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Alshehri S, Al Shalwan MAM, Oraydan AAA, Almuaddi ASH, Alghanim AJA. Factors Influencing Treatment Success in Cholesteatoma Management: A Cross-Sectional Study. J Clin Med 2024; 13:2606. [PMID: 38731136 PMCID: PMC11084144 DOI: 10.3390/jcm13092606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Cholesteatoma presents significant management challenges in otolaryngology. This study aimed to delineate the influence of demographic and clinical characteristics, preoperative imaging, and surgical approaches on treatment success in cholesteatoma management. Methods: A cross-sectional analytical study was conducted at the Otolaryngology Department of the University Hospital from January 2021 to December 2022. It included 68 patients diagnosed with cholesteatoma, focusing on three objectives: assessing the impact of demographic and clinical characteristics on treatment outcomes, evaluating the predictive value of preoperative imaging findings, and analyzing the influence of surgical factors. Results: The study population predominantly consisted of male (56%) and Saudi (81%) patients, with an average age of 45 years. Logistic regression revealed that older age (OR: 1.05), male gender (OR: 0.63), and non-Saudi Arab ethnicity (OR: 2.14) significantly impacted treatment outcomes. Clinical characteristics such as severe disease severity (OR: 3.00) and longer symptom duration (OR: 0.96) also influenced treatment success. In preoperative imaging, labyrinthine fistula (Regression Coefficient: 0.63) and epidural extension (Coefficient: 0.55) emerged as key predictors. The surgical factors that significantly affected the outcomes included the extent of surgery (Complete Removal OR: 3.32) and the use of endoscopic approaches (OR: 1.42). Conclusions: This study highlights that patient demographics, clinical profiles, specific preoperative imaging features, and surgical strategies multifactorially determine cholesteatoma treatment success. These findings suggest the necessity for a tailored approach in cholesteatoma management, reinforcing the importance of individualized treatment plans based on comprehensive preoperative assessments.
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Affiliation(s)
- Sarah Alshehri
- Otology and Neurotology, Department of Surgery, College of Medicine, King Khalid University, Abha 61423, Saudi Arabia
| | | | | | - Abdulrahman Saeed H. Almuaddi
- College of Medicine, King Khalid University, Abha 61423, Saudi Arabia; (M.A.M.A.S.); (A.A.A.O.); (A.S.H.A.); (A.J.A.A.)
| | - Ahmed Jubran A. Alghanim
- College of Medicine, King Khalid University, Abha 61423, Saudi Arabia; (M.A.M.A.S.); (A.A.A.O.); (A.S.H.A.); (A.J.A.A.)
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Kalmanson O, Francom C, Darr O, Hamilton S. Pediatric cholesteatoma associated with congenital aural atresia and stenosis. Am J Otolaryngol 2023; 44:103986. [PMID: 37459737 PMCID: PMC10528927 DOI: 10.1016/j.amjoto.2023.103986] [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: 05/01/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Investigate presenting features, associated surgical treatment, and outcomes in patients with cholesteatoma associated with congenital aural atresia (CAA) or stenosis (CAS). METHODS Colorado Multiple Institution Review Board approval was obtained. A retrospective chart review was performed at a single tertiary care children's hospital of all pediatric patients with congenital aural atresia or stenosis with associated cholesteatoma from January 1, 2003, to October 15, 2018. RESULTS Of the 278 patients identified with CAA or CAS, twelve (4.3 %) were found to have a canal cholesteatoma. There was a male predominance (8:4). Nine patients (75 %) had conductive loss and three (25 %) had mixed loss. Four patients (33.3 %) exhibited canal cholesteatomas extending into the middle ear or mastoid cavity. All patients underwent surgery, and 25 % of patients required revision canalplasty while 58 % of patients required revision surgery for cholesteatoma recidivism. The average age at the time of surgery was 11.3 ± 3.7 years. CONCLUSION Fewer than 5 % of pediatric patients with congenital aural atresia or stenosis were diagnosed with an acquired canal cholesteatoma. The need for revision surgery was common, occurring in >50 % of cases. Screening patients with CAA/CAS for cholesteatoma with imaging is recommended to avoid the morbidity of delayed identification.
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Affiliation(s)
- Olivia Kalmanson
- Department of Otolaryngology, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States; Department of Otolaryngology, The University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, United States.
