1
|
Tan D, Fujiwara RJ, Lee KH. Current Issues With Pediatric Cochlear Implantation. J Audiol Otol 2024; 28:79-87. [PMID: 38695052 PMCID: PMC11065545 DOI: 10.7874/jao.2024.00073] [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: 01/23/2024] [Accepted: 03/16/2024] [Indexed: 05/05/2024] Open
Abstract
Cochlear implants (CIs) have demonstrated a clear functional benefit in children with severe-to-profound sensorineural hearing loss (SNHL) and thus have gained wide acceptance for treating deafness in the pediatric population. When evaluating young children for cochlear implantation, there are unique considerations beyond the standard issues addressed during surgery in adults. Because of advances in genetic testing, imaging resolution, CI technology, post-implant rehabilitation, and other factors, issues related to CI surgery in children continue to evolve. Such factors have led to changes in candidacy guidelines, vaccine requirements, and lowering of age requirement for surgery. In addition, differences in the anatomy and physiology of infants require special attention to ensure safety when operating on young children. This review summarizes these issues and provides guidance for surgeons treating children with SNHL.
Collapse
Affiliation(s)
- Donald Tan
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rance J.T. Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kenneth H. Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Pediatric Otolaryngology, Children’s Health, Dallas, TX, USA
| |
Collapse
|
2
|
Byckova J, Mikstiene V, Kiveryte S, Mickeviciene V, Gromova M, Cernyte G, Mataityte-Dirziene J, Stumbrys D, Utkus A, Lesinskas E. Etiological profile of hearing loss amongst Lithuanian pediatric cochlear implant users. Int J Pediatr Otorhinolaryngol 2020; 134:110043. [PMID: 32305661 DOI: 10.1016/j.ijporl.2020.110043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Congenital sensorineural hearing loss is a heterogeneous disorder; its etiological profile varies between populations. Pathogenic variants of GJB2 gene are the major cause of non-syndromic hearing loss. Congenital cytomegalovirus infection (cCMV) is the most important prenatal etiological factor causing hearing loss and other disorders. Perinatal events, syndromes, postnatal infections or traumas are less common. Causes of the remaining one third of hearing loss cases are unknown. OBJECTIVES To determine the etiological profile of hearing loss in pediatric cochlear implant users in Lithuanian population. METHODS The data of 122 children (70 male/52 female; aged 7.6 ± 3.3 years) cochlear implant users were analysed. Medical records of all children recruited in Santaros Clinics (Vilnius, Lithuania) were analysed to identify prenatal, perinatal, or postnatal risk factors based on the adapted list proposed by the Joint Committee of Infant Hearing. Genetic counselling and testing according to the scheme were performed to 101 children. DNA of 117 children was extracted from the DBS on Guthrie cards and CMV DNA detected using real time PCR. RESULTS Non-syndromic hearing loss was diagnosed in 65 cases (53.3%), 58 of which were GJB2 gene-associated; syndromic hearing loss was diagnosed to 8 children (6.6%). Perinatal (prematurity, low birth weight, hypoxia, hyperbilirubinemia, sepsis, ototoxicity, and meningitis) and postnatal (meningitis) risk factors were associated with hearing loss in 16 (13.1%) and 4 (3.3%) study participants respectively. CMV DNA was detected in 12 samples (9.8%). The cause of hearing loss remained unknown only for 17 (13.9%) children. CONCLUSIONS The major cause of HL in the current study was GJB2 gene alterations. Only 14% of the cohort had congenital hearing loss of unknown origin.
