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Martínez-Ruiz de Apodaca P, Carrasco-Llatas M, Esteller-Moré E. Surgical versus non-surgical treatment in the Obstructive Sleep Apnea-Hypopnea Syndrome. Int J Pediatr Otorhinolaryngol 2020; 138:110310. [PMID: 32836142 DOI: 10.1016/j.ijporl.2020.110310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The treatment of choice for pediatric OSAHS is surgical. However, its etiopathogenesis is multifactorial and surgery does not always solve it. Therefore, other modalities of treatment are used. The main objective of this study is to shed light on the efficacy of surgery compared to other treatments. METHODS AND MATERIALS Prospective cohort study with 317 children ages 1-13 years and apnea-hypopnea index (AHI) ≥3/h with no previous treatment. The treatment was organised into 3 categories: surgical (n = 201), medical (n = 75) and observation (n = 41). Quality of life and sleep was assessed by two validated questionnaires (PSQ & Esteller et al.) The upper airway was explored, and nocturnal polysomnography (PSG) performed in every patient. After 12 ± 3 months of treatment was completed, a new PSG and questionnaires were evaluated. RESULTS The surgical group improved significantly both subjectively and objectively. Mean AHI decreased from 7.95/h to 2.57/h and T 90 (time spent with arterial oxygen saturation <90%) from 0.49 to 0. AHI of the medical group decreased only from 5.09/h to 4.9/h. Subjective parameters improved less than in the surgical group. Persistence after surgery was 31%, 50% following medical treatment, and after observation 75%. There were no differences in age and BMI between groups. Age or obesity showed no relationship with treatment success or failure. CONCLUSIONS The best results were achieved in surgically treated children. However, 31% of those operated had OSAHS persistence, which means a combination of treatments may be the most appropriate strategy.
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Affiliation(s)
| | - Marina Carrasco-Llatas
- ENT Department, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar, Nº 90, Valencia, Spain.
| | - Eduard Esteller-Moré
- ENT Department, Hospital Universitari General de Catalunya, San Cugat Del Vallès, Barcelona, Spain; Universitat Internacional de Catalunya, Calle Josep Trueta, s/n, San Cugat Del Vallès, Barcelona, Spain.
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Outcome of drug-induced sleep endoscopy-directed surgery for persistent obstructive sleep apnea after adenotonsillar surgery. Int J Pediatr Otorhinolaryngol 2019; 120:118-122. [PMID: 30776569 DOI: 10.1016/j.ijporl.2019.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Drug-induced sleep endoscopy (DISE) is suitable for evaluating persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillar surgery as a means to guide surgical intervention, yet few studies demonstrate its usefulness in resolving the syndrome. We describe our experience of DISE-directed surgery in children with persistent OSAS by analysing objective and subjective outcomes of this treatment. METHODS Prospective study of 20 otherwise healthy 2-12 year-old children with OSAS persisting after adenotonsillar surgery. All patients underwent DISE-directed surgery and were followed up clinically and with a polysomnogram at 12 ± 3 months. RESULTS All 20 children had an apnea-hypopnea index (AHI) score ≥1 (mean: 6.1 ± 4.9) and 75% had AHI>3 before surgery. We performed a total of 14 total tonsillectomies (70%), 7 with associated pharyngoplasties; 5 radiofrequency turbinate reductions (25%); 7 radiofrequency lingual tonsil reductions (35%); and 10 revision adenoidectomies (50%). No surgery-related complications were observed. AHI scores at follow-up were significantly lower than AHI scores before surgery (1.895 ± 1.11 vs 6.143 ± 4.88; p < 0.05) and, in 85% (n = 17) of patients, AHI was below 3. There was a significant reduction in the number of children with AHI>3 in follow-up at 12 ± 3 months (15%; n = 3) compared to before surgery (75%; n = 15) (p < 0.005). CONCLUSION DISE-directed surgery for otherwise healthy children with persistent OSAS is a useful and safe technique to decide a therapeutic strategy and to obtain good objective and subjective results regarding resolution of the syndrome.
