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Han EX, Fernandez JM, Swanberg C, Shi R, Bartlett EL. Longitudinal auditory pathophysiology following mild blast-induced trauma. J Neurophysiol 2021; 126:1172-1189. [PMID: 34469703 DOI: 10.1152/jn.00039.2021] [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: 11/22/2022] Open
Abstract
Blast-induced hearing difficulties affect thousands of veterans and civilians. The long-term impact of even a mild blast exposure on the central auditory system is hypothesized to contribute to lasting behavioral complaints associated with mild blast traumatic brain injury (bTBI). Although recovery from mild blast has been studied separately over brief or long time windows, few, if any, studies have investigated recovery longitudinally over short-term and longer-term (months) time windows. Specifically, many peripheral measures of auditory function either recover or exhibit subclinical deficits, masking deficits in processing complex, real-world stimuli that may recover differently. Thus, examining the acute time course and pattern of neurophysiological impairment using appropriate stimuli is critical to better understanding and intervening in bTBI-induced auditory system impairments. Here, we compared auditory brainstem response, middle-latency auditory-evoked potentials, and envelope following responses. Stimuli were clicks, tone pips, amplitude-modulated tones in quiet and in noise, and speech-like stimuli (iterated rippled noise pitch contours) in adult male rats subjected to mild blast and sham exposure over the course of 2 mo. We found that blast animals demonstrated drastic threshold increases and auditory transmission deficits immediately after blast exposure, followed by substantial recovery during the window of 7-14 days postblast, although with some deficits remaining even after 2 mo. Challenging conditions and speech-like stimuli can better elucidate mild bTBI-induced auditory deficit during this period. Our results suggest multiphasic recovery and therefore potentially different time windows for treatment, and deficits can be best observed using a small battery of sound stimuli.NEW & NOTEWORTHY Few studies on blast-induced hearing deficits go beyond simple sounds and sparsely track postexposure. Therefore, the recovery arc for potential therapies and real-world listening is poorly understood. Evidence suggested multiple recovery phases over 2 mo postexposure. Hearing thresholds largely recovered within 14 days and partially explained recovery. However, midlatency responses, responses to amplitude modulation in noise, and speech-like pitch sweeps exhibited extended changes, implying persistent central auditory deficits and the importance of subclinical threshold shifts.
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Affiliation(s)
- Emily X Han
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Joseph M Fernandez
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.,Department Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Caitlin Swanberg
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Riyi Shi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.,Department Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Edward L Bartlett
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
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Moreira Lana G, Sorg K, Wenzel GI, Hecker D, Hensel R, Schick B, Kruttwig K, Arzt E. Self‐Adhesive Silicone Microstructures for the Treatment of Tympanic Membrane Perforations. ADVANCED NANOBIOMED RESEARCH 2021. [DOI: 10.1002/anbr.202100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Gabriela Moreira Lana
- INM – Leibniz Institute for New Materials Campus D2 2 Saarbrücken 66123 Germany
- Department of Materials Science and Engineering Saarland University Campus D2 2 Saarbrücken 66123 Germany
| | - Katharina Sorg
- Department of Otorhinolaryngology Saarland University Medical Center Homburg 66421 Germany
| | - Gentiana Ioana Wenzel
- Department of Otorhinolaryngology Saarland University Medical Center Homburg 66421 Germany
| | - Dietmar Hecker
- Department of Otorhinolaryngology Saarland University Medical Center Homburg 66421 Germany
| | - René Hensel
- INM – Leibniz Institute for New Materials Campus D2 2 Saarbrücken 66123 Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology Saarland University Medical Center Homburg 66421 Germany
| | - Klaus Kruttwig
- INM – Leibniz Institute for New Materials Campus D2 2 Saarbrücken 66123 Germany
| | - Eduard Arzt
- INM – Leibniz Institute for New Materials Campus D2 2 Saarbrücken 66123 Germany
- Department of Materials Science and Engineering Saarland University Campus D2 2 Saarbrücken 66123 Germany
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The Significance of Audiometric Notching in Individuals With a History of Noise Exposure: A Systematic Review. Ear Hear 2021; 42:1109-1118. [PMID: 33908409 DOI: 10.1097/aud.0000000000001034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The diagnosis of noise-induced hearing loss (NIHL) is reliant on the appraisal of audiometric data. A notch, dip or bulge, centered at the 4-kHz frequency is considered to be pathognomonic. However, guidelines applied to assist the diagnosis of NIHL often allow for a notch centered between the 3- and 6-kHz frequencies. The primary outcome of this review is to document the relationship between audiometric notching at particular frequencies and the populations in which they have been identified. DESIGN We included all population-based studies, cohort, cross-sectional, case-control, case-series, and case reports of adults and children, with exposure to noise and with a notch, dip or bulge. The review has been registered with Prospero (Registration: CRD42017079901) and prepared in line with the PRISMA guidelines. RESULTS We included 84 articles in the final systematic review. There were a total of 1,438,987 individuals, aged 7 to 80 years old. The studies were conducted in 26 different countries. Fourteen studies identified notching at 3 kHz, 63 studies identified notching at 4 kHz, and 47 studies identified notching at 6 kHz. The Newcastle-Ottawa risk assessment tool was performed on 82 of the studies emphasizing the high risk of bias in observational studies. CONCLUSIONS The overwhelming outcome of this systematic review demonstrates that the relationship between noise exposure and a 3- to 6-kHz audiometric notch is not straight-forward. A handful of articles have displayed a clear association between an individual's noise exposure and an audiometric notch. Unilateral notches, notches observed at 3 kHz and notches in the absence of continued high-intensity noise exposure must be scrutinized thoroughly. The ambiguous nature of NIHL directs its continued interest.
