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Bonino AY, Mood D. Identifying reduced hearing in children who have developmental disabilities: Insights for inclusive research practices with electronic health records. Front Psychol 2023; 14:1134034. [PMID: 37008840 PMCID: PMC10050381 DOI: 10.3389/fpsyg.2023.1134034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/21/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionRecent advancements in big data analytics and the formation of large-scale clinical data repositories provide a unique opportunity to determine the current state of pediatric hearing health care for children who have developmental disabilities. Before answering unresolved questions about diagnostic practice, it is paramount to determine a standard and reliable method for identifying children who have reduced hearing because clinical management is affected by hearing status. The purpose of this study was to compare 5 different methods for identifying cases of reduced hearing from pure-tone thresholds based on developmental disability status.MethodsUsing retrospective clinical data from 100,960 children (0–18 years), hearing status was determined for a total of 226,580 encounters from three clinical sites. 9% of the children had a diagnosis of intellectual disability, autism spectrum disorder, Down syndrome, or cerebral palsy.ResultsResults revealed that encounters from children who have developmental disabilities were more likely to have insufficient data to allow hearing status to be determined. Moreover, methods with higher data demands (i.e., number of thresholds and ear-specific thresholds) resulted in fewer classifiable encounters. The average child age when hearing status was classified for the first time was older for children who have developmental disabilities than for children in the comparison group. Allowing thresholds to build up over multiple test sessions did result in more children who have developmental disabilities being classified than for single-encounter methods, but a meaningful decrease in child age at the time of classification was not seen for this strategy. Compared to the comparison group, children who have developmental disabilities were more likely to have reduced hearing that was stable over time, yet their hearing status was determined at older ages.DiscussionResults provide key guidance to researchers for how to determine hearing status in children for big data applications using electronic health records. Furthermore, several assessment disparities are spotlighted for children who have developmental disabilities that warrant further investigation.
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Affiliation(s)
- Angela Yarnell Bonino
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder, Boulder, CO, United States
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- *Correspondence: Angela Yarnell Bonino,
| | - Deborah Mood
- Department of Pediatrics, University of Colorado Denver | Anschutz Medical Campus, Aurora, CO, United States
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Melo SCSD, Vieira FS. Critérios para a classificação do grau da perda auditiva e proteção social de pessoas com essa deficiência. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222437321s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: identificar critérios adotados nacional e internacionalmente para classificação do grau da perda auditiva, compará-los com o estabelecido na legislação brasileira e discutir as possíveis consequências dessa legislação para a proteção social de Pessoas com Deficiência (PcD) auditiva. Métodos: realizou-se uma revisão narrativa para a identificação dos critérios utilizados nessa classificação. A busca foi realizada em abril de 2020, a partir das plataformas BVS e PUBMED. Foram incluídos estudos publicados entre 2015 e 2019, em inglês, espanhol e português, sobre pesquisas primárias realizadas com seres humanos e menção explícita aos critérios utilizados para a classificação do grau da perda auditiva. Revisão da Literatura: observou-se que há uma predileção pela média entre as frequências de 0,5, 1, 2 e 4 kHz. A legislação brasileira não segue esse critério, o que pode ser uma barreira para o acesso das PcD auditiva aos programas de proteção social. Considerações Finais: não há consenso sobre qual é o melhor critério, todavia há predominância de utilização do considerado mais abrangente para a avaliação auditiva, que não é o legalmente adotado no Brasil. É necessário um debate sobre o critério legal brasileiro, a fim de promover os direitos sociais instituídos para parte das PcD auditiva no Brasil.
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Affiliation(s)
| | - Fabiola Sulpino Vieira
- Universidade Federal de Pernambuco, Brazil; Instituto de Pesquisa Econômica Aplicada, Brasil
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Melo SCSD, Vieira FS. Criteria to classify degrees of hearing loss and the social protection of people with this disability. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222437321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Purpose: to identify criteria used nationally and internationally to classify degrees of hearing loss, compare them with what is established in the Brazilian law, and discuss possible consequences of such a law on the social protection of people with hearing loss. Methods: a narrative review was conducted to identify the criteria used in this classification, by searching the platforms VHL and PubMed in April 2020. It included primary human research explicitly mentioning the criteria used to classify the degree of hearing loss, published between 2015 and 2019 in English, Spanish, and Portuguese. Literature Review: there is a preference for the four-frequency mean at 0.5, 1, 2, and 4 kHz. The Brazilian law does not follow these criteria, which may pose a barrier to people with hearing loss, hindering their access to social protection programs. Final Considerations: there is no consensus on the best criteria, although the most encompassing ones in hearing assessment predominate - which are not the ones legally used in Brazil. It is necessary to debate the Brazilian legal criteria to ensure existing social rights to part of people with hearing loss in Brazil.