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Collu MA, Esteller E, Lipari F, Haspert R, Mulas D, Diaz MA, Dwivedi RC. A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications. Int J Pediatr Otorhinolaryngol 2018; 108:113-119. [PMID: 29605338 DOI: 10.1016/j.ijporl.2018.02.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether and when Drug-Induced Sleep Endoscopy (DISE) changes diagnosis and treatment plan in pediatric Obstructive Sleep Apnoea Syndrome (OSAS) with the aim to identify specific subgroups of patients for whom DISE should be especially considered. METHODS A case-control study of DISE in 150 children with OSAS. Pre-operative OSA were assessed through detailed history, Chervin questionnaire, physical examination and overnight polysomnography. The group of study was divided into three subgroups according to clinical and polysomnographyc criteria: conventional OSAS, disproportional OSAS and persistent OSAS. Endoscopic evaluation of the upper airway during DISE was scored using Chan classification. Surgical treatment was tailored individually upon the basis of sleep endoscopy findings: performance of any surgery other than tonsillectomy and adenoidectomy (T&A) was considered as a change of the treatment plan. Cases and controls were compared considering presence and absence of DISE-directed extra surgery, respectively. RESULTS 150 patients with mean age (SD) 56.09 (23.94) months and mean apnoea-hypopnea index (AHI) of 5.79 (6.52) underwent DISE. The conventional subgroup represented the 58.67% of the sample (n = 88), while the disproportional one counted for the 26.67% (n = 40), and the persistent one for 14.66% (n = 22) of the population. Sleep endoscopy changed the surgical plan in 4.5% of conventional OSAS, 17.5% of disproportional OSAS and 72.7% of persistent OSAS (p < 0.005). Overall, a change of the treatment plan operated by DISE was associated with a non-conventional OSAS status (OR = 6; 95% CI = 1.6-26.4). CONCLUSIONS DISE is a safe procedure in children suffering from OSAS, and, despite being unnecessary in conventional cases of OSA, DISE should be considered not only in syndromic children, as previously demonstrated, but also in the general non-syndromic pediatric population, in the case of non-conventional OSA patients, and in children with persistent OSAS.
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Affiliation(s)
| | - Eduard Esteller
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, San Cugat del Vallès, Barcelona, Spain; Universitat Internacional de Catalunya, San Cugat del Vallès, Barcelona, Spain.
| | - Fiorella Lipari
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Raul Haspert
- Anestesia Department, Hospital Universitari General de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Demetrio Mulas
- Anestesia Department, Hospital Universitari General de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Miguel Angel Diaz
- Hospital Universitario General de Catalunya, EAP Sant Ildefons Cornellà Institut Català de la Salut, San Cugat del Vallès, Barcelona, Spain
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Esteller E, Villatoro JC, Agüero A, Lopez R, Matiñó E, Argemi J, Girabent-Farrés M. Obstructive sleep apnea syndrome and growth failure. Int J Pediatr Otorhinolaryngol 2018; 108:214-218. [PMID: 29605357 DOI: 10.1016/j.ijporl.2018.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from tonsillectomy and adenoidectomy to recover and normalize their growth rate.
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Affiliation(s)
- E Esteller
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain; Medicine Department, Universitat Internacional de Catalunya, Spain.
| | - J C Villatoro
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain
| | - A Agüero
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain
| | - R Lopez
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain
| | - E Matiñó
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, Spain; Medicine Department, Universitat Internacional de Catalunya, Spain
| | - J Argemi
- Universitat Internacional de Catalunya, Spain
| | - M Girabent-Farrés
- Physical Therapy Department (Biostatistics Unit), Universitat Internacional de Catalunya, Spain
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Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M. Surgical Treatment for Childhood Obstructive Sleep Apnoea: Cold-Knife Tonsillar Dissection Versus Bipolar Radiofrequency Thermal Ablation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M. Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:261-7. [PMID: 26992775 DOI: 10.1016/j.otorri.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA). METHOD A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared. RESULT The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques. CONCLUSION In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences.