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Joseph AR, Shaw JL, Clouser MC, MacGregor AJ, Dougherty AL, Galarneau MR. Clinical audiometric patterns of hearing loss following blast-related injury in U.S. military personnel. Int J Audiol 2020; 59:772-779. [PMID: 32293926 DOI: 10.1080/14992027.2020.1743884] [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: 10/24/2022]
Abstract
Objective: To identify clinical audiometric patterns of hearing loss following blast-related injury (BRI) in US military personnel.Design: Retrospective cohort study.Study sample: A total of 1186 male Navy and Marine Corps service members with normal hearing thresholds on pre-injury audiograms who had post-injury audiograms in the Blast-Related Auditory Injury Database.Results: Low- and high-frequency pure-tone averages (PTAs) were significantly higher in those with BRI than non-blast-related injury (NBRI) for both ears (p < 0.001 for all comparisons). Overall, 172 (15%) service members met criteria for post-injury hearing loss and were categorised into PTA or single-frequency hearing loss subgroups. PTA hearing loss was more common in the BRI group (50% vs. 33%, p < 0.036), whereas single-frequency hearing loss was more common in the NBRI group. Most hearing loss was mild to moderate in degree, and three distinct audiometric patterns emerged (i.e. flat, sloping and rising). A flat pattern was the most prevalent configuration among those with PTA hearing loss, especially bilateral loss. Single-frequency hearing loss was mostly unilateral and high frequency.Conclusions: In this study, BRI produced hearing loss across test frequencies, generating more clinically actionable post-injury audiograms than NBRI. We found that post-injury audiometric patterns of hearing loss among military personnel may vary.
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Affiliation(s)
- Antony R Joseph
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.,Hearing Loss Prevention Laboratory, Communication Sciences and Disorders Department, Illinois State University, Normal, IL, USA
| | - Jaime L Shaw
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Mary C Clouser
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Michael R Galarneau
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA
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Sogebi OA, Oyewole EA, Ogunbanwo O. Audiological characteristics of the contralateral ear in patients with unilateral physical non-explosive ear trauma. J Otol 2019; 15:54-58. [PMID: 32440266 PMCID: PMC7231985 DOI: 10.1016/j.joto.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 10/30/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022] Open
Abstract
Objectives To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive (UPN) ear trauma and to compare the audiometric and tympanometric parameters between asymptomatic and symptomatic contralateral ears. Design Prospective analytical clinical study Setting: Specialized (Ear, Nose, and Throat) clinic of a tertiary health institution. Participants: Patients with UPN ear trauma who presented within the first week of the incident. Main outcome measures: Otologic symptoms in the contralateral ear in UPN ear trauma. Results Eighteen out of 53 patients (34.0%) experienced symptoms in the contralateral ear. The symptoms were tinnitus in 77.8% (14/18), hearing loss in 66.7% (12/18), and ear blockage in 27.8% (5/18). There was hearing loss in 38/53 (71.7%) of contralateral ears. Hearing loss type and PTAv at the low frequencies were not significantly different (p=0.142), but other audiometric parameters were significantly different between asymptomatic and symptomatic contralateral ears (p<0.05 in all). Type C tympanogram was more prominent in the symptomatic contralateral ear. There was a statistically-significant difference in the type of tympanogram between the two categories of patients (p=0.018). There was no difference in acoustic reflex between the two categories of patients (p=0.095). Conclusions The contralateral ear may be affected in up to one-third of patients with UPN ear trauma, and experience otologic symptoms similar to those of the traumatized ears. Audiologic and audiometric parameters were abnormal in most of the contralateral ears. The two ears must be assessed thoroughly in cases of UPN ear trauma.