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Affiliation(s)
| | - Fabiola Sulpino Vieira
- Universidade Federal de Pernambuco, Brazil; Instituto de Pesquisa Econômica Aplicada, Brasil
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Pennington JW, Ruth B, Miller JM, Peterson J, Xu B, Masino A, Krantz I, Manganella J, Gomes T, Stiles D, Kenna M, Hood LJ, Germiller J, Crenshaw EB. Perspective on the Development of a Large-Scale Clinical Data Repository for Pediatric Hearing Research. Ear Hear 2021; 41:231-238. [PMID: 31408044 PMCID: PMC7007829 DOI: 10.1097/aud.0000000000000779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The use of "big data" for pediatric hearing research requires new approaches to both data collection and research methods. The widespread deployment of electronic health record systems creates new opportunities and corresponding challenges in the secondary use of large volumes of audiological and medical data. Opportunities include cost-effective hypothesis generation, rapid cohort expansion for rare conditions, and observational studies based on sample sizes in the thousands to tens of thousands. Challenges include finding and forming appropriately skilled teams, access to data, data quality assessment, and engagement with a research community new to big data. The authors share their experience and perspective on the work required to build and validate a pediatric hearing research database that integrates clinical data for over 185,000 patients from the electronic health record systems of three major academic medical centers.
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Affiliation(s)
- Jeffrey W. Pennington
- Department of Biomedical and Health Informatics, The Children’s Hospital Of Philadelphia, Philadelphia, PA, USA
| | - Byron Ruth
- Department of Biomedical and Health Informatics, The Children’s Hospital Of Philadelphia, Philadelphia, PA, USA
| | - Jeffrey M. Miller
- Department of Biomedical and Health Informatics, The Children’s Hospital Of Philadelphia, Philadelphia, PA, USA
| | - Joy Peterson
- Center for Childhood Communication, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Baichen Xu
- Center for Childhood Communication, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron Masino
- Department of Biomedical and Health Informatics, The Children’s Hospital Of Philadelphia, Philadelphia, PA, USA
| | - Ian Krantz
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Juliana Manganella
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Tamar Gomes
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Derek Stiles
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Linda J. Hood
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University, Nashville, TN, USA
| | - John Germiller
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Otorhinolaryngology: Head and Neck Surgery, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - E. Bryan Crenshaw
- Center for Childhood Communication, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Otorhinolaryngology: Head and Neck Surgery, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Warnecke A, Giesemann A. Embryology, Malformations, and Rare Diseases of the Cochlea. Laryngorhinootologie 2021; 100:S1-S43. [PMID: 34352899 PMCID: PMC8354575 DOI: 10.1055/a-1349-3824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Despite the low overall prevalence of individual rare diseases, cochlear
dysfunction leading to hearing loss represents a symptom in a large
proportion. The aim of this work was to provide a clear overview of rare
cochlear diseases, taking into account the embryonic development of the
cochlea and the systematic presentation of the different disorders. Although
rapid biotechnological and bioinformatic advances may facilitate the
diagnosis of a rare disease, an interdisciplinary exchange is often required
to raise the suspicion of a rare disease. It is important to recognize that
the phenotype of rare inner ear diseases can vary greatly not only in
non-syndromic but also in syndromic hearing disorders. Finally, it becomes
clear that the phenotype of the individual rare diseases cannot be
determined exclusively by classical genetics even in monogenetic
disorders.
