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P S, P M. Exploring the relationship between auditory late latency response and language age in children using cochlear implant. Int J Pediatr Otorhinolaryngol 2024; 180:111968. [PMID: 38714045 DOI: 10.1016/j.ijporl.2024.111968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/09/2024]
Abstract
AIM & OBJECTIVES The study aimed to compare P1 latency and P1-N1 amplitude with receptive and expressive language ages in children using cochlear implant (CI) in one ear and a hearing aid (HA) in non-implanted ear. METHODS The study included 30 children, consisting of 18 males and 12 females, aged between 48 and 96 months. The age at which the children received CI ranged from 42 to 69 months. A within-subject research design was utilized and participants were selected through purposive sampling. Auditory late latency responses (ALLR) were assessed using the Intelligent hearing system to measure P1 latency and P1-N1 amplitude. The assessment checklist for speech-language skills (ACSLS) was employed to evaluate receptive and expressive language age. Both assessments were conducted after cochlear implantation. RESULTS A total of 30 children participated in the study, with a mean implant age of 20.03 months (SD: 8.14 months). The mean P1 latency and P1-N1 amplitude was 129.50 ms (SD: 15.05 ms) and 6.93 μV (SD: 2.24 μV) respectively. Correlation analysis revealed no significant association between ALLR measures and receptive or expressive language ages. However, there was significant negative correlation between the P1 latency and implant age (Spearman's rho = -0.371, p = 0.043). CONCLUSIONS The study suggests that P1 latency which is an indicative of auditory maturation, may not be a reliable marker for predicting language outcomes. It can be concluded that language development is likely to be influenced by other factors beyond auditory maturation alone.
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Affiliation(s)
- Sahana P
- All India Institute of Speech and Hearing (AIISH), Manasagangothri, Mysore, 570006, India.
| | - Manjula P
- All India Institute of Speech and Hearing (AIISH), Manasagangothri, Mysore, 570006, India.
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Yun Y, Lee SY. Updates on Genetic Hearing Loss: From Diagnosis to Targeted Therapies. J Audiol Otol 2024; 28:88-92. [PMID: 38695053 PMCID: PMC11065549 DOI: 10.7874/jao.2024.00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/21/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Sensorineural hearing loss (SNHL) is the most common sensory disorder, with a high Mendelian genetic contribution. Considering the genotypic and phenotypic heterogeneity of SNHL, the advent of next-generation sequencing technologies has revolutionized knowledge on its genomic architecture. Nonetheless, the conventional application of panel and exome sequencing in real-world practice is being challenged by the emerging need to explore the diagnostic capability of whole-genome sequencing, which enables the detection of both noncoding and structural variations. Small molecules and gene therapies represent good examples of how breakthroughs in genetic understanding can be translated into targeted therapies for SNHL. For example, targeted small molecules have been used to ameliorate autoinflammatory hearing loss caused by gain-of-function variants of NLRP3 and inner ear proteinopathy with OSBPL2 variants underlying dysfunctional autophagy. Strikingly, the successful outcomes of the first-in-human trial of OTOF gene therapy highlighted its potential in the treatment of various forms of genetic hearing loss. clustered regularly interspaced short palindromic repeats (CRISPR)-based technologies are currently being developed for site-specific genome editing to treat human genetic disorders. These advancements have led to an era of genotype- and mechanism-based precision medicine in SNHL practice.
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Affiliation(s)
- Yejin Yun
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea
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Sahwan M, Abdelsamad Y, Alasfoor F, Alfayez F, Binkhamis G, Nichani J. Cochlear implantation in children with auditory neuropathy spectrum disorder: an updated systematic review. Eur Arch Otorhinolaryngol 2024; 281:1149-1162. [PMID: 37638998 DOI: 10.1007/s00405-023-08194-4] [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: 07/07/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The goal of managing auditory neuropathy spectrum disorder (ANSD) is to restore the children's ability to discriminate auditory information. Children who are not making sufficient progress in speech comprehension, and speech and language development after receiving adequate auditory re/habilitation and/or acoustic amplification may be candidates for cochlear implantation (CI). Despite the growing number of published literature on CI outcomes in children with ANSD, the current evidence is primarily based on case reports or retrospective chart reviews some of which had a limited number of children. In addition, the outcomes of CI seem to vary between children with ANSD. Thus, compelling evidence is lacking. This updated systematic review evaluated the speech perception, language, and speech intelligibility outcomes of children with ANSD post-CI. METHODS An online bibliographic search was conducted in PubMed, Scopus, Web of Science, and CENTRAL databases. We included both interventional and observational studies that assessed the outcomes of the CI in children with ANSD. RESULTS Thirty-three studies were included in this systematic review. Several tests were used to assess speech perception following CI in children with ANSD. The findings of this study revealed that children with ANSD had mean Categories of Auditory Performance scores ranging from 4.3 to 7 post-operatively, this result was better than the pre-operative scores which ranged between 0.4 to 2.5. Likewise, the Infant-Toddler Meaningful Auditory Integration Scale, Phonetically Balanced Kindergarten, and multisyllabic lexical neighborhood test showed clinically relevant improvement after CI. The same findings were reported for language and speech intelligibility scores. One study investigated the quality of life/children satisfaction after CI and showed overall good satisfaction with the outcomes. CONCLUSIONS The present systematic review suggests that CI is a feasible and effective hearing rehabilitation modality for children with ANSD. REGISTRATION AND PROTOCOL PROSPERO ID: CRD42021279140.
