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Rahimi V, Tavanai E, Falahzadeh S, Ranjbar AR, Farahani S. Omega-3 fatty acids and health of auditory and vestibular systems: a comprehensive review. Eur J Nutr 2024; 63:1453-1469. [PMID: 38693450 DOI: 10.1007/s00394-024-03369-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/04/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The purpose of this study was to comprehensively review animal and human studies that explore the role of omega-3 PUFAs in maintaining the health of the auditory organ across all life stages. METHODS This narrative review involved searching Scopus, PubMed, Google Scholar, and Cochrane Library databases for relevant articles from December 1980 to July 2023. RESULTS some animal and human studies suggest that both deficiency and excessive intake of long-chain omega-3 PUFAs, particularly docosahexaenoic acid (DHA), can lead to auditory neural conduction impairment and reduced hearing acuity from fetal development to old age (presbycusis). These effects are likely to be dependent on the dosage. Some research indicates that an excessive intake of omega-3, rather than a deficiency, can result in nutritional toxicity and hearing impairments. Animal studies highlight the positive impact of omega-3 supplements with high DHA content in addressing hearing damage, but human research on this subject is limited. Furthermore, certain studies propose that omega-3 PUFAs may prevent or delay age-related hearing loss, with high plasma omega-3 concentration, particularly long-chain omega-3 PUFA, linked to reduced hearing loss. Additionally, consuming fish more than twice a week may be associated with a lower risk of hearing loss in adulthood, with these effects potentially influenced by age and gender. However, the majority of studies have been conducted on animals, and clinical trials are scarce. Research on the influence of omega-3 PUFAs on the peripheral and central vestibular systems remains limited. CONCLUSION This article delves into the impact of omega-3 on the auditory-vestibular system, exploring its influence on neurodevelopment, protection, and treatment. It not only highlights specific research gaps but also offers valuable insights for potential future studies.
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Affiliation(s)
- Vida Rahimi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Tavanai
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Falahzadeh
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Department of Audiology, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Reza Ranjbar
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Farahani
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Audiology, Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Piche-Shemiran, Enghelab Ave, Tehran, 1148965141, Iran.
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Jin Y, Tanaka T, Reed NS, Tucker KL, Ferrucci L, Talegawkar SA. Associations between dietary indices and hearing status among middle-older aged adults - results from the Baltimore Longitudinal Study of Aging. Am J Clin Nutr 2024; 119:1338-1345. [PMID: 38447686 PMCID: PMC11130650 DOI: 10.1016/j.ajcnut.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/30/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Hearing loss, a public health issue in older populations, is closely related to functional decline. OBJECTIVE To investigate the longitudinal associations between 4 dietary indices and hearing status. METHODS Data from the Baltimore Longitudinal Study of Aging were used and included 882 participants ≥45 y of age. Dietary intake was assessed using a validated food frequency questionnaire, and 4 dietary scores (Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet [MIND], Mediterranean style diet score [MDS], Alternative Healthy Eating Index [AHEI], and Healthy Eating Index [HEI]) were calculated as averages over time. Hearing status was examined using pure-tone audiometry, and pure-tone average (PTA) of hearing thresholds were calculated at speech-level (PTA(500, 1000, 2000, 4000 Hz)), low (PTA(500, 1000 Hz)), and high (PTA(4000, 8000 Hz)) frequencies, with lower thresholds indicating better hearing. Multivariable linear mixed-effect models were used to examine associations between dietary indices and hearing threshold change over time adjusted for confounders. RESULTS At baseline, the mean age of participants was 67 y and 55% were female. Over a median of 8 y of follow-up, MDS ≥7 was associated with 3.5 (95% CI: -6.5, -0.4) and 5.0 (95% CI: -9.1, -1.0) dB lower PTA(500, 1000, 2000, 4000 Hz) and PTA(4000, 8000 Hz), respectively, compared with MDS ≤3; the highest tertile of the AHEI was associated with 2.3 (95% CI: -4.6, -0.1) and 5.0 (95% CI: -8.0, -2.0) dB lower PTA(500, 1000, 2000, 4000 Hz) and PTA(4000, 8000 Hz); and each standard deviation increment in HEI was associated with 1.6 dB (95% CI: -2.7, -0.6), 1.1 dB (95% CI: -2.1, -0.1), and 2.1 dB (95% CI: -3.5, -0.6) lower PTA(500, 1000, 2000, 4000 Hz), PTA(500, 1000 Hz), and PTA(4000, 8000 Hz), respectively. CONCLUSIONS Adherence to healthy dietary patterns was associated with better hearing status, with stronger associations at high frequencies. Am J Clin Nutr 20xx;x:xx.