Collapse
Affiliation(s)
- Jekaterina Byckova
- Clinic of Ear, Nose, Throat and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Violeta Mikstiene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Silvija Kiveryte
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vaiva Mickeviciene
- Children's Hospital, Affiliate of Vilnius University Santaros Clinics, Vilnius, Lithuania
| | | | | | | | | | - Algirdas Utkus
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eugenijus Lesinskas
- Clinic of Ear, Nose, Throat and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
3
|
Molecular basis of hearing loss associated with enlarged vestibular aqueduct. JOURNAL OF BIO-X RESEARCH 2019. [DOI: 10.1097/jbr.0000000000000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
4
|
The Jervell and Lange-Nielsen syndrome; atrial pacing combined with ß-blocker therapy, a favorable approach in young high-risk patients with long QT syndrome? Heart Rhythm 2016; 13:2186-2192. [DOI: 10.1016/j.hrthm.2016.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Indexed: 11/17/2022]
|
5
|
Barashkov NA, Pshennikova VG, Posukh OL, Teryutin FM, Solovyev AV, Klarov LA, Romanov GP, Gotovtsev NN, Kozhevnikov AA, Kirillina EV, Sidorova OG, Vasilyevа LM, Fedotova EE, Morozov IV, Bondar AA, Solovyevа NA, Kononova SK, Rafailov AM, Sazonov NN, Alekseev AN, Tomsky MI, Dzhemileva LU, Khusnutdinova EK, Fedorova SA. Spectrum and Frequency of the GJB2 Gene Pathogenic Variants in a Large Cohort of Patients with Hearing Impairment Living in a Subarctic Region of Russia (the Sakha Republic). PLoS One 2016; 11:e0156300. [PMID: 27224056 PMCID: PMC4880331 DOI: 10.1371/journal.pone.0156300] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/12/2016] [Indexed: 11/29/2022] Open
Abstract
Pathogenic variants in the GJB2 gene, encoding connexin 26, are known to be a major cause of hearing impairment (HI). More than 300 allelic variants have been identified in the GJB2 gene. Spectrum and allelic frequencies of the GJB2 gene vary significantly among different ethnic groups worldwide. Until now, the spectrum and frequency of the pathogenic variants in exon 1, exon 2 and the flanking intronic regions of the GJB2 gene have not been described thoroughly in the Sakha Republic (Yakutia), which is located in a subarctic region in Russia. The complete sequencing of the non-coding and coding regions of the GJB2 gene was performed in 393 patients with HI (Yakuts—296, Russians—51, mixed and other ethnicities—46) and in 187 normal hearing individuals of Yakut (n = 107) and Russian (n = 80) populations. In the total sample (n = 580), we revealed 12 allelic variants of the GJB2 gene, 8 of which were recessive pathogenic variants. Ten genotypes with biallelic recessive pathogenic variants in the GJB2 gene (in a homozygous or a compound heterozygous state) were found in 192 out of 393 patients (48.85%). We found that the most frequent GJB2 pathogenic variant in the Yakut patients was c.-23+1G>A (51.82%) and that the second most frequent was c.109G>A (2.37%), followed by c.35delG (1.64%). Pathogenic variants с.35delG (22.34%), c.-23+1G>A (5.31%), and c.313_326del14 (2.12%) were found to be the most frequent among the Russian patients. The carrier frequencies of the c.-23+1G>A and с.109G>A pathogenic variants in the Yakut control group were 10.20% and 2.80%, respectively. The carrier frequencies of с.35delG and c.101T>C were identical (2.5%) in the Russian control group. We found that the contribution of the GJB2 gene pathogenic variants in HI in the population of the Sakha Republic (48.85%) was the highest among all of the previously studied regions of Asia. We suggest that extensive accumulation of the c.-23+1G>A pathogenic variant in the indigenous Yakut population (92.20% of all mutant chromosomes in patients) and an extremely high (10.20%) carrier frequency in the control group may indicate a possible selective advantage for the c.-23+1G>A carriers living in subarctic climate.
Collapse
Affiliation(s)
- Nikolay A. Barashkov
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
- * E-mail:
| | - Vera G. Pshennikova
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Olga L. Posukh
- Laboratory of Human Molecular Genetics, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
- Novosibirsk State University, Novosibirsk, Russian Federation
| | - Fedor M. Teryutin
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Aisen V. Solovyev
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Leonid A. Klarov
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Department of Radiology, Republican Hospital # 2 –Center of Emergency Medicine, Ministry of Public Health of the Sakha Republic, Yakutsk, Russian Federation
| | - Georgii P. Romanov
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Nyurgun N. Gotovtsev
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Andrey A. Kozhevnikov
- Republican Centre of Professional Pathology, Republican Hospital # 2 –Center of Emergency Medicine, Ministry of Public Health of the Sakha Republic, Yakutsk, Russian Federation
| | - Elena V. Kirillina
- Institute of Foreign Philology and Regional Studies, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Oksana G. Sidorova
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
| | - Lena M. Vasilyevа
- Audiology-Logopaedic Centre, Republican Hospital #1– National Medical Centre, Ministry of Public Health of the Sakha Republic, Yakutsk, Russian Federation
| | - Elvira E. Fedotova
- Audiology-Logopaedic Centre, Republican Hospital #1– National Medical Centre, Ministry of Public Health of the Sakha Republic, Yakutsk, Russian Federation
| | - Igor V. Morozov
- Novosibirsk State University, Novosibirsk, Russian Federation
- SB RAS Genomics Core Facility, Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
| | - Alexander A. Bondar
- SB RAS Genomics Core Facility, Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
