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Abstract
INTRODUCTION More than 5% of the world's population have a disabling hearing loss which can be managed by hearing aids or implanted electrical devices. However, outcomes are highly variable, and the sound perceived by recipients is far from perfect. Sparked by the discovery of progenitor cells in the cochlea and rapid progress in drug delivery to the cochlea, biological and pharmaceutical therapies are currently in development to improve the function of the cochlear implant or eliminate the need for it altogether. AREAS COVERED This review highlights progress in emerging regenerative strategies to restore hearing and adjunct therapies to augment the cochlear implant. Novel approaches include the reprogramming of progenitor cells to restore the sensory hair cell population in the cochlea, gene therapy and gene editing to treat hereditary and acquired hearing loss. A detailed review of optogenetics is also presented as a technique that could enable optical stimulation of the spiral ganglion neurons, replacing or complementing electrical stimulation. EXPERT OPINION Increasing evidence of substantial reversal of hearing loss in animal models, alongside rapid advances in delivery strategies to the cochlea and learnings from clinical trials will amalgamate into a biological or pharmaceutical therapy to replace or complement the cochlear implant.
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Affiliation(s)
- Elise Ajay
- Bionics Institute, East Melbourne, Victoria, Australia.,University of Melbourne, Department of Engineering
| | | | - Rachael Richardson
- Bionics Institute, East Melbourne, Victoria, Australia.,University of Melbourne, Medical Bionics Department, Parkville, Victoria, Australia.,University of Melbourne, Department of Surgery (Otolaryngology), East Melbourne, Victoria, Australia
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Bimodal Stimulation in Children With Bilateral Profound Sensorineural Hearing Loss: A Suitable Intervention Model for Children at the Early Developmental Stage. Otol Neurotol 2021; 41:1357-1362. [PMID: 33492797 DOI: 10.1097/mao.0000000000002812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the auditory and speech benefit of bimodal stimulation for prelingual deafened cochlear implantation recipients. STUDY DESIGN Retrospective and comparative study. SETTING Tertiary referral center. PATIENTS Fifty-six children with bilateral prelingual profound sensorineural hearing loss were enrolled, including 28 consecutive children with unilateral cochlear implantation (CI group), and 28 consecutive children with bimodal stimulation (BI group) who used an additional hearing aid (HA) in the contralateral ear. MAIN OUTCOME MEASURES Hearing assessments included the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and Categories of Auditory Performance (CAP). Speech evaluations included the Meaningful Use of Speech Scale (MUSS), and Speech Intelligibility Rating (SIR). These measurements were evaluated at the first mapping of cochlear implants and 0.5, 1, 3, 6, 12, 18, 24 months after. Data were analyzed by repeated measures analysis. RESULTS The mean ages of BI and CI groups were similar (17.6 ± 6.87 vs 19.0 ± 8.10 months, p = 0.497). The initial scores for hearing and speech assessments showed no differences between the two groups, apart from IT-MAIS (2.46 ± 0.631 in BI group vs 0.50 ± 0.279 in CI group, p = 0.004). The auditory and speech development over time were different in the two groups as seen in IT-MAIS (p < 0.001), CAP (p = 0.029), MUSS (p < 0.001), and SIR (p < 0.001). A continuing but stable difference was observed in CAP, MUSS, and SIR at 3, 18, and 12 months after the first mapping, respectively. In addition, the BI group had better IT-MAIS scores at 3 and 6 months compared with the CI group; however, the difference was not significant after 12 months. CONCLUSION Bimodal stimulation is beneficial for prelingually deafened CI recipients who have minimal contralateral residual hearing when bilateral CIs are not available. Hearing aid use in the contralateral ear might be recommended for children after unilateral cochlear implantation to facilitate the development of auditory and speech skills.