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Affiliation(s)
- Athanasia Warnecke
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover.,Deutsche Forschungsgemeinschaft Exzellenzcluster"Hearing4all" - EXC 2177/1 - Project ID 390895286
| | - Anja Giesemann
- Institut für Neuroradiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover
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Dillard LK, Saunders GH, Zobay O, Naylor G. Insights Into Conducting Audiological Research With Clinical Databases. Am J Audiol 2020; 29:676-681. [PMID: 32946255 DOI: 10.1044/2020_aja-19-00067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The clinical data stored in electronic health records (EHRs) provide unique opportunities for audiological clinical research. In this article, we share insights from our experience of working with a large clinical database of over 730,000 cases. Method Under a framework outlining the process from patient care to researcher data use, we describe issues that can arise in each step of this process and how we overcame specific issues in our data set. Results Correct interpretation of findings depends on an understanding of the data source and structure, and efforts to establish confidence in the data through the processes are discussed under the framework. Conclusion We conclude that EHRs have considerable utility in audiological research, though researchers must exhibit caution and consideration when working with EHRs.
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Affiliation(s)
- Lauren K. Dillard
- School of Medicine and Public Health, University of Wisconsin–Madison
- VA Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Portland, OR
| | - Gabrielle H. Saunders
- VA Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Portland, OR
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, United Kingdom
| | - Oliver Zobay
- VA Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Portland, OR
- School of Medicine, University of Nottingham, United Kingdom
| | - Graham Naylor
- School of Medicine, University of Nottingham, United Kingdom
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Abstract
OBJECTIVE To characterize the relation between protein-calorie malnutrition (PCM) and hearing loss (HL) in children. STUDY DESIGN Retrospective review. SETTING Tertiary referral hospital. PATIENTS Children in the Audiological and Genetic Database with a diagnosis of protein-calorie malnutrition, marasmus, and/or kwashiorkor. INTERVENTIONS None. MAIN OUTCOME MEASURES Prevalence, type, severity (4-tone pure-tone average, PTA), and progression of HL. RESULTS Of 770 children with PCM, 57.8% had HL, compared to 45.5% of children without PCM (p < 0.001). Severely malnourished children had significantly higher odds of moderate-profound HL (aOR 2.27, 95% CI 1.47-3.43), high-frequency HL (aOR 1.82, 95% CI 1.21-2.75), and sensorineural or mixed HL (aOR 1.60, 95% CI 1.05-2.41) compared to children without PCM. Severely malnourished children had significantly worse initial (35.0 dB vs 25.0 dB, p < 0.001), and final median PTA (31.3 dB vs 20.0 dB, p < 0.001) compared to children without PCM. Additionally, HL in children who were moderately and severely malnourished was significantly less likely to improve (aOR 0.47, 95% CI 0.25-0.82 and aOR 0.4, 95% CI 0.2-0.9) when compared to those without PCM. CONCLUSIONS Given the greater prevalence and severity of hearing loss, children with PCM should be considered an at-risk group for poor audiological outcomes, and clinical practice should focus on early treatment and intervention for malnourished children. Routine audiological evaluation should be considered in this population.
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Absent cochlear and abducens nerves in a patient with Duane retraction syndrome. Neurol Sci 2018; 40:643-644. [PMID: 30377846 DOI: 10.1007/s10072-018-3630-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
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Kreicher KL, Weir FW, Nguyen SA, Meyer TA. Characteristics and Progression of Hearing Loss in Children with Down Syndrome. J Pediatr 2018; 193:27-33.e2. [PMID: 29174076 DOI: 10.1016/j.jpeds.2017.09.053] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate hearing impairment in children with Down syndrome, and to describe the factors that influence the severity of hearing loss or changes in hearing over time. STUDY DESIGN Using the Audiological and Genetic Database (AudGenDB), audiograms of children with Down syndrome were analyzed retrospectively for type, severity, and laterality of hearing loss, as well as changes over time. Medical charts and imaging results were reviewed to identify factors influencing hearing loss. RESULTS Among the 1088 patients with Down syndrome included in the study, 921 had hearing loss in at least 1 ear, 91.1% had bilateral hearing loss, and 8.9% had unilateral hearing loss (1760 total ears with hearing loss). Of the ears with hearing loss, 18.8% (n = 180) had moderate or worse hearing loss. "Undefined" hearing loss and pure conductive hearing loss (CHL) were the most common types, followed by mixed hearing loss and sensorineural hearing loss (SNHL). Three-quarters (75.4%) of the children had experienced chronic otitis media or more than 2 episodes of acute otitis media. Patients with bilateral, mixed hearing loss or a history of seizures were at risk for more severe hearing loss. CHL, absence of cholesteatoma, and placement of first ear tubes before age 2 years were associated with greater improvement in hearing over time, whereas SNHL and mixed hearing loss were associated with progressive decline. CONCLUSION Children with Down syndrome who have bilateral, mixed hearing loss or a history of seizures are at risk for more severe hearing loss. SNHL and mixed hearing loss should not be overlooked in patients with CHL. All patients with Down syndrome will benefit from serial audiograms, especially those children with SNHL or mixed hearing loss, which is likely to worsen over time.