| | - Christian Francom
- Department of Otolaryngology, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States; Department of Otolaryngology, The University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, United States
| | - Owen Darr
- Department of Otolaryngology, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States; Department of Otolaryngology, The University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, United States
| | - Steven Hamilton
- Department of Otolaryngology, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States; Department of Otolaryngology, The University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, United States
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Teranishi Y, Koda Y, Kajimoto Y, Oishi M, Sunami K. A Case of a Congenital Cholesteatoma Without Growth for a Long Term. Cureus 2023; 15:e40945. [PMID: 37366477 PMCID: PMC10290909 DOI: 10.7759/cureus.40945] [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] [Accepted: 06/23/2023] [Indexed: 06/28/2023] Open
Abstract
Congenital cholesteatoma is typically an expanding cystic mass of keratinizing squamous epithelium located medial to the intact tympanic membrane in patients with no prior history of perforation, otorrhea and ear. It is generally thought to be a progressive disease and is usually surgically removed upon detection as the first-choice treatment. As such, it is rare to be observed for a long term without progression. Here we report a rare case of congenital cholesteatoma that remained in an undetectable size and did not deteriorate mild hearing loss for 12 years. A seven years old boy was referred to us with right hearing impairment. Pure-tone audiometry found conductive hearing loss with an air-bone gap of 25 dB and a high-resolution computed tomography (CT) scan found the eroded long process of incus but did not detect any soft tissue density indicating congenital cholesteatoma. He initially did not wish to undergo surgery. His hearing level and image finding remained virtually unchanged during the next 12 years of the follow-up period. Twelve years later, endoscopic ear surgery was performed, which revealed a very small cholesteatoma mass, an eroded long process of the incus and ossicular chain discontinuities. We suspect that the cholesteatoma was originally larger, partially eroded the incus, then regressed to a very small size, and remained small for at least 12 years under our observation.
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Affiliation(s)
- Yuichi Teranishi
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
| | - Yuki Koda
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
| | - Yasuyuki Kajimoto
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
| | - Masaya Oishi
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
| | - Kishiko Sunami
- Otolaryngology - Head and Neck Surgery, Osaka Metropolitan University, Osaka, JPN
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Coleman H, Tikka T, Curran J, Iyer A. Comparison of endoscopic vs microscopic ossiculoplasty: a study of 157 consecutive cases. Eur Arch Otorhinolaryngol 2023; 280:89-96. [PMID: 35598229 DOI: 10.1007/s00405-022-07451-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/13/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The relatively new technique of trans-canal endoscopic ear surgery (TEES) when compared to microsurgery for ossiculoplasty has advantages of better visualization and no external incision but also has the disadvantage of being a one-handed procedure. Our study aimed to compare audiometric outcomes following ossiculoplasty performed via TESS with results of microsurgery. MATERIALS AND METHODS Data from a prospective audit of 157 consecutive patients who underwent ossiculoplasty by a single otologist from 2009 to 2018 was analyzed. TEES was introduced in the department in 2014; therefore, all patients before this period underwent microsurgery. Patients were classified by surgical approach, TEES, or microsurgery. Audiological outcomes were recorded at 3 and 12 months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used. RESULTS Of the 157 cases, 50 were TEES and 107 were microsurgery (81 microscope only and 27 combined with endoscope). There was statistically significant improvement (p < 0.001) in AC (43.4 dB pre-operatively, 36.2 dB postoperatively), BC (20.3 dB pre-operatively, 17.6 dB postoperatively), and ABG (21.8 dB pre-operatively, 16.7 dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20 dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12 months when compared to 3 months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft. CONCLUSION TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Holli Coleman
- Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK
| | - Theofano Tikka
- Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK
| | - John Curran
- Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK
| | - Arunachalam Iyer
- Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK.
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Wang X, Guo J, Liu W, Chen M, Shao J, Zhang X, Ma N, Li Y, Peng Y, Zhang J. Comparison of the EAONO/JOS, STAMCO and ChOLE cholesteatoma staging systems in the prognostic evaluation of acquired middle ear cholesteatoma in children. Eur Arch Otorhinolaryngol 2022; 279:5583-5590. [PMID: 35554663 DOI: 10.1007/s00405-022-07400-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare the performance of the EAONO/JOS, STAMCO, and ChOLE Cholesteatoma Staging Systems in prognostic evaluation of children acquired middle ear cholesteatoma after primary surgery and identify the other factors that could predict cholesteatoma recidivism. And the correlation between the staging and the recidivism of cholesteatoma after grouping according to operation was evaluated. METHODS A total of 123 ears of 118 patients that underwent surgery for primary cholesteatoma from November 2008 to May 2020 were included in this retrospective study, and then classified and staged according to the EAONO/JOS, STAMCO, and ChOLE cholesteatoma staging system, respectively. Each indicator involved in the system above was analyzed separately to evaluate its prognostic value for cholesteatoma recidivism. RESULTS The type of surgical procedure performed (P = 0.020) was shown to be associated with cholesteatoma recidivism. Cholesteatoma location the supratubal recess (S1) (P = 0.026, HR = 3.614, 95% CI 1.137, 7.945), and the sinus tympani (S2) (P = 0.004, HR = 4.208, 95% CI 1.574, 11.250) were shown to be significantly associated with disease recidivism. When focusing on the CWU operation group, ossicular chain status in STAMCO stage (P = 0.043) and in the ChOLE stage (P = 0.018) were significantly associated with cholesteatoma recidivism. The results had shown no association between the three stages and cholesteatoma recidivism in the CWD and endoscopic surgery groups. CONCLUSIONS Based on our study, the EAONO/JOS, STAMCO, and ChOLE Classifications have limited value in predicting cholesteatoma recidivism, in acquired middle ear cholesteatoma in children. Adding the pathological status of the ossicular chain may be useful for predicting the recidivism of cholesteatoma. Additional validation studies are entailed to definitively assess the clinical utility of these classifications.
