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Lahlou G, Daoudi H, Djian C, Mosnier I. Bilateral cochlear fibrosis complicating chronic myeloid leukemia: A CARE case report. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00095-4. [PMID: 39117480 DOI: 10.1016/j.anorl.2024.07.003] [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: 08/10/2024]
Abstract
PURPOSE We report the second case of bilateral sudden sensorineural hearing loss with intracochlear fibrosis due to chronic myeloid leukemia. CASE REPORT A 44-year-old man presented to the emergency department with rapidly progressive bilateral hearing loss, tinnitus and vertigo, associated with dyspnea. Chronic myeloid leukemia complicated by pulmonary and cochleovestibular leukostasis was diagnosed, and cytoreductive treatment was started. Despite this treatment, bilateral total hearing loss and complete vestibular deficit persisted. MRI showed bilateral labyrinthitis, and emergency cochlear implantation was indicated. During surgery, inflammatory intracochlear tissue made electrode array insertion possible only against resistance. One year after implantation, there was significant improvement in speech recognition and communication scores. CONCLUSION In case of sudden sensorineural hearing loss induced by chronic myeloid leukemia, treatment should be as fast as possible, with prompt cochlear implantation in case of definitive profound hearing loss, because of the risk of cochlear fibrosis and ossification.
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Affiliation(s)
- G Lahlou
- Département d'oto-rhino-laryngologie, groupe hospitalo-universitaire Pitié-Salpêtrière, AP-HP, Sorbonne université, Paris, France; Équipe TGTD (Technologies and Gene Therapy for Deafness), Institut de l'audition-Institut Pasteur, Paris, France.
| | - H Daoudi
- Département d'oto-rhino-laryngologie, groupe hospitalo-universitaire Pitié-Salpêtrière, AP-HP, Sorbonne université, Paris, France; Équipe TGTD (Technologies and Gene Therapy for Deafness), Institut de l'audition-Institut Pasteur, Paris, France
| | - C Djian
- Département d'oto-rhino-laryngologie, hôpital Lariboisière, AP-HP, université Paris Cité, Paris, France
| | - I Mosnier
- Département d'oto-rhino-laryngologie, groupe hospitalo-universitaire Pitié-Salpêtrière, AP-HP, Sorbonne université, Paris, France; Équipe TGTD (Technologies and Gene Therapy for Deafness), Institut de l'audition-Institut Pasteur, Paris, France
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2
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Kettani ME, Shah K, Farooq H, Li K, Badar T. Chronic myeloid leukemia with involvement of membranous labyrinth. Leuk Res Rep 2024; 22:100471. [PMID: 39188694 PMCID: PMC11346178 DOI: 10.1016/j.lrr.2024.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/23/2024] [Indexed: 08/28/2024] Open
Abstract
This case report explains an extraordinary presentation of chronic myeloid leukemia (CML) in a 39-year-old male with a T315I mutation, presenting with acute bilateral hearing loss and imbalance secondary to myeloid blast crisis. Neurological involvement was confirmed through MRI brain and cerebrospinal fluid analysis. Initial treatment with ponatinib and FLAG (fludarabine, cytarabine, G-CSF) regimen showed promise, but complications necessitated discontinuation. The patient's complex clinical trajectory, marked by complications and intolerance to tyrosine kinase inhibitors, highlights the intricate nature of CML blast crisis with T315I mutation management. Recognizing atypical presentations and early mutation analysis are pivotal for tailored treatment strategies.
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Affiliation(s)
- Mobachir El Kettani
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Kashish Shah
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Hareem Farooq
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Ke Li
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Florida, USA
| | - Talha Badar
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
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3
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Raymond MJ, Ottinger A, Rowley MA, Bobian M, Dornhoffer J, Brennan E, Rizk HG. A Scoping Review of Otologic Manifestations of Hematologic Malignancies. Otol Neurotol 2024; 45:362-375. [PMID: 38437804 DOI: 10.1097/mao.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To examine the otologic and neurotologic symptoms, physical examination findings, and imaging features secondary to hematologic malignancies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases, including PubMed, Scopus, and CINAHL, were searched for articles including patients with otologic manifestations of leukemia, lymphoma and multiple myeloma. Data collected included patient and study demographics, specific hematologic malignancy, timing and classification of otologic symptoms, physical examination findings, imaging features and methods of diagnosis. Pooled descriptive analysis was performed. RESULTS Two hundred seventy-two articles, of which 255 (93.8%) were case reports and 17 (6.2%) were case series, reporting on 553 patients were identified. Otologic manifestations were reported on 307 patients with leukemia, 204 patients with lymphoma and 42 patients with multiple myeloma. Hearing loss and unilateral facial palsy were the most common presenting symptoms for 111 reported subjects with leukemia (n = 46, 41.4%; n = 43, 38.7%) and 90 with lymphoma (n = 38, 42.2%; n = 39, 43.3%). Hearing loss and otalgia were the most common presenting symptoms for 21 subjects with multiple myeloma (n = 10, 47.6%; n = 6, 28.6%). Hearing loss and unilateral facial palsy were the most common otologic symptoms indicative of relapse in subjects with leukemia (n = 14, 43.8%) and lymphoma (n = 5, 50%). CONCLUSION Hearing loss, facial palsy, and otalgia might be the first indication of a new diagnosis or relapse of leukemia, lymphoma, or multiple myeloma. Clinicians should have a heightened level of suspicion of malignant etiologies of otologic symptoms in patients with current or medical histories of these malignancies.