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A Neurophysiological Study of Musical Pitch Identification in Mandarin-Speaking Cochlear Implant Users. Neural Plast 2020; 2020:4576729. [PMID: 32774355 PMCID: PMC7396015 DOI: 10.1155/2020/4576729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/26/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023] Open
Abstract
Music perception in cochlear implant (CI) users is far from satisfactory, not only because of the technological limitations of current CI devices but also due to the neurophysiological alterations that generally accompany deafness. Early behavioral studies revealed that similar mechanisms underlie musical and lexical pitch perception in CI-based electric hearing. Although neurophysiological studies of the musical pitch perception of English-speaking CI users are actively ongoing, little such research has been conducted with Mandarin-speaking CI users; as Mandarin is a tonal language, these individuals require pitch information to understand speech. The aim of this work was to study the neurophysiological mechanisms accounting for the musical pitch identification abilities of Mandarin-speaking CI users and normal-hearing (NH) listeners. Behavioral and mismatch negativity (MMN) data were analyzed to examine musical pitch processing performance. Moreover, neurophysiological results from CI users with good and bad pitch discrimination performance (according to the just-noticeable differences (JND) and pitch-direction discrimination (PDD) tasks) were compared to identify cortical responses associated with musical pitch perception differences. The MMN experiment was conducted using a passive oddball paradigm, with musical tone C4 (262 Hz) presented as the standard and tones D4 (294 Hz), E4 (330 Hz), G#4 (415 Hz), and C5 (523 Hz) presented as deviants. CI users demonstrated worse musical pitch discrimination ability than did NH listeners, as reflected by larger JND and PDD thresholds for pitch identification, and significantly increased latencies and reduced amplitudes in MMN responses. Good CI performers had better MMN results than did bad performers. Consistent with findings for English-speaking CI users, the results of this work suggest that MMN is a viable marker of cortical pitch perception in Mandarin-speaking CI users.
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Wong P, Cheng MW. On the Relationship Between General Auditory Sensitivity and Speech Perception: An Examination of Pitch and Lexical Tone Perception in 4- to 6-Year-Old Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:487-498. [PMID: 32073343 DOI: 10.1044/2019_jslhr-19-00104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Theoretical models and substantial research have proposed that general auditory sensitivity is a developmental foundation for speech perception and language acquisition. Nonetheless, controversies exist about the effectiveness of general auditory training in improving speech and language skills. This research investigated the relationships among general auditory sensitivity, phonemic speech perception, and word-level speech perception via the examination of pitch and lexical tone perception in children. Method Forty-eight typically developing 4- to 6-year-old Cantonese-speaking children were tested on the discrimination of the pitch patterns of lexical tones in synthetic stimuli, discrimination of naturally produced lexical tones, and identification of lexical tone in familiar words. Results The findings revealed that accurate lexical tone discrimination and identification did not necessarily entail the accurate discrimination of nonlinguistic stimuli that followed the pitch levels and pitch shapes of lexical tones. Although pitch discrimination and tone discrimination abilities were strongly correlated, accuracy in pitch discrimination was lower than that in tone discrimination, and nonspeech pitch discrimination ability did not precede linguistic tone discrimination in the developmental trajectory. Conclusions Contradicting the theoretical models, the findings of this study suggest that general auditory sensitivity and speech perception may not be causally or hierarchically related. The finding that accuracy in pitch discrimination is lower than that in tone discrimination suggests that comparable nonlinguistic auditory perceptual ability may not be necessary for accurate speech perception and language learning. The results cast doubt on the use of nonlinguistic auditory perceptual training to improve children's speech, language, and literacy abilities.
