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Kemps G, Geven L, Kunst H, Mylanus E, Mulder J, Lanting C, Pennings R. Surgical Treatment for Troublesome Mastoid Cavities: Canal Wall Reconstruction With Bony Obliteration Versus Subtotal Petrosectomy. Otol Neurotol 2024; 45:273-280. [PMID: 38270225 DOI: 10.1097/mao.0000000000004109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
INTRODUCTION A chronically discharging modified radical mastoid cavity may require surgical intervention. We aim to explore two techniques. OBJECTIVE To compare outcomes of subtotal petrosectomy (STP) and canal wall reconstruction with bony obliteration technique (CWR-BOT). STUDY DESIGN Retrospective cohort study. SETTING A tertiary referral center. PATIENTS All patients with a chronically discharging mastoid cavity surgically treated at the Radboud University Medical Center by STP or CWR-BOT in 2015 to 2020, excluding patients with preoperative cholesteatoma. MAIN OUTCOME MEASURES Dry ear rate, audiometry, and rehabilitation. SECONDARY OUTCOME MEASURES Healing time, number of postoperative visits, complications, cholesteatoma, and need for revision surgeries. RESULTS Thirty-four (58%) patients underwent STP, and 25 (42%) CWR-BOT. A dry ear was established in 100% of patients (STP) and 87% (CWR-BOT). The air-bone gap (ABG) increased by 12 dB in STP, and decreased by 11 dB in CWR-BOT. Postoperative ABG of CWR-BOT patients was better when preoperative computed tomography imaging showed aerated middle ear aeration. ABG improvement was higher when ossicular chain reconstruction took place. Mean follow-up time was 32.5 months (STP) versus 40.5 months (CWR-BOT). Healing time was 1.2 months (STP) versus 4.1 months (CWR-BOT). The number of postoperative visits was 2.5 (STP) versus 5 (CWR-BOT). Cholesteatoma was found in 15% (STP) versus 4% (CWR-BOT) of patients. Complication rate was 18% (STP) and 24% (CWR-BOT) with a need for revision in 21% (STP) and 8% (CWR-BOT), including revisions for cholesteatoma. CONCLUSION STP and CWR-BOT are excellent treatment options for obtaining a dry ear in patients with a chronically discharging mastoid cavity. This article outlines essential contributing factors in counseling patients when opting for one or the other. Magnetic resonance imaging with diffusion-weighted imaging follow-up should be conducted at 3 and 5 years postoperatively.
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Affiliation(s)
- Glen Kemps
- Department of Otorhinolaryngology, Isala Hospital, Zwolle
| | | | | | | | - Jef Mulder
- Department of Otorhinolaryngology, Radboudumc, Nijmegen
| | - Cris Lanting
- Department of Otorhinolaryngology, Radboudumc, Nijmegen
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Pontillo V, Ciprelli S, Grillo R, Quaranta N. Quality of life after revision mastoidectomy with mastoid obliteration. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:352-358. [PMID: 37331626 DOI: 10.1016/j.otoeng.2023.06.004] [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: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 06/20/2023]
Abstract
AIMS To evaluate the postoperative quality of life (QoL) after revision canal wall down mastoidectomy with mastoid obliteration (rCWD). MATERIAL AND METHODS A retrospective analysis was conducted on patients treated by rCWD for cholesteatoma between 2016 and 2019. A control group including all patients treated by primary canal wall down with mastoid obliteration (pCWD) for cholesteatoma between 2009 and 2014 was used for the comparison of the postoperative QoL, assessed by the COMQ-12. RESULTS The rCWD and pCWD groups respectively counted 38 and 78 patients with an average follow-up of 30 and 62 months respectively. No significant difference was found in terms of QoL between the two groups. An intra-group analysis among rCWD patients, showed that patients treated by canal wall down (CWD) at the primary surgery had a significantly worse post-revision QoL compared to those initially treated by canal wall up (CWU), specifically in the hearing and balance domains of the questionnaire. CONCLUSIONS Revision mastoid obliteration leads to similar QoL results to those obtained after primary CWD with obliteration. Patients who had undergone a CWD as primary surgery complain worse hearing and balance problems compared to those primarily submitted to CWU, even after revision surgery.
