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Zhang Y, Pei Q. Prenatal tomography ultrasound imaging diagnosis of fetal pyriform sinus cysts (third or fourth branchial cleft cyst): A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:820-823. [PMID: 38676547 DOI: 10.1002/jcu.23702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
This case report describes a fetal piriform sinus cyst identified via tomographic ultrasound imaging and discusses its prenatal sonographic characteristics. We employed the tomographic ultrasound imaging function of the GE Voluson Ultrasound E10 to visualize multilevel transverse sections of the cyst. Specifically, we propose for the first time that the cross-sectional shape of a piriform sinus cyst composed of aryepiglottic folds approximates a triangle. This special shape facilitates the precise localization of the piriform sinus, providing valuable insights for timely diagnosis and appropriate postnatal management.
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Affiliation(s)
- Yujie Zhang
- Department of Ultrasound, Weifang People's Hospital, Weifang, People's Republic of China
| | - Qiuyan Pei
- Department of Obstetric Ultrasound, Peking University People's Hospital, Beijing, People's Republic of China
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Liu L, Wang R, Zheng Q, Xie F, Liu T, Lin Z, Zhou J, Wu Z, Zhao C, Xie H, Lin Z. Ultrasonography in Children With Congenital Pyriform Sinus Fistula: Analysis of 31 Cases. KLINISCHE PADIATRIE 2024; 236:5-10. [PMID: 37678408 PMCID: PMC10803176 DOI: 10.1055/a-2151-2422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Congenital pyriform sinus fistula (CPSF) is a rare disease that can be easily misdiagnosed. This study investigates the value of ultrasonography in the early diagnosis and treatment of CPSF in children. METHODS Clinical features and ultrasonography images of 31 CPSF pediatric patients confirmed by operation were retrospectively analyzed, different sonographic features during the infection period and the quiescence period were summarized and the consistency test of ultrasonic recognition and diagnosis between observers was conducted. RESULTS In this study, 25 CPSF children had thick-walled cystic masses during the infection period, and cystic masses of 8 cases showed gas echo inside; after the modified valsalva maneuver, gas echo was found in another 5 cases. The detection rate of gas can be enhanced through the modified valsalva maneuver and infants' cry so as to provide an important basis for the diagnosis of pyriform sinus fistula. During the quiescent period of inflammation of 6 cases, fistula can be completely shown, and the wall structure has not been completely destroyed, so that the running position of fistula can be clearly seen. Ultrasonography boasted a good inter-observer consistency in identification and determination (Kappa:0.799-0.857; P<0.001). CONCLUSION Ultrasonography could clearly reveal the position and direction of CPSF fistula. Different ultrasonic characteristics in different periods could provide relevant information for the selection of clinical operation timing and evaluate the post-operative effects.
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Affiliation(s)
- Lei Liu
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Ruijie Wang
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Qiuying Zheng
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Fusui Xie
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Tingting Liu
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Zhouqin Lin
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Jingran Zhou
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Zebin Wu
- Department of Otolaryngology, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Cailei Zhao
- Department of Radiology, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Haiyang Xie
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
| | - Zhou Lin
- Department of Ultrasound, Shenzhen Children’s Hospital,
Shenzhen, China
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Zenno A, Ramamoorthy B, Hammoud DA, Quezado M, Zeiger MA, Jha S. Case Report: Nine-year-old with parathyroid adenoma within the piriform sinus. Front Endocrinol (Lausanne) 2023; 14:1171052. [PMID: 37288292 PMCID: PMC10242159 DOI: 10.3389/fendo.2023.1171052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
We present the case of a 9-year-old girl who presented with symptomatic hypercalcemia from primary hyperparathyroidism (PHPT). Laboratory results revealed elevated serum calcium 12.1 mg/dl (ref: 9.1-10.4), elevated ionized calcium 6.8 (ref: 4.5-5.6) mg/dl, phosphorus 3.8 (ref: 3.3-5.1) mg/dl, 25-OH vitamin D 20.1 (30-100) ng/ml, and elevated intact PTH 70 (15-65) pg/ml, consistent with the diagnosis of PHPT. She had persistent hyperparathyroidism after bilateral neck exploration, left thyroid lobectomy, and transcervical thymectomy. Neither inferior gland was identified. No parathyroid tissue was seen on histology. Repeat preoperative imaging identified a 7-mm × 5-mm adenoma on 4DCT not seen on 99Tc-sestamibi parathyroid scan. The patient then underwent a successful redo parathyroidectomy with removal of a submucosal left parathyroid adenoma at the superior aspect of the thyroid cartilage in the piriform sinus. Her biochemical work-up remains consistent with surgical cure 6 months after surgery. Herein, we also review common locations for ectopic parathyroid adenomas. Clinical Trial Registration NCT04969926.