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Affiliation(s)
- Maryam Sahwan
- ENT Department, Government Hospitals, Manama, Kingdom of Bahrain.
| | | | - Fatema Alasfoor
- ENT Department, Government Hospitals, Manama, Kingdom of Bahrain
| | - Fatema Alfayez
- ENT Department, Government Hospitals, Manama, Kingdom of Bahrain
| | - Ghada Binkhamis
- Communication and Swallowing Disorders Department, King Fahad Medical City, Riyadh, Saudi Arabia
- Manchester Centre for Audiology & Deafness (ManCAD), Division of Human Communication, Development and Hearing, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jaya Nichani
- Royal Manchester Children's Hospital, Manchester, UK
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Lamminmäki S, Cormier K, Davidson H, Grigsby J, Sharma A. Auditory Cortex Maturation and Language Development in Children with Hearing Loss and Additional Disabilities. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1813. [PMID: 38002904 PMCID: PMC10670362 DOI: 10.3390/children10111813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
A significant portion of hearing-impaired children have additional disabilities, but data about the maturation of their auditory cortex are scarce. In these children, behavioral tests are often unreliable, and objective tests are needed for diagnostics and follow-up. This study aimed to explore auditory cortical maturation and language development, and the usability of an objective electroencephalogram-based biomarker in children with multiple disabilities. In 65 hearing aid and cochlear implant users (36 females; 36 with multiple disabilities; 44.3 ± 18.5 months of age, mean ± SD), auditory processing was examined using the P1 cortical auditory evoked response biomarker, and language development with the Preschool Language Scales 5th edition (PLS-5). During the study, all of the children received intensive extra language therapy for six months. No significant differences were found between the groups in P1 latency development, the proportion of abnormal P1 latencies, or the number of children whose P1 latencies changed from abnormal to normal during the study. The PLS-5 total language scores, auditory comprehension scores, or expressive communication scores did not differ between groups either. The P1 latencies showed meaningful negative correlations with the language scores. The results suggest that auditory cortex development is similar in hearing-impaired children with/without additional disabilities, and the P1 biomarker is a feasible tool to evaluate central auditory maturation in children with multiple disabilities.
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Affiliation(s)
- Satu Lamminmäki
- Department of Speech Language and Hearing Sciences, University of Colorado Boulder, 2501 Kittredge Loop Dr. UCB 409, Boulder, CO 80309, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland
| | - Kayla Cormier
- Department of Speech Language and Hearing Sciences, University of Colorado Boulder, 2501 Kittredge Loop Dr. UCB 409, Boulder, CO 80309, USA
| | - Hanna Davidson
- Department of Speech Language and Hearing Sciences, University of Colorado Boulder, 2501 Kittredge Loop Dr. UCB 409, Boulder, CO 80309, USA
| | - Jim Grigsby
- Department of Psychology, University of Colorado Denver, Denver, CO 80217, USA
| | - Anu Sharma
- Department of Speech Language and Hearing Sciences, University of Colorado Boulder, 2501 Kittredge Loop Dr. UCB 409, Boulder, CO 80309, USA
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Keintzel T, Raffelsberger T, Niederwanger L, Gundacker G, Rasse T. Systematic Literature Review and Early Benefit of Cochlear Implantation in Two Pediatric Auditory Neuropathy Cases. J Pers Med 2023; 13:jpm13050848. [PMID: 37241018 DOI: 10.3390/jpm13050848] [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: 04/05/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Approximately 1 in 10 children with hearing loss is affected by auditory neuropathy spectrum disorder (ANSD). People who have ANSD usually have great difficulty understanding speech or communicating. However, it is possible for these patients to have audiograms that may indicate profound hearing loss up to normal hearing. This disorder is prognosed with positive, intact or present otoacoustic emissions (OAE) and/or cochlear microphonics (CM) as well as abnormal or absent auditory brainstem responses (ABR). Treatment methods include conventional hearing aids as well as cochlear implants. Cochlear implants (CI) usually promise better speech understanding for ANSD patients. We performed a systematic literature review aiming to show what improvements can effectively be achieved with cochlear implants in children with ANSD and compare this with our experience with two cases of ANSD implanted at our clinic. The retrospective review of two young CI patients diagnosed with ANSD during infancy demonstrated improvements over time in speech development communicated by their parents.