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Affiliation(s)
- Puisan Wong
- Faculty of Education, Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam
| | - Man Wai Cheng
- Faculty of Education, Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam
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Zhang F, Underwood G, McGuire K, Liang C, Moore DR, Fu QJ. Frequency change detection and speech perception in cochlear implant users. Hear Res 2019; 379:12-20. [PMID: 31035223 PMCID: PMC6571168 DOI: 10.1016/j.heares.2019.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
Dynamic frequency changes in sound provide critical cues for speech perception. Most previous studies examining frequency discrimination in cochlear implant (CI) users have employed behavioral tasks in which target and reference tones (differing in frequency) are presented statically in separate time intervals. Participants are required to identify the target frequency by comparing stimuli across these time intervals. However, perceiving dynamic frequency changes in speech requires detection of within-interval frequency change. This study explored the relationship between detection of within-interval frequency changes and speech perception performance of CI users. Frequency change detection thresholds (FCDTs) were measured in 20 adult CI users using a 3-alternative forced-choice (3AFC) procedure. Stimuli were 1-sec pure tones (base frequencies at 0.25, 1, 4 kHz) with frequency changes occurring 0.5 s after the tone onset. Speech tests were 1) Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition, 2) Arizona Biomedical Sentence Recognition (AzBio) in Quiet, 3) AzBio in Noise (AzBio-N, +10 dB signal-to-noise/SNR ratio), and 4) Digits-in-noise (DIN). Participants' subjective satisfaction with the CI was obtained. Results showed that correlations between FCDTs and speech perception were all statistically significant. The satisfaction level of CI use was not related to FCDTs, after controlling for major demographic factors. DIN speech reception thresholds were significantly correlated to AzBio-N scores. The current findings suggest that the ability to detect within-interval frequency changes may play an important role in speech perception performance of CI users. FCDT and DIN can serve as simple and rapid tests that require no or minimal linguistic background for the prediction of CI speech outcomes.
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Affiliation(s)
- Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA.
| | - Gabrielle Underwood
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA
| | - Kelli McGuire
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA
| | - Chun Liang
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA; Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology, University of Cincinnati, Ohio, USA
| | - Qian-Jie Fu
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA
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Cheng X, Liu Y, Shu Y, Tao DD, Wang B, Yuan Y, Galvin JJ, Fu QJ, Chen B. Music Training Can Improve Music and Speech Perception in Pediatric Mandarin-Speaking Cochlear Implant Users. Trends Hear 2019; 22:2331216518759214. [PMID: 29484971 PMCID: PMC5833165 DOI: 10.1177/2331216518759214] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Due to limited spectral resolution, cochlear implants (CIs) do not convey pitch information very well. Pitch cues are important for perception of music and tonal language; it is possible that music training may improve performance in both listening tasks. In this study, we investigated music training outcomes in terms of perception of music, lexical tones, and sentences in 22 young (4.8 to 9.3 years old), prelingually deaf Mandarin-speaking CI users. Music perception was measured using a melodic contour identification (MCI) task. Speech perception was measured for lexical tones and sentences presented in quiet. Subjects received 8 weeks of MCI training using pitch ranges not used for testing. Music and speech perception were measured at 2, 4, and 8 weeks after training was begun; follow-up measures were made 4 weeks after training was stopped. Mean baseline performance was 33.2%, 76.9%, and 45.8% correct for MCI, lexical tone recognition, and sentence recognition, respectively. After 8 weeks of MCI training, mean performance significantly improved by 22.9, 14.4, and 14.5 percentage points for MCI, lexical tone recognition, and sentence recognition, respectively (p < .05 in all cases). Four weeks after training was stopped, there was no significant change in posttraining music and speech performance. The results suggest that music training can significantly improve pediatric Mandarin-speaking CI users’ music and speech perception.