| | - Natalya A. Solovyevа
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Sardana K. Kononova
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Adyum M. Rafailov
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Nikolay N. Sazonov
- Department of Biochemistry and Biotechnology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| | - Anatoliy N. Alekseev
- Institute of Humanitarian Research and Indigenous Peoples of the North, Siberian Branch of the Russian Academy of Sciences, Yakutsk, Russian Federation
| | - Mikhail I. Tomsky
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
| | - Lilya U. Dzhemileva
- Laboratory of Human Molecular Genetics, Institute of Biochemistry and Genetics, Ufa Scientific Centre, Russian Academy of Sciences, Ufa, Russian Federation
- Department of Immunology and Human Reproductive Health, Bashkir State Medical University, Ufa, Russian Federation
| | - Elza K. Khusnutdinova
- Laboratory of Human Molecular Genetics, Institute of Biochemistry and Genetics, Ufa Scientific Centre, Russian Academy of Sciences, Ufa, Russian Federation
- Department of Genetics and Fundamental Medicine, Bashkir State University, Ufa, Russian Federation
| | - Sardana A. Fedorova
- Department of Molecular Genetics, Federal State Budgetary Scientific Institution “Yakut Science Centre of Complex Medical Problems,” Yakutsk, Russian Federation
- Laboratory of Molecular Biology, Institute of Natural Sciences, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russian Federation
| |
Collapse
|
6
|
Mikstiene V, Jakaitiene A, Byckova J, Gradauskiene E, Preiksaitiene E, Burnyte B, Tumiene B, Matuleviciene A, Ambrozaityte L, Uktveryte I, Domarkiene I, Rancelis T, Cimbalistiene L, Lesinskas E, Kucinskas V, Utkus A. The high frequency of GJB2 gene mutation c.313_326del14 suggests its possible origin in ancestors of Lithuanian population. BMC Genet 2016; 17:45. [PMID: 26896187 PMCID: PMC4761217 DOI: 10.1186/s12863-016-0354-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/15/2016] [Indexed: 12/30/2022] Open
Abstract
Background Congenital hearing loss (CHL) is diagnosed in 1 – 2 newborns in 1000, genetic factors contribute to two thirds of CHL cases in industrialised countries. Mutations of the GJB2 gene located in the DFNB1 locus (13q11-12) are a major cause of CHL worldwide. The aim of this cross-sectional study was to assess the contribution of the DFNB1 locus containing the GJB2 and GJB6 genes in the development of early onset hearing loss in the affected group of participants, to determine the population-specific mutational profile and DFNB1-related HL burden in Lithuanian population. Methods Clinical data were obtained from a collection of 158 affected participants (146 unrelated probands) with early onset non-syndromic HL. GJB2 and GJB6 gene sequencing and GJB6 gene deletion testing were performed. The data of GJB2 and GJB6 gene sequencing in 98 participants in group of self-reported healthy Lithuanian inhabitants were analysed. Statistic summary, homogeneity tests, and logistic regression analysis were used for the assessment of genotype-phenotype correlation. Results Our findings show 57.5 % of affected participants with two pathogenic GJB2 gene mutations identified. The most prevalent GJB2 mutations were c.35delG, p. (Gly12Valfs*2) (rs80338939) and c.313_326del14, p. (Lys105Glyfs*5) (rs111033253) with allele frequencies 64.7 % and 28.3 % respectively. GJB6 gene mutations were not identified in the affected group of participants. The statistical analysis revealed significant differences between GJB2(−) and GJB2(+) groups in disease severity (p = 0.001), and family history (p = 0.01). The probability of identification of GJB2 mutations in patients with various HL characteristics was estimated. The carrier rate of GJB2 gene mutations – 7.1 % (~1 in 14) was identified in the group of healthy participants and a high frequency of GJB2-related hearing loss was estimated in our population. Discussion The results show a very high proportion of GJB2-positive individuals in the research group affected with sensorineural HL. The allele frequency of c.35delG mutation (64.7 %) is consistent with many previously published studies in groups of affected individuals of Caucasian populations. The high frequency of the c.313_326del14 (28.3 % of pathogenic alleles) mutation in affected group of participants was an unexpected finding in our study suggesting not only a high frequency of carriers of this mutation in our population but also its possible origin in Lithuanian ancestors. The high frequency of carriers of the c.313_326del14 mutation in the entire Lithuanian population is supported by it being identified twice in the ethnic Lithuanian group of healthy participants (a frequency 2.0 % of carriers in the study group). Conclusion Analysis of the allele frequency of GJB2 gene mutations revealed a high proportion of c. 313_326del14 (rs111033253) mutations in the GJB2-positive group suggesting its possible origin in Lithuanian forebears. The high frequency of carriers of GJB2 gene mutations in the group of healthy participants corresponds to the substantial frequency of GJB2-associated HL in Lithuania. The observations of the study indicate the significant contribution of GJB2 gene mutations to the pathogenesis of the disorder in the Lithuanian population and will contribute to introducing principles to predict the characteristics of the disease in patients. Electronic supplementary material The online version of this article (doi:10.1186/s12863-016-0354-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Violeta Mikstiene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Audrone Jakaitiene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Jekaterina Byckova
- Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santariskiu clinics, Vilnius, Lithuania.