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Affiliation(s)
- Vito Pontillo
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Sabino Ciprelli
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Rossella Grillo
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Kroon VJ, Mes SW, Borggreven PA, van de Langenberg R, Colnot DR, Quak JJ. Efficacy of S53P4 Bioactive Glass for the Secondary Obliteration of Chronically Discharging Radical Cavities. OTO Open 2023; 7:e96. [PMID: 38034064 PMCID: PMC10685330 DOI: 10.1002/oto2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/27/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Present the results of the secondary obliteration of chronically discharging radical cavities using S53P4 bioactive glass (BAG). Study Design Retrospective cohort study. Setting Single-center study. Methods A single-center retrospective cohort study was conducted of all patients that underwent secondary obliteration of persistently draining radical cavities using S53P4 BAG between 2011 and 2022. Patients with middle ear cholesteatoma were excluded. The main outcome was postoperative otorrhea, as indicated by Merchant grading. Results In total, 97 patients were included. The median postoperative follow-up time was 3.9 years (range 0.5-10.4). Average time between the original canal wall down surgery and the secondary obliteration was 25.3 years (SD 11.7, range 2-66). At the most recent follow-up visit, a Merchant grade of 0 to 1 was observed in 95% of the cases. There were no cases of sensorineural hearing loss or facial palsy, one case developed a retro auricular skin defect and 1 patient developed CSF leakage. Minor complications were seen in 10 patients (10%). Ossicular chain reconstruction with a titanium prosthesis was performed in 42 cases, resulting in a median improvement of 11.2 dB in air conduction thresholds. In 9/42 cases (21%), closure of the postoperative air-bone gap to ≤20 dB was achieved. Twenty-five percent of cases could be discharged from out-patient visits. Conclusion Revision of persistently draining radical cavities with BAG obliteration is feasible and results in a dry and safe ear in 95% of the patients, thereby enabling wearing of a conventional hearing aid. Out-patient visits could be ceased in 25% of the cases.
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Affiliation(s)
- Victor J. Kroon
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Steven W. Mes
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Department of OtolaryngologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Pepijn A. Borggreven
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Rick van de Langenberg
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - David R. Colnot
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Jasper J. Quak
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Bartel R, Cruellas F, Gonzalez-Compta X, Hamdan M, Huguet G, Mesalles M, Cisa E, Nogues J. Mastoid obliteration and canal wall reconstruction with posterior auricular artery (PAA) fascia-periosteum flap. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:1-7. [PMID: 36858782 DOI: 10.1016/j.otoeng.2021.07.006] [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: 03/25/2021] [Accepted: 07/24/2021] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Unstable cavities are defined as cavities with cerumen accumulation that need frequent cavity cleaning in the out-patient clinic, cavities that are intolerant to water due to risk of infection or that are subject to frequent infection and otorrhoea. The objective of this study is to address the problem of troublesome mastoid cavities, with the performance of secondary mastoid obliteration and canal wall reconstruction, using a novel posterior auricular artery (PAA) fascia-periosteum flap. MATERIALS AND METHODS A prospective study was designed, only secondary obliterations were included. Unstable mastoid cavities were defined as Merchant grade 2 or 3 and were included for surgery. RESULTS At 12 months of follow up, a complete external auditory canal (EAC) and a self-cleaning ear were achieved in all 23 patients. Completely dry ears were achieved in 21 patients (91.3%). An air-bone gap improvement of 5dB was achieved. CONCLUSION Mastoid obliteration and EAC reconstruction are effective procedures to treat troublesome post canal wall down mastoid cavities. They improve quality of life and enable patients to overcome ear discharge. A standard EAC size enables the utilization of conventional hearing aids, it also reduces the need for constant mastoid cleaning and decreases healthcare expenses. The PAA flap seems to be an effective procedure to achieve all these features, as it is used to obliterate the mastoid and becomes a structural component of the neo-EAC.
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Affiliation(s)
- Ricardo Bartel
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain; Otology Research Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Otology Commission of the Catalan Society of Otorhinolaryngology (SCORL), Barcelona, Spain.
| | - Francesc Cruellas
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Xavier Gonzalez-Compta
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Miriam Hamdan
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Gabriel Huguet
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Marta Mesalles
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Enric Cisa
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Julio Nogues
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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Cherdantseva DD, Vakhrushev SG, Toropova LA. [Mastoid obliteration during last 5 years]. Vestn Otorinolaringol 2022; 87:55-60. [PMID: 36580510 DOI: 10.17116/otorino20228706155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The article presents modern approaches to mastoid obliteration in cases of chronic purulent otitis media with cholesteatoma, published in peer-reviewed russian and foreign journals from 2017 to 2021. The review tells us about effect of mastoid cavity obliteration on reducing the recurrence of cholesteatoma, improving the quality of life of patients according to the results of international questionnaires and the effect of surgery on hearing in the long-term postoperative period. An analysis of the use of autologous and biocompatible materials in middle ear surgery is presented. Their safety and ease of use during surgical intervention were evaluated.