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Affiliation(s)
- Olusola Ayodele Sogebi
- Department of Ear, Nose and Throat, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Emmanuel Abayomi Oyewole
- Department of Ear, Nose and Throat, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Olatundun Ogunbanwo
- Department of Ear, Nose and Throat, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
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Xie P, Peng Y, Hu J, Peng A, Yi S. Assessment of hearing loss induced by tympanic membrane perforations under blast environment. Eur Arch Otorhinolaryngol 2019; 277:453-461. [PMID: 31691016 DOI: 10.1007/s00405-019-05710-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
PURPOSES This study provides an approach to estimating tympanic membrane perforation-induced hearing loss (HL) using a human middle ear model. METHODS Sixty-one cases of tympanic membrane perforation originating from fireworks were reported from the Ear-Nose-Throat Department. The otoscope, audiometry data and diagnosis records were organized, and gender, age, etiology, perforation size and diseased ear side were classified as independent variables. A multinomial regression model was used to analyze the potential effects of the variables on HL. Meanwhile, a human middle ear model was implemented to calculate the ensued HL resulting from different perforation areas and sites. In addition, linear regression models were used to establish functions between perforation size and HL. RESULTS The audiometry data indicate that HL at high frequencies (f > 2 kHz) is much more profound than that at the speech frequency band (f < 1 kHz). Compared with mild HL (<15 dB), mediate HL (15-30 dB) was correlated with the perforation area (p < 0.05, 95% CI), while severe HL (>30 dB) was affected by both perforation size and age (p < 0.05, 95% CI). However, other factors, including gender and diseased ear side, do not show a statistically significant effect on HL. Furthermore, the Kruskal-Wallis test result reveals that HL at frequencies of 0.25 kHz ≤ f ≤ 8 kHz is strongly associated with the perforation size (p < 0.05, 95% CI). CONCLUSIONS It is conclusive that HL is positively proportional to the perforation size. However, HL is not correlated with the perforation site for small perforation areas of < 10% (p > 0.05, 95% CI).
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Affiliation(s)
- Pengpeng Xie
- Key Laboratory of Traffic Safety On Track, Ministry of Education, School of Traffic and Transportation Engineering, Central South University, Changsha, China.,Joint International Research Laboratory of Key Technology for Rail Traffic Safety, Central South University, Changsha, China
| | - Yong Peng
- Key Laboratory of Traffic Safety On Track, Ministry of Education, School of Traffic and Transportation Engineering, Central South University, Changsha, China. .,National and Local Joint Engineering Research Center of Safety Technology for Rail Vehicle, Central South University, Changsha, China.
| | - Junjiao Hu
- Department of of RadiologyThe Second Xiangya Hospital, Central South University, Changsha, China
| | - Anquan Peng
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shengen Yi
- Research Laboratory of Hepatobiliary Diseases General Surgical Department, The Second Xiangya Hospital, Central South University, Changsha, China
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Determinants of hearing loss severity in tympanic membrane perforations in a sub-Saharan African setting. The Journal of Laryngology & Otology 2018; 132:1013-1017. [PMID: 30409241 DOI: 10.1017/s0022215118001962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Factors specific to sub-Saharan Africa could have an impact on tympanic membrane perforation characteristics. Obtaining precise information on these characteristics and determinants of hearing loss severity would enable better management. OBJECTIVE To determine the relationship between characteristics of tympanic membrane perforation and subsequent hearing impairment. METHODS A cross-sectional study of consenting patients presenting with tympanic membrane perforation was conducted. They were examined using otoendoscopy with a digital camera to obtain precise measurements, followed by pure tone audiometry. RESULTS Eighty-six cases of tympanic membrane perforation were included. Mean tympanic membrane perforation proportion was 34.1 ± 18.4 per cent. Medium-sized tympanic membrane perforations were predominant (47.7 per cent). Median tympanic membrane perforation duration was 20 years. Tympanic membrane perforation size was found to be a predictor of hearing loss severity (odds ratio = 2.5, 95 per cent confidence interval = 1.02-6.13, p = 0.04). CONCLUSION Tympanic membrane perforation size was a predictor of hearing loss severity in our setting. Site, duration and aetiology seem to have no impact on hearing loss severity.