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Affiliation(s)
| | - Allie Ottinger
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - M Andrew Rowley
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Michael Bobian
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jim Dornhoffer
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | | | - Habib G Rizk
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
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Malhan H, Dammag E, Alkahiry W, Ali G, Bahkali F, Alhakim A, Bakkar M. Bilateral Sudden Irreversible Hearing Loss in a Case of Chronic Myeloid Leukaemia: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:2104-2107. [PMID: 38566638 PMCID: PMC10982179 DOI: 10.1007/s12070-023-04429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/03/2023] [Indexed: 04/04/2024] Open
Abstract
Chronic myeloid leukemia is a type of blood cancer that affects the bone marrow and results in an overproduction of immature WBCs. The genetic mutation that causes CML is the BCR-ABL fusion gene. Adolescents are rarely affected. The case study aims to discuss a rare case of chronic myeloid leukemia causing bilateral hearing impairment, tinnitus, and vertigo. A 30-year-old female presented to the hospital in November, 2021, with sudden hearing impairment and other symptoms, leading to a CML diagnosis. Blood tests revealed hyperleukocytosis with marked neutrophilia, mild basophilia, and eosinophilia, and a BCR-ABL quantitation of 85%. Bone marrow aspiration showed granulocytic hyperplasia, mild left-shifted maturation, and less than 1% blasts. The patient was started with options including tyrosine kinase inhibitors (TKIs) such as Imatinib, which target the BCR-ABL fusion gene, reducing the number of leukemia cells and improving her white blood cell count. However, her deafness persisted, and she became dependent on hearing aids. CML presenting with hearing loss is rare, believed to be related to the infiltration of leukemic cells in the inner ear or microvascular complications. Treatment with tyrosine kinase inhibitors such as Imatinib can improve hematologic parameters, but the effect on hearing loss is uncertaint.
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Affiliation(s)
- Hafiz Malhan
- Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, 2034 King Abdul Aziz Rd, Jazan, 82943 Saudi Arabia
| | - Enas Dammag
- Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, 2034 King Abdul Aziz Rd, Jazan, 82943 Saudi Arabia
| | - Waiel Alkahiry
- Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, 2034 King Abdul Aziz Rd, Jazan, 82943 Saudi Arabia
| | - Gadallah Ali
- Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, 2034 King Abdul Aziz Rd, Jazan, 82943 Saudi Arabia
| | - Fahad Bahkali
- Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, 2034 King Abdul Aziz Rd, Jazan, 82943 Saudi Arabia
| | - Anas Alhakim
- Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, 2034 King Abdul Aziz Rd, Jazan, 82943 Saudi Arabia
| | - Mohammad Bakkar
- Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, 2034 King Abdul Aziz Rd, Jazan, 82943 Saudi Arabia
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Flahat B, Bonnard Å, Arebro J. Bilateral intracochlear hemorrhage: A rare onset of chronic myelogenous leukemia. Clin Case Rep 2024; 12:e8741. [PMID: 38645606 PMCID: PMC11031744 DOI: 10.1002/ccr3.8741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 04/23/2024] Open
Abstract
Acute onset of vertigo and hearing loss is rare in leukemic disorders. MRI can diagnose intracochlear hemorrhage as the underlying cause. The hearing can improve but if severe hearing loss preserves, cochlear implantation can be considered.
