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Background: Metformin plays a major part in the treatment of polycystic ovarian syndrome .Trials are being conducted to compare the effectiveness of combination of metformin with cabergoline in the treatment of hyperprolactinemia and polycystic ovarian syndrome. Objectives: The purpose of this study is to compare the effectiveness of metformin monotherapy and combination therapy with cabergoline versus metformin for the management of polycystic ovarian syndrome with hyperprolactinemia. Methodology: An extensive search up until 31 May 2024 of electronic databases (PubMed, Registry of Controlled Clinical Trials, Web of Sciences, SCOPUS) to find pertinent studies. An analysis was conducted with both observational data and randomized clinical trials . To compute the standard mean difference, weighted mean difference, odds ratio, and 95% confidence interval, RevMan (v5.3) was utilized. Primary outcomes that were assessed included body-mass index, regular menstruation, weight change, prolactin, testosterone, and dehydroepiandrosterone-sulfate levels. Results: Three randomized controlled trials and 1 observational study, taking a total patient population of n = 535, were part of our final analysis. Prolactin (SMD = −3.23 95% CI: (−4.90, −1.55)) and dehydroepiandrosterone-sulfate levels (SMD = −0.27 95% CI: (−0.52, −0.01)) were significantly lower in the metformin and cabergoline combination therapy group; monthly regularity was also significantly higher (OR = 3.07 95% CI: (2.09, 4.51)). Statistically, there was no significant difference in weight, body-mass index, or testosterone levels. Conclusions: In the treatment of polycystic ovarian syndrome, the combination of metformin and cabergoline significantly lowers prolactin levels and encourages regular menstrual cycles. Although metformin has the potential to suppress testosterone levels, more investigation is required to determine how combination therapy affect dehydroepiandrosterone-sulfate and testosterone levels. It’s interesting to note that while neither intervention had a substantial impact on weight or body-mass index, metformin and cabergoline combination therapy outperformed metformin monotherapy in terms of supporting regular menstrual cycles. Customized therapy approaches are essential, and large-scale trials involving a variety of groups are required to comprehend the safety and effectiveness of treatments. Plain language summary: Efficacy of metformin compared to metformin and cabergoline combination In this study, 2 therapies for women with high prolactin levels—a hormone associated with PCOS—were examined. Their goal was to determine which combination of metformin and cabergoline produced the best results.Observational data and randomized clinical trials were included while searching through several databases for pertinent studies. Researchers discovered that the combination of metformin and cabergoline was superior to using metformin alone in reducing prolactin and another hormone called DHEAS. The menstrual periods of women receiving the combined therapy were also more regular. However, there wasn’t much difference in weight, body mass index (BMI), or testosterone levels between the 2 groups. In summary, it appears that the combination of cabergoline and metformin is a more effective way to treat the symptoms of PCOS, which include irregular periods and elevated prolactin levels. To find out how it impacts other hormones and whether it’s long-term safe and effective, further research is still required.

Background Hearing assessment after middle ear surgery has always been of interest to otologists for one of its major unavoidable and unpredictable complication is hearing loss. As the initial indication for operation is to treat precisely this problem, this complication poses a major dilemma for surgeons. We, thus, aimed to detect the proportion of postoperative worsening of hearing, causes, and risk factors in patients undergoing middle ear surgery. Method This retrospective descriptive study was conducted in the department of otolaryngology of a tertiary care center and data of medical records were retrieved from January 2016 until December 2020. This study included middle ear surgery patients with pre- and postoperative audiometric results. Those patients whose hearing worsened post-operatively (where bone conduction deteriorated > 10 dB) were noted and assessed accordingly. Results The medical records regarding morphological and audiological outcomes of 178 patients were available. We observed auditory degradation after surgery in eight patients (five primary cases and three revision cases), with an overall incidence rate of 4.49%. The mastoidectomy was performed in seven cases, either cortical ( n = 5) and modified radical ( n = 2). Modified radical mastoidectomy showed the greatest incidence of hearing loss (40%) among all surgical procedures. Except in one case, where sudden, profound loss occurred following otorrhoea on third day, hearing loss was progressive in rest of cases. Conclusion A patient with deteriorating hearing after middle ear surgery must be evaluated properly. There is an increased chance of hearing loss following surgery that involves more ossicular manipulation, drilling, extensive disease clearance, and revision. Utmost care must be taken while operating around ossicles and during disease clearance in key areas. Proper consent should be taken from such patients to avoid future litigations.