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Affiliation(s)
- D D Cherdantseva
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S G Vakhrushev
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - L A Toropova
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Mastoid obliteration and canal wall reconstruction with posterior auricular artery (PAA) fascia-periosteum flap. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otorri.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Faramarzi M, Kaboodkhani R, Faramarzi A, Roosta S, Erfanizadeh M, Hosseinialhashemi M. Mastoid obliteration and external auditory canal reconstruction with silicone block in canal wall down mastoidectomy. Laryngoscope Investig Otolaryngol 2021; 6:1188-1195. [PMID: 34693003 PMCID: PMC8513454 DOI: 10.1002/lio2.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/19/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To prevent cavity problems in canal wall down mastoidectomy, silicone block for mastoid obliteration was used. METHODS In this retrospective cohort study, 39 patients (21 males and 18 females) underwent canal wall down mastoidectomy and mastoid obliteration using silicone block. We evaluated the postoperative outcome, the time until epithelialization of the cavity, graft success rate, and the hearing outcome. RESULTS The time until complete epithelialization of the mastoid cavity was 35.5 ± 5.4 days. We had a graft success rate of 100% during the follow-ups. The postoperative evaluation revealed 36 dry ears (92.3%) patients without any cavity problems. However, one ear developed granulation tissue, and two ears had partially exposed silicone block, which required revision mastoidectomy. Regarding hearing outcomes, a complication such as deaf ear was not reported. CONCLUSION Silicone block is safe and suitable for mastoid obliteration and external auditory canal reconstruction in canal wall down mastoidectomy. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mohammad Faramarzi
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Reza Kaboodkhani
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Ali Faramarzi
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Sareh Roosta
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Mohammadjavad Erfanizadeh
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
| | - Milad Hosseinialhashemi
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
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Hundertpfund J, Meyer JE, Ovari A. Long-term audiological benefit with an active transcutaneous bone-conduction device: a retrospective cohort analysis. Eur Arch Otorhinolaryngol 2021; 279:3309-3326. [PMID: 34424382 DOI: 10.1007/s00405-021-07031-w] [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: 04/25/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate long-term audiological, surgical and safety outcomes of a complex patient cohort treated with an active transcutaneous bone-conduction device (tBCD). METHODS This retrospective, monocentric cohort analysis involves 31 adults with conductive (CHL) and mixed hearing loss (MHL). For outcome analysis, study results were divided into short-term follow-up data (< 12 months) and long-term follow-up data (> 12 months). RESULTS 31 patients with a total person-time of 90.4 years and an average number of 3.2 ± 1.5 preoperatively performed surgeries on the implanted side were investigated. Mean BCD-aided PTA4 thresholds were significantly lower than unaided PTA4AC before surgery (64.7 ± 16.1 dB HL; CHL 50.6 ± 10.6 dB HL; MHL 72.8 ± 12.8 dB HL) and did not change between short-term (42.3 ± 13.1 dB HL; CHL 35.8 ± 6.8 dB HL; MHL 45.2 ± 14.3 dB HL) and long-term (43.4 ± 10.0 dB HL; CHL 35.8 ± 4.3 dB HL; MHL 48.1 ± 9.6 dB HL) follow-up periods. Speech intelligibility in the Freiburg monosyllables test at 65 dB improved significantly, from 16.3 ± 21.5% (CHL 26.8 ± 19.0%; MHL 8.7 ± 20.5%) in the unaided condition to 82.7 ± 15.5% (CHL 90.0 ± 12.2%; MHL 79.4 ± 16.3%) in the short-term and 85.5 ± 13.2% (CHL 93.8 ± 7.9%; MHL 79.5 ± 13.3%) BCD-aided in the long-term follow-up periods. Ten minor procedure-related and 6 implant-related (5 minor, 1 major) AEs occurred over the total follow-up period. CONCLUSION The device provides satisfactory audiological and speech benefit over long-term follow-up periods, up to 7 years. Explant rates were very low, while the overall rate of manageable AEs was high in this complex patient cohort. The device is considered a safe and effective option in the long-term hearing rehabilitation of patients with CHL and MHL.
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Affiliation(s)
| | - Jens Eduard Meyer
- Asklepios Medical School, Semmelweis University, Hamburg, Germany.,Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Attila Ovari
- Asklepios Medical School, Semmelweis University, Hamburg, Germany. .,Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany. .,Department of Oto-Rhino-Laryngology, Head and Neck Surgery, "Otto Koerner", University Medical Center, Rostock, Germany.
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Song CI, Cho HH, Choi BY, Choi JY, Choi JW, Choung YH, Chung JW, Chung WH, Hong SH, Kim Y, Lee BD, Lee IW, Lee JD, Lee JH, Lee KY, Moon IJ, Moon IS, Oh SH, Park HJ, Park SN, Seo JW. Results of the Active Middle Ear Implantation in Patients With Mixed Hearing Loss After the Middle Ear Surgery: Prospective Multicenter Study (ROMEO Study). Clin Exp Otorhinolaryngol 2021; 15:69-76. [PMID: 33848418 PMCID: PMC8901952 DOI: 10.21053/ceo.2020.01851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. Methods The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. Results The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. Conclusion RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.
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Affiliation(s)
- Chan Il Song
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyong-Ho Cho
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Won-Ho Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hwa Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yehree Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Byung Don Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jong Dae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Korea
| | - Il Joon Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Shi Nae Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Won Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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