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Affiliation(s)
- Thomas Keintzel
- Department of Otorhinolaryngology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Tobias Raffelsberger
- Department of Otorhinolaryngology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Lisa Niederwanger
- Department of Otorhinolaryngology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Gina Gundacker
- Department Health and Rehabilitation Engineering, University of Applied Sciences Technikum Wien, 1200 Vienna, Austria
| | - Thomas Rasse
- Department of Otorhinolaryngology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
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Tsuzuki N, Namba K, Saegusa C, Mutai H, Nishiyama T, Oishi N, Matsunaga T, Fujioka M, Ozawa H. Apoptosis of type I spiral ganglion neuron cells in Otof-mutant mice. Neurosci Lett 2023; 803:137178. [PMID: 36914046 DOI: 10.1016/j.neulet.2023.137178] [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: 11/29/2022] [Revised: 02/08/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023]
Abstract
Otof, which encodes otoferlin, knockout mice are considered model mice for auditory neuropathy spectrum disorder, which is characterized by an absent auditory brainstem response (ABR) despite preserved distortion product otoacoustic emission (DPOAE). Although otoferlin-deficient mice lack neurotransmitter release at the inner hair cell (IHC) synapse, it remains unclear how the Otof mutation affects spiral ganglions. Thus, we used Otof-mutant mice carrying the Otoftm1a(KOMP)Wtsi allele (Otoftm1a) and analyzed spiral ganglion neurons (SGNs) in Otoftm1a/tm1a mice by immunolabeling type Ⅰ SGNs (SGN-Ⅰ) and type II SGNs (SGN-II). We also examined apoptotic cells in SGNs. Four-week-old Otoftm1a/tm1a mice had an absent ABR but normal DPOAEs. The number of SGNs was significantly lower in Otoftm1a/tm1a mice on postnatal day 7 (P7), P14, and P28 compared with that of wild-type mice. Moreover, significantly more apoptotic SGNs were observed in Otoftm1a/tm1a mice than in wild-type mice on P7, P14, and P28. SGN-IIs were not significantly reduced in Otoftm1a/tm1a mice on P7, P14, and P28. No apoptotic SGN-IIs were observed under our experimental conditions. In summary, Otoftm1a/tm1a mice showed a reduction in SGNs accompanied by apoptosis of SGN-Ⅰs even before the onset of hearing. We speculate that the reduction in SGNs with apoptosis is a secondary defect caused by a lack of otoferlin in IHCs. Appropriate glutamatergic synaptic inputs may be important for the survival of SGNs.
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Affiliation(s)
- Nobuyoshi Tsuzuki
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo 152-8902, Japan; Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo 152-8902, Japan.
| | - Kazunori Namba
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo 152-8902, Japan
| | - Chika Saegusa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Department of Molecular Genetics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
| | - Hideki Mutai
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo 152-8902, Japan.
| | - Takanori Nishiyama
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Naoki Oishi
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Tatsuo Matsunaga
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo 152-8902, Japan; Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo 152-8902, Japan.