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Affiliation(s)
- Kathryn L Kreicher
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC; Case Western Reserve University School of Medicine, Cleveland, OH.
| | - Forest W Weir
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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Kreicher KL, Bauschard MJ, Clemmens CS, Riva CM, Meyer TA. Audiometric assessment of pediatric patients with cystic fibrosis. J Cyst Fibros 2017; 17:383-390. [PMID: 29289454 DOI: 10.1016/j.jcf.2017.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate hearing impairment in pediatric patients with cystic fibrosis (CF). METHODS This is a retrospective analysis of the AudGen database generated by Children's Hospital of Philadelphia. Audiograms were analyzed for type of hearing loss (HL), pure-tone-average (PTA), laterality, and change in hearing over time. Medical charts were reviewed to identify factors that influence development and progression of hearing loss. RESULTS 217 patients with CF were included in this study. 69 (31.8%) had hearing loss on initial audiogram. Chronic otitis media (OR: 2.4, 95% CI: 1.3-4.5, p<0.01), Eustachian tube dysfunction (OR: 2.4, 95% CI: 1.4-5.4, p<0.01), and otorrhea (OR: 6.3, 95% CI: 1.6-24.7, p<0.01) were positive predictors of HL. Children with a diagnosis of diabetes had more decline in hearing over time than those without diabetes (12.4±17.2dB worsening vs. -5.7±9.8dB improvement in PTA, p=0.014). CONCLUSION This is the largest comprehensive analysis of all types of hearing loss in pediatric patients with CF. Our data suggest that children with more severe sinus disease may be at lower risk for inflammatory middle ear disease and subsequent hearing loss. Patients who develop complications of CF such as diabetes should be monitored frequently, and the use of ototoxic drugs should be limited if possible.
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Affiliation(s)
- Kathryn L Kreicher
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States.
| | - Michael J Bauschard
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
| | - Clarice S Clemmens
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
| | - Concetta Maria Riva
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
| | - Ted A Meyer
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
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Muus JS, Weir FW, Kreicher KL, Bowlby DA, Discolo CM, Meyer TA. Hearing loss in children with growth hormone deficiency. Int J Pediatr Otorhinolaryngol 2017; 100:107-113. [PMID: 28802353 DOI: 10.1016/j.ijporl.2017.06.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/26/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although insulin-like growth factor 1 (IGF-1) has been shown to be important for inner-ear development in animal models, little is known about the otologic and audiologic findings of children with growth hormone deficiency (GHD). The goal of this study is to evaluate the prevalence, type, and severity of hearing impairment in children with GHD. METHODS Audiologic, otologic, and demographic data were recorded for children with a diagnosis of GHD in the AudGen database. Data for each patient were selected based on the first encounter with available complete audiometric data or the first encounter with a type of hearing loss documented. The patients were then stratified by type and severity of hearing loss, and otologic issues were documented. A separate cohort comprised of children with GHD without hearing loss was compared as a control. RESULTS 209 children with GHD met inclusion criteria. 173 (83%) of these patients had hearing loss. 79% of losses were bilateral and 21% were unilateral (309 total ears with hearing loss). 293 of the 309 ears with hearing loss had audiograms with ear-specific thresholds; 47 had conductive, 24 had sensorineural, 65 had mixed and 157 had undefined hearing loss with incomplete audiograms. Pure-tone averages (PTA) were higher among patients with mixed hearing loss compared to patients with all other loss types. CONCLUSION Hearing loss is prevalent in children with GHD with a predisposition to be bilateral. These findings suggest the need for increased awareness and routine hearing screening for patients with GHD. Further studies may elucidate the etiology of the hearing impairment in children with GHD to better aid pediatricians, endocrinologists, otolaryngologists and audiologists when assessing and managing these children.
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Affiliation(s)
- John S Muus
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
| | - Forest W Weir
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
| | - Kathryn L Kreicher
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
| | - Deborah A Bowlby
- Department of Endocrinology, Medical University of South Carolina, Charleston, SC, United States.
| | - Christopher M Discolo
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
| | - Ted A Meyer
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
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