearing loss, making it harder to hear high-pitched sounds. This means the hair cells responsible for detecting high frequencies are damaged. (While less common, some people have low-frequency hearing loss or mid-range hearing loss.) You’re born with about 16,000 of these hair cells, according to the Centers for Disease Control and Prevention (CDC). These hair cells translate the vibrations from sound waves into electrical impulses that get kamagra online then travel along a complex pathway of nerve fibers to the brain.

Note. Hair cells play a vital role in your hearing. They’re also get kamagra online quite fragile. Loud sounds can damage or even destroy them, and once they’re destroyed, they can’t be repaired—and you’ll feel the effects of noise-induced hearing loss. Blasting hair cells with noise is akin to trees in a hurricane, struggling to remain standing.

Step 4 get kamagra online. Your brain interprets the signal. Once sound is converted to electrical signals in the cochlea, these signals travelvia a complex circuit of auditory nerve pathways to the auditory cortex and otherparts of the brain that regulate awareness and sensory perception. (Some of thesepathways shut down to let you sleep at night, for get kamagra online example, even if noise is present). Sound processing likely occurs in both the cochlea and the brain, Dr.

Mehdizadeh says. But most of get kamagra online the neurological processing of sound occurs in the brain, he says. Brain cells, known as sensory neurons, transmit the sound information to various areas of the brain, including the thalamus, temporal lobe, and auditory cortex, the National Institutes of Health explains. These are known as the auditory pathways. The auditory pathways process and decode sounds, turning them into something meaningful, like a question, get kamagra online a honking horn, or music.

They also help distinguish between nearby, important sounds and less vital background sounds, as well as processing the direction and location of sounds. Many parts of hearing work directly in concert with the vestibular, or balance system, which is located nearby, within the semicircular canals of the inner ear. "There's many different centers in the brain get kamagra online that are interpreting and receiving sounds," Dr. Mehdizadeh says. How exactly your brain works when it comes to sound is still being explored by researchers.

For example, tinnitus, or ringing in the ears, is still poorly understood, even as common as it is get kamagra online. Common hearing disorders Given this elaborate, multi-step process that allows humans to hear, it’s no wonder that sometimes things go wrong along the way. Anything that obstructs the transmission of sound can lead to issues, Dr. Mehdizadeh says get kamagra online. Here, the types of hearing loss, and where the problem starts within the process.

Conductive hearing loss—this is defined as hearing loss due to sounds not making their way through the outer or middle ear, the CDC explains. This can happen due to a number of reasons, including a damaged eardrum, excessive earwax getting stuck get kamagra online in the ear canal, and ear s, according to the American Speech-Language-Hearing Association (ASHA). Medical or surgical treatments can sometimes resolve this type of hearing loss. Sensorineural hearing loss—the most common type of hearing loss, it occurs from damage to those tiny hair cells present in the inner ear, and/or to the auditory nerve. Age-related hearing loss is sensorineural, as is noise-induced get kamagra online hearing loss.

Diseases, head trauma, tumors, and certain drugs can also cause sensorineural hearing loss. Sensorineural hearing loss is permanent, and ranges in severity. Mixed hearing loss—as the name indicates, this type of hearing loss is a combination of conductive and sensorineural hearing loss. It can occur over time, or due to sudden trauma. Auditory disorders—Several types of hearing loss occur within the auditory nerve and brain.

People with this kind of hearing loss may not show any problems on standard hearing tests, but still feel like they can't hear.

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