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Affiliation(s)
- Babak Flahat
- Department of NeuroradiologyKarolinska University HospitalStockholmSweden
| | - Åsa Bonnard
- Division of Otorhinolaryngology, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of Otorhinolaryngology, Head and Neck SurgeryKarolinska University HospitalStockholmSweden
| | - Julia Arebro
- Division of Otorhinolaryngology, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of Otorhinolaryngology, Head and Neck SurgeryKarolinska University HospitalStockholmSweden
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Babakhanlou R, Nader ME, Alvarado Y. A case of sudden hearing loss in a patient with chronic myelomonocytic leukemia. Ann Hematol 2023; 102:3427-3430. [PMID: 37713123 DOI: 10.1007/s00277-023-05433-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
Chronic myelomonocytic leukemia is a myeloid stem cell disease characterized by an abnormal production and accumulation of monocytic cells in association with other signs of myeloproliferation. Extramedullary manifestations of CMML are common and can affect the spleen, liver skin, and lymph nodes. However, otologic manifestations are extremely rare and could have occurred from either direct leukemic infiltration, hemorrhage of the cochlea, labyrinth, leukostasis, or infection. There is no standard treatment protocol for sensorineural hearing loss in CMML patients. More research is needed to improve the understanding of the pathogenesis of this condition, in order to provide better treatment options.
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Affiliation(s)
- Rodrick Babakhanlou
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Yesid Alvarado
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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Syamsuddin IK, Notopuro PB. Sensorineural Hearing Loss in Juvenile CML: A Rare Case Report in Surabaya, Indonesia. Int Med Case Rep J 2022; 15:367-371. [PMID: 35855765 PMCID: PMC9288187 DOI: 10.2147/imcrj.s371745] [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] [Received: 04/21/2022] [Accepted: 07/08/2022] [Indexed: 01/11/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a type of myeloproliferative neoplasm (MPN) in which granulocytes are the primary proliferating cells. CML in pediatric patients (juvenile CML) is an uncommon MPN, representing 2–3% of children newly diagnosed with leukemia. Sensorineural hearing loss that progresses rapidly is an uncommon early sign of a hematological disorder in patients with CML. This article presents the case of a 10-year-old patient with complaints of bilateral hearing loss for 2 weeks. Pure-tone audiometry indicated sensorineural hearing loss of the left ear and mixed hearing loss of the right ear. After an in-depth evaluation of a bone marrow smear and positivity for the BCR-ABL fusion gene, it was concluded that the patient had chronic-phase juvenile CML. However, hearing loss recovery after hydroxyurea therapy could not be observed because the patient died after suffering an uncontrolled seizure on day 14 of hospitalization.
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Affiliation(s)
- Ihda Kartika Syamsuddin
- Department of Clinical Pathology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Paulus Budiono Notopuro
- Department of Clinical Pathology, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
- Correspondence: Paulus Budiono Notopuro, Email
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Dumberger LD, Hwa TP, Panara K, Husain S, Yver C, Bigelow DC. Profound Sudden Sensorineural Hearing Loss in Hematologic Malignancy: A Case for Urgent Cochlear Implantation With Discussion and Systematic Review of the Literature. Otol Neurotol 2021; 42:e815-e824. [PMID: 33782258 DOI: 10.1097/mao.0000000000003131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To perform a systematic review of sensorineural hearing loss (SNHL) in hematologic malignancy; to describe an illustrative case of urgent cochlear implantation for bilateral profound SNHL and vestibular hypofunction in hyperviscosity syndrome; to suggest an approach to management of hyperviscosity syndrome-associated deafness with cochlear implantation. DATA SOURCES Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematic search of PubMed and Embase databases was undertaken for articles detailing clinical information about SNHL caused directly by hematologic malignancies. RESULTS A total of 37 studies from 1989 to 2020 were qualitatively reviewed, the majority of which were case studies or case series. Causes of hearing loss in hematologic malignancy were found to include hyperviscosity syndrome, labyrinthine hemorrhage, infiltration, and infection. Patients with profound SNHL in hematologic malignancies from hyperviscosity syndrome may be candidates for cochlear implantation, and are also at increased risk for cochlear ossification. We review previous cases for their diagnostic approach, treatment paradigm, and outcomes data, and propose an approach to management. CONCLUSION Bilateral sudden profound SNHL and vestibular hypofunction is a presenting symptom of hyperviscosity syndrome in hematologic malignancy. Although this entity is rare and previous reports have suggested improvement in hearing with oncologic treatment, cases with profound hearing loss are unlikely to recover serviceable hearing. We advocate for early magnetic resonance imaging with attention to fluid signal in the inner ear and serial audiometric follow-up to guide clinical decisions. We advise early consideration for cochlear implantation.