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Affiliation(s)
- Xiaoxu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Jianlin Guo
- Department of Radiology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Wei Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Min Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Jianbo Shao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Xiao Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Ning Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Yanhong Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China.
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China. .,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China.
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Cheeney S, Wright JN, Sie KC, Chapman T. Pearls of Temporal Bone Imaging in Children with Hearing Loss. Semin Ultrasound CT MR 2022; 43:3-18. [PMID: 35164907 DOI: 10.1053/j.sult.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hearing loss is one of the most common indications for temporal bone imaging in children. Hearing loss may be congenital or acquired, and it may be conductive, sensorineural, or mixed audiologically. Temporal bone imaging plays an important role in the assessment and management of this condition. An understanding of the embryology of ear structures better enables the radiologist to interpret abnormalities on imaging of the temporal bone. Here, we provide a general review of ear development and a description of known genetic defects that contribute to congenital ear anomalies associated with hearing loss. We provide appropriate imaging techniques for the temporal bone depending on the clinical presentation and a systematic approach to imaging for children with hearing loss. Diagnostic imaging for developmental anomalies of the ear and cholesteatoma will be discussed.
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Affiliation(s)
- Safia Cheeney
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Jason N Wright
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Kathleen C Sie
- Department of Otolaryngology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
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Kim HC, Yang HC, Cho HH. Endoscopic Surgery of Congenital Cholesteatoma in the Anterior Epitympanic Recess: A Case Report of a Rare Location. EAR, NOSE & THROAT JOURNAL 2020; 101:677-679. [PMID: 33314962 DOI: 10.1177/0145561320969249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Congenital cholesteatoma is a whitish mass in the middle ear medial to an intact tympanic membrane. It is often without symptoms and therefore incidentally diagnosed. Pediatric congenital cholesteatoma generally starts as a small pearl-like mass in the middle ear cavity that eventually expands to involve the ossicles, epitympanum, and mastoid. The location, size, histopathological type, and extent of the mass must be evaluated to select the appropriate surgical method. Although microscopic ear surgery has traditionally been performed to remove congenital cholesteatoma, a recently introduced alternative is endoscopic surgery, which allows a minimally invasive approach and has better visualization. Here, we report the first known case of a patient with congenital cholesteatoma in the anterior epitympanic recess and discuss the utility of an endoscopic approach in the removal of a congenital cholesteatoma in the hidden area within the middle ear.
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Affiliation(s)
- Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyong-Ho Cho
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
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Lee JA, Fuller SR, Nguyen SA, Meyer TA. Factors affecting complications and comorbidities in children with cholesteatoma. Int J Pediatr Otorhinolaryngol 2020; 135:110080. [PMID: 32413646 DOI: 10.1016/j.ijporl.2020.110080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the effects of age, race, payer status, and socioeconomic status on complications and comorbidities in children with cholesteatoma. METHODS An analysis of the Kids' Inpatient Database was performed on cases of cholesteatoma between 2006 and 2016, along with associated complications or co-morbidities and surgical interventions. RESULTS 1552 cases of pediatric cholesteatoma represented 5.6 cases per 100,000 total discharges over the study period. The mean age was 9.9 (±5.4) years. Compared to children in the 4th age quartile, those in the 1st age quartile had decreased risk of conductive hearing loss (OR 0.64 [0.42-0.99]), venous thrombosis (OR 0.24 [0.06-0.88]), intracranial abscess (OR 0.35 [0.13-0.96]), and facial nerve palsy (0.44 [0.20-0.97]), but increased risk of chronic otitis media (OR 2.24 [1.23-4.10]). Compared to children identified as Other race, children identified as Black had increased risk of acute otitis media (OR 9.20 [1.35-62.78]). Both children identified as Black (OR 9.90 [1.48-66.35]) or Hispanic (OR 6.24 [1.01-38.51]) had increased risk of facial nerve palsy. Relative to children in the 4th income quartile, children in the 1st income quartile had increased risk of acute mastoiditis (OR 1.87 [1.15-3.03]) and subperiosteal abscess (OR 6.75 [2.22-20.56]). Children in the 2nd income quartile were less likely to receive ossicular chain surgery (OR 0.31 [0.13-0.72]). CONCLUSION Differences pertaining to age, race, payer status, and socioeconomic status exist in the presentation and surgical management of children hospitalized with cholesteatoma. Older children are at increased risk of intracranial complications. Patients of Black and Hispanic race might have a higher risk of facial nerve palsy. Compared to children of higher income families, those from lower income families more frequently develop acute mastoiditis and subperiosteal abscess. Providers should be mindful of these risk factors when caring for children with cholesteatoma.
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Affiliation(s)
- Joshua A Lee
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Stephen R Fuller
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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