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Affiliation(s)
- Yichen Jin
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Toshiko Tanaka
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, United States
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Katherine L Tucker
- Department of Biomedical and Nutrition Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, United States
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, United States
| | - Sameera A Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.
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Yévenes-Briones H, Caballero FF, Struijk EA, Arias-Fernández L, Lana A, Rey-Martinez J, Rodríguez-Artalejo F, Lopez-Garcia E. Association Between Speech Reception Threshold in Noise and Multimorbidity: The UK Biobank Study. Otolaryngol Head Neck Surg 2024; 170:480-489. [PMID: 37622533 DOI: 10.1002/ohn.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/17/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To investigate the association between hearing function, as approached with the functional auditory capacity, and multimorbidity. STUDY DESIGN Cross-sectional study. SETTING The UK Biobank was established from 2006 to 2010 in the United Kingdom. This cross-sectional analysis included 165,524 participants who provided baseline information on hearing function. METHODS Functional auditory capacity was measured with a digit triplet test. Three categories were defined according to the speech reception threshold in noise (SRTn): normal (SRTn < -5.5 dB signal-to-noise ratio [SNR]), insufficient (SRTn ≥ -5.5 to ≤ -3.5 dB SNR) and poor hearing function (SRTn > -3.5 dB SNR). To define multimorbidity, 9 chronic diseases were considered, including chronic obstructive pulmonary disease, dementia, Parkinson's disease, stroke, cancer, depression, osteoarthritis, coronary heart disease, and diabetes; multimorbidity was defined as the coexistence of 2 or more in the same individual. Analyses were conducted using logistic models adjusted for relevant confounders. RESULTS Among the study participants, 54.5% were women, and the mean (range) age was 56.7 (39-72) years. The prevalence of insufficient and poor hearing function and multimorbidity was 13% and 13.2%, respectively. In comparison with having a normal SRTn, the odds ratio (95% confidence interval) of multimorbidity associated with insufficient SRTn was 1.13 (1.08-1.18), and with poor SRTn was 1.25 (1.14-1.37). CONCLUSION Insufficient and poor hearing function was associated with multimorbidity. This association suggests common biological pathways for many of the considered morbidities.
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Affiliation(s)
- Humberto Yévenes-Briones
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Alberto Lana
- Department of Medicine, Universidad de Oviedo/ISPA, Oviedo, Spain
| | - Jorge Rey-Martinez
- Neurotology Unit, ENT Department, Hospital Universitario Donostia, San Sebastián-Donostia, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA-Food Institute, CEI UAM, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA-Food Institute, CEI UAM, Madrid, Spain
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Suzuki J, Hemmi T, Maekawa M, Watanabe M, Inada H, Ikushima H, Oishi T, Ikeda R, Honkura Y, Kagawa Y, Kawase T, Mano N, Owada Y, Osumi N, Katori Y. Fatty acid binding protein type 7 deficiency preserves auditory function in noise-exposed mice. Sci Rep 2023; 13:21494. [PMID: 38057582 PMCID: PMC10700610 DOI: 10.1038/s41598-023-48702-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
Fatty acid-binding protein 7 (FABP7) is vital for uptake and trafficking of fatty acids in the nervous system. To investigate the involvement of FABP7 in noise-induced hearing loss (NIHL) pathogenesis, we used Fabp7 knockout (KO) mice generated via CRISPR/Cas9 in the C57BL/6 background. Initial auditory brainstem response (ABR) measurements were conducted at 9 weeks, followed by noise exposure at 10 weeks. Subsequent ABRs were performed 24 h later, with final measurements at 12 weeks. Inner ears were harvested 24 h after noise exposure for RNA sequencing and metabolic analyses. We found no significant differences in initial ABR measurements, but Fabp7 KO mice showed significantly lower thresholds in the final ABR measurements. Hair cell survival was also enhanced in Fabp7 KO mice. RNA sequencing revealed that genes associated with the electron transport chain were upregulated or less impaired in Fabp7 KO mice. Metabolomic analysis revealed various alterations, including decreased glutamate and aspartate in Fabp7 KO mice. In conclusion, FABP7 deficiency mitigates cochlear damage following noise exposure. This protective effect was supported by the changes in gene expression of the electron transport chain, and in several metabolites, including excitotoxic neurotransmitters. Our study highlights the potential therapeutic significance of targeting FABP7 in NIHL.