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Affiliation(s)
- Lukas D Dumberger
- Division of Neurotology & Lateral Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Zeng X, Lin Z, Han X, Li J, Zhang P, Gou L, Xu J. Bilateral Hearing Loss and Unilateral Cochlear Ossification in a Patient With Chronic Myelogenous Leukemia. EAR, NOSE & THROAT JOURNAL 2020; 100:301S-303S. [PMID: 32970497 DOI: 10.1177/0145561320961073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bilateral sensorineural deafness and unilateral cochlear ossification have rarely been described in patients with chronic myeloid leukemia (CML). A 21-year-old man presented to a hospital with right-sided sudden hearing loss and tinnitus. He was diagnosed with CML. Five days later, sudden hearing loss appeared in the other ear. Abnormality of the right-sided inner ear structure was revealed by preoperative magnetic resonance imaging; honeycomb-like cochlear ossification was observed during cochlear implant surgery in the right ear. The patient's auditory performance exhibited significant improvement after bilateral cochlear implantation in our hospital. Hematological disorders must be considered in patients with sensorineural hearing loss. Cochlear implantation is feasible in patients with CML who exhibit sensorineural deafness, but cochlear ossification should be carefully evaluated by means of preoperative imaging examinations.
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Affiliation(s)
- Xianhai Zeng
- Department of Otolaryngology, Longgang E.N.T. Hospital, Longgang, Shenzhen, Guangdong, China.,Shenzhen Key Laboratory of E.N.T., Institute of E.N.T., Longgang, Shenzhen, Guangdong, China
| | - Zengping Lin
- Department of Otolaryngology, Longgang E.N.T. Hospital, Longgang, Shenzhen, Guangdong, China
| | - Xiaodong Han
- Department of Otolaryngology, Longgang E.N.T. Hospital, Longgang, Shenzhen, Guangdong, China
| | - Juanjuan Li
- Department of Otolaryngology, Longgang E.N.T. Hospital, Longgang, Shenzhen, Guangdong, China
| | - Peng Zhang
- Department of Otolaryngology, Longgang E.N.T. Hospital, Longgang, Shenzhen, Guangdong, China.,Shenzhen Key Laboratory of E.N.T., Institute of E.N.T., Longgang, Shenzhen, Guangdong, China
| | - Lingshan Gou
- 557766Xuzhou Maternity and Child Health Care Hospital, Xuzhou, Jiangsu, China
| | - Jian Xu
- Department of Otolaryngology, Longgang E.N.T. Hospital, Longgang, Shenzhen, Guangdong, China.,Shenzhen Key Laboratory of E.N.T., Institute of E.N.T., Longgang, Shenzhen, Guangdong, China.,Shenzhen Longgang Institute of Stomatology, Longgang, Shenzhen, Guangdong, China
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Chen C, Shi G, He M, Song X, Cheng X, Wang B, Gu H, Liang X, Yu S. Characteristics and prognosis of idiopathic sudden sensorineural hearing loss in aged people: a retrospective study. Acta Otolaryngol 2019; 139:959-965. [PMID: 31498008 DOI: 10.1080/00016489.2019.1657589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Few studies focused on the prognosis of sudden sensorineural hearing loss (ISSHL) of aged people. Objectives: The aim of this study is to analyze the characteristics, treatment, and prognostic factors of ISSHL in aged people. Material and methods: A total of 278 patients diagnosed of ISSHL in aged people from 2014 to 2019 were retrospectively analyzed. Univariates were analyzed by univariate and multivariate logistic analysis. Results: Among the 13 univariates, the patients' age was younger in the overall recovery group ORG (p = .018), while onset days was shorter in ORG (p = .000). The percentage of DM and HTN comorbidities were higher in ORG (p = .026 and .038). Meanwhile differences were significant in audiogram configurations (p = .037), the degree of hearing loss (p = .033), and types of lipid treatment (p = .020). Then these seven independent risk factors were included in the multivariate analysis, final results indicated that hypertension (p = .028), lipid control groups (p = .009), age (p = .000), and onset days (p = .001) were related to the treatment outcome of ISSHL. Conclusions: The prognosis of ISSHL in aged patients was closely related to age, the onset days of treatment, and good control of complications such as hypertension and hyperlipidemia, so vascular factors were considered as the main causes of morbidity.
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Affiliation(s)
- Chengfang Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Guanggang Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Mingqiang He
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xinlei Song
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xueqing Cheng
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Baowei Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Hongbo Gu
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xuhui Liang
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shudong Yu
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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