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Affiliation(s)
- Xiaoting Cheng
- 1 Department of Otology and Skull Base Surgery, Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Yangwenyi Liu
- 1 Department of Otology and Skull Base Surgery, Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Yilai Shu
- 1 Department of Otology and Skull Base Surgery, Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Duo-Duo Tao
- 3 Department of Ear, Nose and Throat, The First Affiliated Hospital of Soochow University, Suzhu, China
| | - Bing Wang
- 1 Department of Otology and Skull Base Surgery, Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Yasheng Yuan
- 1 Department of Otology and Skull Base Surgery, Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | | | - Qian-Jie Fu
- 5 Department of Head and Neck Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Bing Chen
- 1 Department of Otology and Skull Base Surgery, Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
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Mondelli MFCG, José IDS, José MR, Lopes NBF. Elaboration of an instrument to evaluate the recognition of Brazilian melodies in children. Braz J Otorhinolaryngol 2018; 85:690-697. [PMID: 30017874 PMCID: PMC9443065 DOI: 10.1016/j.bjorl.2018.05.011] [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: 01/16/2018] [Revised: 05/09/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION There is evidence pointing to the importance of the evaluation of musical perception through objective and subjective instruments. In Brazil, there is a shortage of instruments that evaluates musical perception. OBJECTIVE To develop an instrument to evaluate the recognition of traditional Brazilian melodies and investigate the performance of children with typical hearing. METHODS The study was carried out after approval of the research ethics committee (1.198.607). The instrument was developed in software format with website access, using the languages PHP 5.5.12, Javascript, Cascade style sheets and "HTML5"; database "MYSQL 5.6.17" on the "Apache 2.4.9" server. Fifteen melodies of Brazilian folk songs were recorded in piano synthesized timbre, with 12 seconds per melody reproduction and four second intervals between them. A total of 155 schooled children, aged eight to 11 years, of both sexes, with typical hearing participated in the study. The test was performed in a silent room with sound stimuli amplified by a sound box at 65dBNA, positioned at 0 azimuth, and at one meter from the participant, the notebook was used for children to play with on the screen on the title and illustration of the melody they recognized they were listening to. The responses were recorded on their own database. RESULTS The instrument titled "Evaluation of recognition of traditional melodies in children" can be run on various devices (computers, notebooks, tablets, mobile phones) and operating systems (Windows, Macintosh, Android, Linux). Access: http://192.185.216.17/ivan/home/login.php by login and password. The most easily recognized melody was "Cai, cai balão" (89%) and the least recognized was "Capelinha de melão" (25.2%). The average time to perform the test was 3'15″. CONCLUSION The development and application of the software proved effective for the studied population. This instrument may contribute to the improvement of protocols for the evaluation of musical perception in children with hearing aid and/or cochlear implants users.
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Affiliation(s)
| | - Ivan Dos Santos José
- Universidade de São Paulo (USP), Faculdade de Odontologia de Bauru, Programa de Pós-Graduação em Fonoaudiologia, Bauru, SP, Brazil
| | - Maria Renata José
- Universidade de São Paulo (USP), Faculdade de Odontologia de Bauru, Programa de Pós-Graduação em Fonoaudiologia, Bauru, SP, Brazil
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Holt CM, Lee KYS, Dowell RC, Vogel AP. Perception of Cantonese Lexical Tones by Pediatric Cochlear Implant Users. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:174-185. [PMID: 29344625 DOI: 10.1044/2017_jslhr-h-17-0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study is to assess Cantonese word recognition and the discrimination of Cantonese tones with manipulated contours by child and adolescent cochlear implant (CI) users and a group of peers with normal hearing (NH). It was hypothesized that the CI users would perform more poorly than their counterparts with NH in both tasks and that CI users implanted before 2 years of age would perform better than those implanted after 2 years. METHOD Forty-one participants were recruited from hospitals, schools, and kindergartens in Hong Kong: Ten CI users implanted at or before 2 years of age ("early" CI group), 13 CI users implanted after 2 years of age ("late" CI group), and 18 individuals with NH. The mean age at implantation of the early CI group was 1.5 years (SD = 0.3), and for the late CI group, it was 4.3 years (SD = 2.1). Participants were a mean of 13.3 years of age (SD = 3.7) at time of testing. Participants completed a Cantonese word recognition test and a discrimination task using Cantonese tones with modified fundamental frequency trajectories. RESULTS Both CI user groups obtained significantly lower scores than the group with NH on the word recognition test. Mean percent correct scores for the word recognition test were 79% for the early CI group, 69% for the late CI group, and 97% for the group with NH. The group with NH consistently achieved higher scores than the CI user groups when discriminating manipulated Cantonese tones. Increasing the acoustic difference between tones improved discrimination performance for CI users for level tone contrasts only. CI users implanted at or before 2 years of age obtained higher scores than those implanted later. CONCLUSIONS The results of this study add further evidence that children using CIs do not perform as well as peers in perceiving Cantonese tones. Modification of tones to increase pitch range did not consistently improve the ability of children with implants to perceive the difference between tones. Further research is required to fully assess potential benefits of early implantation for speakers of tonal languages. SUPPLEMENTAL MATERIALS https://doi.org/10.23641/asha.5782209.