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Affiliation(s)
- Eduard Esteller
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España.
| | - Juan Carlos Villatoro
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Gabriel Pedemonte
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Adriana Agüero
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Joan Manel Ademà
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Montserrat Girabent-Farrés
- Unidad de Bioestadística, Departamento de Fisioterapia, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
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Esteller E, Barceló M, Segarra F, Estivill E, Girabent-Farrés M. Alteraciones cognitivas y conductuales tras adenoamigdalectomía en el síndrome de apnea del sueño. An Pediatr (Barc) 2014; 80:214-20. [DOI: 10.1016/j.anpedi.2013.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/04/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022] Open
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Clinical and Polysomnographic Correlation in Sleep-related Breathing Disorders in Children. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Esteller E, Santos P, Segarra F, Estivill E, Lopez R, Matiñó E, Ademà JM. Clinical and polysomnographic correlation in sleep-related breathing disorders in children. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:108-14. [PMID: 23141633 DOI: 10.1016/j.otorri.2012.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/30/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Although polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms. OBJECTIVE To evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment. MATERIAL AND METHODS We compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up. RESULTS Before surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=.047). CONCLUSION Despite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation.
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Affiliation(s)
- Eduard Esteller
- Servicio de Otorrinolaringología, Hospital General de Catalunya, San Cugat del Vallès, Barcelona, Spain.
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Esteller-Moré E, Castells-Vilella L, Segarra-Isern F, Argemí-Renom J. Childhood Obesity and Sleep-related Breathing Disorders. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012. [DOI: 10.1016/j.otoeng.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Persistencia a largo plazo del síndrome de la apnea-hipopnea obstructiva del sueño infantil tratada con adenoamigdalectomía. Análisis de factores pronósticos. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:85-92. [DOI: 10.1016/j.otorri.2011.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 08/24/2011] [Accepted: 08/29/2011] [Indexed: 01/17/2023]
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Long-term Persistence of Obstructive Sleep Apnoea–hypopnoea Syndrome in Children Treated With Adenotonsillectomy. Analysis of Prognostic Factors. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.otoeng.2011.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Esteller-Moré E, Castells-Vilella L, Segarra-Isern F, Argemí-Renom J. [Childhood obesity and sleep-related breathing disorders]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 63:180-6. [PMID: 22197456 DOI: 10.1016/j.otorri.2011.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 10/07/2011] [Accepted: 10/20/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The increasing prevalence of childhood obesity leads to an increase risk of sleep-disordered breathing and may exacerbate their comorbidities. PURPOSE To assess the rate of obesity in children with sleep-disordered breathing and to study the possible clinical and epidemiological differences between children with and without overweight in a private hospital in the Mediterranean area. MATERIALS AND METHODS We prospectively studied 340 children between 2 and 10 years. There were 170 children with sleep-disordered breathing (study group) and 170 healthy children (control group). In the problem group, the apnea-hypopnea index was around 7.61 ± 6.3. RESULTS The comparison of the percentage of cases with a BMI percentile ≥85 (overweight) between problem and control groups (44: 25.9% vs 34: 20%) or with a BMI ≥95 (obesity) (30: 17.6% vs 20: 11.8%) showed no statistically-significant differences. In addition, the comparison of clinical and epidemiological variables in the problem group, cases with (44/170: 25.9%) and without (126/170: 74.1%) overweight, did not show significant differences in any of the parameters analysed. CONCLUSION In the population studied, it does not appear that the group of children with sleep breathing disorders presents higher rates of obesity, nor does obesity influence its presentation clinically. These results had probably been influenced by the characteristics of the studied population and therefore should not be an obstacle for being attentive to the possible association of respiratory disease to obesity and its negative consequences.
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Affiliation(s)
- Eduard Esteller-Moré
- Servicio de Otorrinolaringología, Hospital General de Catalunya, San Cugat del Vallés, Barcelona, España.
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Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s2173-5735(09)70152-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Alteraciones neurocognitivas y conductuales en los trastornos respiratorios del sueño infantil. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 60:325-31. [DOI: 10.1016/j.otorri.2009.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 01/07/2009] [Indexed: 11/20/2022]
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