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Comparing Spontaneous Closure and Paper Patching in Traumatic Tympanic Membrane Perforations. J Craniofac Surg 2018; 29:1922-1924. [DOI: 10.1097/scs.0000000000005047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Race N, Lai J, Shi R, Bartlett EL. Differences in postinjury auditory system pathophysiology after mild blast and nonblast acute acoustic trauma. J Neurophysiol 2017; 118:782-799. [PMID: 28275059 PMCID: PMC5539456 DOI: 10.1152/jn.00710.2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 01/05/2023] Open
Abstract
Hearing difficulties are the most commonly reported disabilities among veterans. Blast exposures during explosive events likely play a role, given their propensity to directly damage both peripheral (PAS) and central auditory system (CAS) components. Postblast PAS pathophysiology has been well documented in both clinical case reports and laboratory investigations. In contrast, blast-induced CAS dysfunction remains understudied but has been hypothesized to contribute to an array of common veteran behavioral complaints, including learning, memory, communication, and emotional regulation. This investigation compared the effects of acute blast and nonblast acoustic impulse trauma in adult male Sprague-Dawley rats. An array of audiometric tests were utilized, including distortion product otoacoustic emissions (DPOAE), auditory brain stem responses (ABR), middle latency responses (MLR), and envelope following responses (EFRs). Generally, more severe and persistent postinjury central auditory processing (CAP) deficits were observed in blast-exposed animals throughout the auditory neuraxis, spanning from the cochlea to the cortex. DPOAE and ABR results captured cochlear and auditory nerve/brain stem deficits, respectively. EFRs demonstrated temporal processing impairments suggestive of functional damage to regions in the auditory brain stem and the inferior colliculus. MLRs captured thalamocortical transmission and cortical activation impairments. Taken together, the results suggest blast-induced CAS dysfunction may play a complementary pathophysiological role to maladaptive neuroplasticity of PAS origin. Even mild blasts can produce lasting hearing impairments that can be assessed with noninvasive electrophysiology, allowing these measurements to serve as simple, effective diagnostics.NEW & NOTEWORTHY Blasts exposures often produce hearing difficulties. Although cochlear damage typically occurs, the downstream effects on central auditory processing are less clear. Moreover, outcomes were compared between individuals exposed to the blast pressure wave vs. those who experienced the blast noise without the pressure wave. It was found that a single blast exposure produced changes at all stages of the ascending auditory path at least 4 wk postblast, whereas blast noise alone produced largely transient changes.
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Affiliation(s)
- Nicholas Race
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Jesyin Lai
- Purdue University Inderdisciplinary Life Science (PULSe) Program, Purdue University, West Lafayette, Indiana; and
| | - Riyi Shi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- Purdue University Inderdisciplinary Life Science (PULSe) Program, Purdue University, West Lafayette, Indiana; and
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Edward L Bartlett
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana;
- Purdue University Inderdisciplinary Life Science (PULSe) Program, Purdue University, West Lafayette, Indiana; and
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Early Paper Patching Versus Observation in Patients With Traumatic Eardrum Perforations. J Craniofac Surg 2014; 25:2030-2. [DOI: 10.1097/scs.0000000000001027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Effect of tympanic membrane perforation on middle-ear sound transmission. The Journal of Laryngology & Otology 2010:81-9. [PMID: 19460211 DOI: 10.1017/s0022215109005155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tympanic membrane perforation causes a sound conduction disturbance, and the size of this conduction disturbance is proportional to the perforation area. However, precise evaluation of perforation size is difficult, and there are few detailed reports addressing this issue. Furthermore, such evaluation becomes more difficult for irregularly shaped perforations. This study conducted a quantitative evaluation of tympanic membrane perforations, using image analysis equipment.A significant correlation was found between the degree of sound conduction disturbance and the perforation area; this correlation was greater at low frequencies following a traumatic perforation. The conductive disturbance associated with chronic otitis media was significantly greater at low frequencies. Circular perforations caused only minor conduction disturbance. Perforations in the anteroinferior quadrant were associated with greater conduction disturbance. Traumatic spindle-shaped perforations and malleolar perforations were associated with greater conduction disturbance.
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Orji F, Agu C. Patterns of hearing loss in tympanic membrane perforation resulting from physical blow to the ear: a prospective controlled cohort study. Clin Otolaryngol 2009; 34:526-32. [DOI: 10.1111/j.1749-4486.2009.02035.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Orji FT, Agu CC. Determinants of spontaneous healing in traumatic perforations of the tympanic membrane. Clin Otolaryngol 2008; 33:420-6. [PMID: 18983374 DOI: 10.1111/j.1749-4486.2008.01764.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F T Orji
- Department of Otolaryngology, Federal Medical Center Umuahia, Abia State, Nigeria.
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