| | - Masato Fujioka
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Department of Molecular Genetics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan; Clinical and Translational Research Center, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Hiroyuki Ozawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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Full etiologic spectrum of pediatric severe to profound hearing loss of consecutive 119 cases. Sci Rep 2022; 12:12335. [PMID: 35853923 PMCID: PMC9296524 DOI: 10.1038/s41598-022-16421-x] [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: 09/13/2021] [Accepted: 07/11/2022] [Indexed: 12/03/2022] Open
Abstract
Determining the etiology of severe-to-profound sensorineural hearing loss (SP-SNHL) in pediatric subjects is particularly important in aiding the decision for auditory rehabilitation. We aimed to update the etiologic spectrum of pediatric SP-SNHL by combining internal auditory canal (IAC)-MRI with comprehensive and state-of-the-art genetic testings. From May 2013 to September 2020, 119 cochlear implantees under the age of 15 years with SP-SNHL were all prospectively recruited. They were subjected to genetic tests, including exome sequencing, and IAC-MRI for etiologic diagnosis. Strict interpretation of results were made based on ACMG/AMP guidelines and by an experienced neuroradiologist. The etiology was determined in of 65.5% (78/119) of our cohort. If only one of the two tests was done, the etiologic diagnostic rate would be reduced by at least 21.8%. Notably, cochlear nerve deficiency (n = 20) detected by IAC-MRI topped the etiology list of our cohort, followed by DFNB4 (n = 18), DFNB1 (n = 10), DFNB9 (n = 10) and periventricular leukomalacia associated with congenital CMV infection (n = 8). Simultaneous application of state-of-the-art genetic tests and IAC-MRI is essential for etiologic diagnosis, and if lesions of the auditory nerve or central nerve system are carefully examined on an MRI, we can identify the cause of deafness in more than 65% of pediatric SP-SNHL cases.
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Lin PH, Wu HP, Wu CM, Chiang YT, Hsu JS, Tsai CY, Wang H, Tseng LH, Chen PY, Yang TH, Hsu CJ, Chen PL, Wu CC, Liu TC. Cochlear Implantation Outcomes in Patients with Auditory Neuropathy Spectrum Disorder of Genetic and Non-Genetic Etiologies: A Multicenter Study. Biomedicines 2022; 10:biomedicines10071523. [PMID: 35884828 PMCID: PMC9313466 DOI: 10.3390/biomedicines10071523] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/04/2023] Open
Abstract
With diverse etiologies and clinical features, the management of pediatric auditory neuropathy spectrum disorder (ANSD) is often challenging, and the outcomes of cochlear implants (CIs) are variable. This study aimed to investigate CI outcomes in pediatric patients with ANSD of different etiologies. Thirty-six children with ANSD who underwent cochlear implantation between 2001 and 2021 were included. Comprehensive etiological analyses were conducted, including a history review, next-generation sequencing-based genetic examinations, and imaging studies using high-resolution computed tomography and magnetic resonance imaging. Serial behavioral and speech audiometry were performed before and after surgery, and the outcomes with CI were evaluated using the Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores. By etiology, 18, 1, 1, and 10 patients had OTOF-related, WFS1-related, OPA1-related, and cochlear nerve deficiency (CND)-related ANSD, respectively. Six patients had no definite etiology. The average CI-aided behavioral threshold was 28.3 ± 7.8 dBHL, and those with CND-related ANSD were significantly worse than OTOF-related ANSD. The patients’ median CAP and SIR scores were 6 and 4, respectively. Favorable CI outcomes were observed in patients with certain etiologies of ANSD, particularly those with OTOF (CAP/SIR scores 5–7/2–5), WFS1 (CAP/SIR score 6/5), and OPA1 variants (CAP/SIR score 7/5). Patients with CND had suboptimal CI outcomes (CAP/SIR scores 2–6/1–3). Identifying the etiologies in ANSD patients is crucial before surgery and can aid in predicting prognoses.
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Affiliation(s)
- Pei-Hsuan Lin
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan; (P.-H.L.); (P.-L.C.)
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
- Department of Otolaryngology, National Taiwan University Hospital Yunlin Branch, Yunlin 64041, Taiwan
| | - Hung-Pin Wu
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan;
| | - Che-Ming Wu
- Department of Otolaryngology & Head and Neck Surgery, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 23652, Taiwan;
- Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33305, Taiwan
| | - Yu-Ting Chiang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 10051, Taiwan;
| | - Jacob Shujui Hsu
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 10051, Taiwan;
| | - Cheng-Yu Tsai
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 10051, Taiwan;
| | - Han Wang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
| | - Li-Hui Tseng
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
| | - Pey-Yu Chen
- Department of Otolaryngology, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- Department of Audiology and Speech-Language Pathology, Mackay Medical College, New Taipei City 25245, Taiwan
| | - Ting-Hua Yang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
| | - Chuan-Jen Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan;
| | - Pei-Lung Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan; (P.-H.L.); (P.-L.C.)
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 10051, Taiwan;
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Chen-Chi Wu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 10002, Taiwan
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30261, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30261, Taiwan
- Hearing and Speech Center, National Taiwan University Hospital, Taipei 10002, Taiwan
- Correspondence: (C.-C.W.); (T.-C.L.)
| | - Tien-Chen Liu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (C.-Y.T.); (H.W.); (L.-H.T.); (T.-H.Y.); (C.-J.H.)
- Correspondence: (C.-C.W.); (T.-C.L.)
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