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Affiliation(s)
- Anna Zenno
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Bhavishya Ramamoorthy
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Dima A. Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Martha Quezado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Martha A. Zeiger
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Smita Jha
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
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Zhao L, Chen L, Li W, Ni K, Chen W, Li X. Retrospective review of 70 cases of pyriform sinus fistula. Int J Pediatr Otorhinolaryngol 2021; 150:110904. [PMID: 34479061 DOI: 10.1016/j.ijporl.2021.110904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/07/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pyriform sinus fistula (PSF) is a rare branchial pouch anomaly of the neck that presents a diagnostic and management challenge. The objective of this study is to highlight the value of intraoperative suspension laryngoscope-assisted methylene blue injection through the internal opening as a guide for locating the fistula. METHODS A retrospective study of 70 cases of PSF in children from 2009 to 2017 was managed, and an intraoperative suspension laryngoscope-assisted method combined with neck exploration and excision of the tract were performed in all cases. RESULTS The patients comprised 36 males and 34 females ranging in age from 7 days to 15 years. Sixty-four cases were predominantly left-sided (64/70, 91.4%), and 6 cases (6/70, 8.6%) occurred on the right side. Four cases exhibited temporary postoperative hoarseness (4/70, 5.7%), which disappeared after one week. There were no instances of recurrence during follow-up ranging from two to nine years, and the median follow-up period was four years. CONCLUSION The use of our surgical approaches can facilitate the localization of the fistula during dissection in open neck surgery, and reduce recurrence.
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Affiliation(s)
- Limin Zhao
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China.
| | - Le Chen
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, 200031, China.
| | - Wanpeng Li
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China; Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, 200031, China.
| | - Kun Ni
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China.
| | - Wei Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China.
| | - Xiaoyan Li
- Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200062, China.
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Hao Z, Hou Y, Li X, Wang J, Wang Y, Gao Z, Lou L, Li Y. Misdiagnosis of asymptomatic intrathyroidal pyriform sinus fistula: a case report. J Int Med Res 2021; 49:3000605211031430. [PMID: 34282642 PMCID: PMC8295969 DOI: 10.1177/03000605211031430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pyriform sinus fistula is uncommon and easily misdiagnosed. Most reported cases occur in children and are associated with either acute suppurative thyroiditis or deep neck infection. Asymptomatic pyriform sinus fistula is difficult to diagnose because it can manifest as an incidental thyroid nodule with highly suspicious malignant features on ultrasonography. The patient was a 41-year-old man with asymptomatic thyroid nodules incidentally detected on ultrasonography. Surgery was performed under the suspicion of thyroid cancer. Pathology findings revealed multiple cystic walls lined by ciliated columnar cells with stratified squamous epithelial cysts in a background of inflammatory and lymphoid cells. Barium swallow examination performed 2 weeks later revealed a sinus tract measuring 1.8 cm that arose from the apex of the left pyriform sinus. The diagnosis and management of pyriform sinus anomalies are challenging. The majority of physicians, including some otolaryngologists, lack an understanding of the disease, which should be considered one of the important differential diagnoses of neck masses. Barium swallow examination, ultrasonography, computed tomography, and laryngoscopy are useful to diagnose this condition.
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Affiliation(s)
- Zengfang Hao
- Department of Pathology, Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, P. R. China
| | - Yuqi Hou
- Department of Pathology, Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, P. R. China
| | - Xiaoyu Li
- Department of Thyroid and Breast Surgery, Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Juan Wang
- Department of Ultrasonography, Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Ying Wang
- Department of Ultrasonography, Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Zhihong Gao
- Department of Radiology, Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Lei Lou
- Department of Pathology, Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, P. R. China
- Lei Lou, Department of Pathology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang City, Hebei Province 050017, P. R. China. Emails:
| | - Yuehong Li
- Department of Pathology, Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, P. R. China
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Chen W, Chen J, Chen F, Wu J, Zhao L, Xu H, Li X. Endoscopic coblation treatment for congenital pyriform sinus fistula in children. Medicine (Baltimore) 2021; 100:e25942. [PMID: 34106664 PMCID: PMC8133172 DOI: 10.1097/md.0000000000025942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
Congenital pyriform sinus fistula (CPSF) is a very rare branchial apparatus malformation. Traditional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. Herein, we report our experience of endoscopic coblation technique for treatment of CPSF in children.To observe the clinical efficacy of endoscopic coblation treatment of CPSF in children, especially for those in acute infection stage.Retrospective case series with 54 patients (including 20 cases in acute infection stage and 34 cases in non infection stage) who were diagnosed with CPSF between October 2017 to November 2019, all patients were treated with endoscopic coblation to close the piriform fossa fistula, neck abscess incision and drainage performed simultaneously for acute infection stage cases. Data collected including age of diagnosis, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospitalization, and recurrence were analyzed.Of the 20 cases in acute infection stage, there were 3 children with transient vocal cord paresis all of which resolved with 1 month. Four children of the 34 cases in non infection stage appeared reddish swelling of the neck on the 4th, 5th, 6th, and 7th days after coblation and then underwent abscess incision and drainage. All cases experienced no recurrence, vocal cord paralysis, pharyngeal fistula and massive hemorrhage after their first endoscopic coblation of the sinus tract in the follow up of 3 to 28 months.Endoscopic coblation is an effective and safe approach for children with CPSF, neck abscess incision and drainage could be performed simultaneously in acute infection stage. We advocate using this minimally invasive technique as first line of treatment for CPSF.