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Affiliation(s)
- Jun Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Tomotaka Hemmi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masamitsu Maekawa
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
- Graduate School of Pharmaceutical Sciences, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Watanabe
- Graduate School of Pharmaceutical Sciences, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hitoshi Inada
- Department of Developmental Neuroscience, Centers for Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hiroyuki Ikushima
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tetsuya Oishi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University School of Medicine, 19-1 Odori, Yahaba, Shiwa, 020-8505, Japan
| | - Yohei Honkura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yoshiteru Kagawa
- Department of Organ Anatomy, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Nariyasu Mano
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
- Graduate School of Pharmaceutical Sciences, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yuji Owada
- Department of Organ Anatomy, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Noriko Osumi
- Department of Developmental Neuroscience, Centers for Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Wu S, Zhu S, Mo F, Yuan X, Zheng Q, Bai Y, Yang W, Chen Q. Association of coffee consumption with the prevalence of hearing loss in US adults, NHANES 2003-2006. Public Health Nutr 2023; 26:2322-2332. [PMID: 37485659 DOI: 10.1017/s1368980023001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
OBJECTIVE This study aims to explore the association between coffee consumption and the prevalence of hearing loss in American adults based on a national population-based survey. DESIGN Cross-sectional analysis of reported audiometric status and coffee intake from the 2003-2006 National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression, forest plots and restricted cubic spline (RCS) analyses were used to explore the associations and dose-response relationships between coffee consumption frequency and hearing loss. SETTING The USA. PARTICIPANT This study included 1894 individuals aged ≥ 20 from the 2003-2006 NHANES. RESULTS In this study, the prevalence of speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL) among the participants was 35·90 % and 51·54 %, respectively. Compared with those who no consumed coffee, non-Hispanic White who consumed ≥ 4 cups/d had higher prevalence of SFHL (OR: 1·87; 95 % CI: 1·003. 3·47). And a positive trend of coffee consumption frequency with the prevalence of HFHL was found (Ptrend = 0·001). This association of HFHL was similar for participants aged 20-64 (Ptrend = 0·001), non-Hispanic White (Ptrend = 0·002), non-noise exposure participants (Ptrend = 0·03) and noise-exposed participants (Ptrend = 0·003). The forest plots analysis found that the association between 1 cup-increment of daily coffee consumption and the prevalence of HFHL was statistically significant in males. RCS model supported a positive linear association of coffee consumption with SFHL (P for overall association = 0·02, P for nonlinearity = 0·48) and a positive non-linear association of coffee consumption with HFHL (P for overall association = 0·001, P for nonlinearity = 0·001). CONCLUSION Our findings suggested that coffee consumption was associated with higher prevalence of hearing loss. Further cohort studies in larger population are needed to investigate these findings.
