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PDE5I medications enhance this process by preventing the breakdown of cyclic guanosine monophosphate (cGMP), a molecule that promotes smooth muscle relaxation and blood vessel dilation

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Such created osmotic imbalance, resulting in cellular swelling (vacuolization) of the SGNs and the afferent dendritic endings that synapses onto the inner HCs (Pujol and Puel, 1999