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Xiaohui SMD, Jing MMD, Xifeng GMD, Ligang CMD. Diagnosis of Acute Suppurative Thyroiditis Secondary to Pyriform Sinus Fistula by Local Injection of Ultrasound Contrast Agent. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.190033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Zhu T, Huang Y. Contrast-Enhanced Ultrasound Diagnosed a Pyriform Sinus Fistula That Failed to Be Diagnosed by a Barium Swallow Examination: Case Report and Review of Choices for the Imaging Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1669-1673. [PMID: 32037562 DOI: 10.1002/jum.15239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Tiantong Zhu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Rodríguez Bandera AI, Sebaratnam DF, Feito Rodríguez M, de Lucas Laguna R. Cutaneous ultrasound and its utility in Pediatric Dermatology: Part II-Developmental anomalies and vascular lesions. Pediatr Dermatol 2020; 37:40-51. [PMID: 31742750 DOI: 10.1111/pde.13897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a noninvasive and harmless diagnostic technique that is especially appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and aids our understanding of cutaneous pathology. In this second part, we describe the ultrasonographic findings of developmental anomalies and vascular lesions.
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Affiliation(s)
| | - Deshan Frank Sebaratnam
- Sydney Children's Hospitals' Network, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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Wang S, Mei L, Li Y, Zhang X, Zhang J, Ge W, Guo Y, Yu Y, Wang G, Mei T, Liu Q, Sun N, He Y, Li X, Liu Y, Tai J, Ni X. Application of Gastroscopy in the Diagnosis of Congenital Pyriform Sinus Fistula in Children. Front Pediatr 2020; 8:541249. [PMID: 33569357 PMCID: PMC7868526 DOI: 10.3389/fped.2020.541249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: The aim of this study was to explore the diagnostic value of gastroscopy under local anesthesia for congenital pyriform sinus fistula (CPSF). Methods: This research was a diagnostic study. Patients received gastroscopy under local anesthesia to diagnose CPSF, and suspension laryngoscopy under general anesthesia was performed 2 days after gastroscopy. Various conditions of the internal opening of CPSF were then recorded. Patients were grouped according to lesion sides, age, time after the inflammation subsided, and history of previous surgery. The sensitivity, specificity, area under the receiver operating characteristic curve (AUC), accuracy, and positive and negative predictive values of gastroscopy were compared between the groups. Results: A total of 48 patients were recruited in this study, and no patients had severe gastroscopy-related complications. The diagnostic values of gastroscopy in 41 cases (85.4%) were consistent with suspension laryngoscopy. The sensitivity of gastroscopy was 86.4%, the specificity was 75%, the AUC was 0.807, the positive prediction rate was 97.4%, the negative prediction rate was 33.3%, the accuracy rate was 85.4%, and the diagnostic odds ratio (DOR) was 2.1. The kappa consistency test results had statistical significance (P = 0.0026, kappa = 0.3913). The diagnostic value of gastroscopy was better for the patients with inflammation subsiding for more than 4 weeks (P < 0.0001). Conclusion: Gastroscopy under local anesthesia is a safe, effective, reliable and novel diagnostic method for CPSF, and it is especially recommended as a diagnostic method for the patients with inflammation subsiding for more than 4 weeks.
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Affiliation(s)
- Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lin Mei
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yanzhen Li
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xuexi Zhang
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wentong Ge
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yongbo Yu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Guoli Wang
- Department of Gastroenterology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tianlu Mei
- Department of Gastroenterology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qiaoyin Liu
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Nian Sun
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yuzhu He
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yuwei Liu
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jun Tai
- Department of Otorhinolaryngology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
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