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Affiliation(s)
- Colleen M Holt
- Audiology and Speech Pathology, The University of Melbourne, Victoria, Australia
- Office of the Associate Pro-Vice Chancellor, Coursework, College of Science, Health and Engineering, La Trobe University, Victoria, Australia
| | - Kathy Y S Lee
- Institute of Human Communication Research and Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, HKSAR, China
| | - Richard C Dowell
- Audiology and Speech Pathology, The University of Melbourne, Victoria, Australia
| | - Adam P Vogel
- Audiology and Speech Pathology, The University of Melbourne, Victoria, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, Australia
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
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Barros CG, Swardfager W, Moreno S, Bortz G, Ilari B, Jackowski AP, Ploubidis G, Little TD, Lamont A, Cogo-Moreira H. Assessing Music Perception in Young Children: Evidence for and Psychometric Features of the M-Factor. Front Neurosci 2017; 11:18. [PMID: 28174518 PMCID: PMC5258735 DOI: 10.3389/fnins.2017.00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/09/2017] [Indexed: 01/24/2023] Open
Abstract
Given the relationship between language acquisition and music processing, musical perception (MP) skills have been proposed as a tool for early diagnosis of speech and language difficulties; therefore, a psychometric instrument is needed to assess music perception in children under 10 years of age, a crucial period in neurodevelopment. We created a set of 80 musical stimuli encompassing seven domains of music perception to inform perception of tonal, atonal, and modal stimuli, in a random sample of 1006 children, 6–13 years of age, equally distributed from first to fifth grades, from 14 schools (38% private schools) in So Paulo State. The underlying model was tested using confirmatory factor analysis. A model encompassing seven orthogonal specific domains (contour, loudness, scale, timbre, duration, pitch, and meter) and one general music perception factor, the “m-factor,” showed excellent fit indices. The m-factor, previously hypothesized in the literature but never formally tested, explains 93% of the reliable variance in measurement, while only 3.9% of the reliable variance could be attributed to the multidimensionality caused by the specific domains. The 80 items showed no differential item functioning based on sex, age, or enrolment in public vs. private school, demonstrating the important psychometric feature of invariance. Like Charles Spearman's g-factor of intelligence, the m-factor is robust and reliable. It provides a convenient measure of auditory stimulus apprehension that does not rely on verbal information, offering a new opportunity to probe biological and psychological relationships with music perception phenomena and the etiologies of speech and language disorders.
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Affiliation(s)
- Caio G Barros
- Music Department, State University of São Paulo (UNESP) São Paulo, Brazil
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of TorontoToronto, ON, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research InstituteToronto, ON, Canada
| | - Sylvain Moreno
- School of Engineering, Simon Fraser University Surrey, BC, Canada
| | - Graziela Bortz
- Music Department, State University of São Paulo (UNESP) São Paulo, Brazil
| | - Beatriz Ilari
- Thornton School of Music (Program of Music Teaching and Learning), University of Southern California Los Angeles, CA, USA
| | - Andrea P Jackowski
- Department of Psychiatry and Medical Psychology, Federal University of Sao Paulo São Paulo, Brazil
| | - George Ploubidis
- Department of Social Sciences, Center of Longitudinal Studies, University College of London (Institute of Education) London, UK
| | - Todd D Little
- Institute for Measurement, Methodology, Analysis, and Policy, Texas Tech University Lubbock, TX, USA
| | - Alexandra Lamont
- Faculty of Natural Sciences and School of Psychology, Keele University Keele, UK
| | - Hugo Cogo-Moreira
- Department of Psychiatry and Medical Psychology, Federal University of Sao Paulo São Paulo, Brazil
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