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Affiliation(s)
- Shan Wu
- Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, School of public health, Guangdong Pharmaceutical University, Guangzhou510310, China
| | - Shiheng Zhu
- Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, School of public health, Guangdong Pharmaceutical University, Guangzhou510310, China
| | - Fengxin Mo
- Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, School of public health, Guangdong Pharmaceutical University, Guangzhou510310, China
| | - Xiaojing Yuan
- Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, School of public health, Guangdong Pharmaceutical University, Guangzhou510310, China
| | - Qiutong Zheng
- Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, School of public health, Guangdong Pharmaceutical University, Guangzhou510310, China
| | - Yan Bai
- Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, School of public health, Guangdong Pharmaceutical University, Guangzhou510310, China
| | - Wenhan Yang
- Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, School of public health, Guangdong Pharmaceutical University, Guangzhou510310, China
| | - Qingsong Chen
- Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, School of public health, Guangdong Pharmaceutical University, Guangzhou510310, China
- NMPA Key Laboratory for Technology Research and Evaluation of Pharmacovigilance, Guangdong Pharmaceutical University, Guangzhou, China
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Zhang X, Luo Q, Huang Z, Xiang X. Association between nineteen dietary fatty acids and hearing thresholds: findings from a nationwide survey. Lipids Health Dis 2023; 22:126. [PMID: 37563575 PMCID: PMC10413493 DOI: 10.1186/s12944-023-01896-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Hearing loss is a prevalent health concern, and dietary factors, such as fatty acid intake, may play a role in its development. The current study aimed to investigate the association between the intake of dietary fatty acids and hearing thresholds among U.S. adults. METHODS The researchers examined data from the National Health and Nutrition Examination Survey (NHANES), including 7,623 participants with available dietary fatty acid intake and audiometry data. Dietary fatty acid intake was assessed using dietary recalls, and hearing thresholds were measured using pure-tone audiometry. Multivariate linear regression models and smoothing curve fitting were utilized to explore the associations between dietary fatty acid intake and hearing thresholds, adjusting for relevant covariates. RESULTS This study reveals a direct association between both low and high frequency pure tone average (PTA) hearing thresholds and the dietary intake of total saturated fatty acids (SFAs) and total polyunsaturated fatty acids (PUFAs). Conversely, the intake of total monounsaturated fatty acids (MUFAs) demonstrates an inverted U-shaped correlation with low-frequency and high-frequency PTA hearing thresholds, having inflection points at 11.91 (energy (%)) and 10.88 (energy (%)), respectively. CONCLUSION Dietary intake of certain fatty acids may influence hearing thresholds in adults.
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Affiliation(s)
- Xiaojin Zhang
- Department of Otolaryngology, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Qin Luo
- Department of Otolaryngology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
| | - Zhicheng Huang
- Department of Otolaryngology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xin Xiang
- Department of Otolaryngology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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Long L, Jia Z, Tang X. Serum polyunsaturated fatty acids and hearing threshold shifts in adults in the United States: A cross-sectional study. Front Public Health 2022; 10:939827. [PMID: 36466471 PMCID: PMC9708739 DOI: 10.3389/fpubh.2022.939827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Few studies have evaluated the association between polyunsaturated fatty acids (PUFAs) and hearing levels. This study aimed to investigate the association between serum PUFAs and hearing threshold shifts in US adults. Methods We investigated 913 adults from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Multivariate linear regression analyses were conducted to evaluate associations between PUFA and hearing threshold shifts. Results Overall, 11 serum PUFAs were inversely associated with low-frequency thresholds, especially in men, and were positively related to high-frequency thresholds, particularly in the 40-59 years old cohort. Furthermore, some serum PUFAs were positively associated with both hearing threshold subgroups in women. Conclusion Some PUFAs tend to be beneficial for low-frequency hearing status and detrimental to the high-frequency hearing threshold. The male sex may play a protective role in this association, while the female sex and middle age may be detrimental in the effect of PUFAs on hearing function.
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Affiliation(s)
- Lili Long
- Department of Otorhinolaryngology, Sichuan University Hospital of Sichuan University, Chengdu, China
| | - Zhenchao Jia
- Department of Prevention and Health Care, Sichuan University Hospital of Sichuan University, Chengdu, China,*Correspondence: Zhenchao Jia
| | - Xinghua Tang
- Department of Otorhinolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China,Xinghua Tang
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