| | - Egle Gradauskiene
- Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santariskiu clinics, Vilnius, Lithuania.
| | - Egle Preiksaitiene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Birute Burnyte
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Birute Tumiene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Ausra Matuleviciene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Laima Ambrozaityte
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Ingrida Uktveryte
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Ingrida Domarkiene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Tautvydas Rancelis
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Loreta Cimbalistiene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Eugenijus Lesinskas
- Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santariskiu clinics, Vilnius, Lithuania.
| | - Vaidutis Kucinskas
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| |
Collapse
|
7
|
Pang X, Chai Y, He L, Chen P, Wang X, Li L, Jia H, Wu H, Yang T. A 7666-bp genomic deletion is frequent in Chinese Han deaf patients with non-syndromic enlarged vestibular aqueduct but without bi-allelic SLC26A4 mutations. Int J Pediatr Otorhinolaryngol 2015; 79:2248-52. [PMID: 26549381 DOI: 10.1016/j.ijporl.2015.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the genetic cause of the patients with non-syndromic enlarged vestibular aqueduct (EVA) but without bi-allelic SLC26A4 mutations. METHODS Presence of a homozygous genomic deletion was detected in a Chinese Han deaf patient (D1467-1) who failed to amplify the first three exons of SLC26A4. The breakpoints of the deletion were fine-mapped and revealed by PCR amplification and sequencing. This deletion was subsequently screened in 22 Chinese Han EVA probands with mono-allelic SLC26A4 mutations. The possible founder effect of the newly identified genomic deletion was evaluated by haplotype analysis. RESULTS A homozygous c.-2071_307+3801del7666 deletion of SLC26A4 was identified in patient D1467-1. This novel genomic deletion was subsequently identified in 18% (4/22) of the Chinese Han EVA probands with mono-allelic SLC26A4 mutations. Haplotype analysis showed that this genomic deletion is likely a founder mutation in Chinese Hans. CONCLUSION Our results suggested that the cryptic c.-2071_307+3801del7666 deletion of SLC26A4 is relatively frequent in Chinese Han non-syndromic EVA patients without bi-allelic SLC26A4 mutations. Screening of this genomic deletion should be incorporated into the routine DNA testing of SLC26A4 in Chinese Hans.
Collapse
Affiliation(s)
- Xiuhong Pang
- Department of Otorhinolaryngology-Head and Neck Surgery, Taizhou People's Hospital, Jiangsu Province, China; Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yongchuan Chai
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Longxia He
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Penghui Chen
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Xiaowen Wang
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Lei Li
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Huan Jia
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China.
| | - Tao Yang
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China.
| |
Collapse
|
8
|
Petersen NK, Jørgensen AW, Ovesen T. Prevalence of various etiologies of hearing loss among cochlear implant recipients: Systematic review and meta-analysis. Int J Audiol 2015; 54:924-32. [PMID: 26642892 PMCID: PMC4732452 DOI: 10.3109/14992027.2015.1091094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the etiology of deafness in cochlear implanted children and to address the question whether there is a need for more thorough diagnostics, especially concerning genetics. DESIGN Systematic review. Four databases were searched for studies (year 2000-2014) on cochlear implanted children (n > 100). Studies were excluded if etiology had influenced their inclusion criteria. Eligibility and methodological quality were assessed independently by three authors. The studies' description of diagnostic evaluation was categorized in three groups. STUDY SAMPLE Sixteen studies were included (5069 children). RESULTS The most common etiological categories were 'Unknown' 40.3% (95% CI 32.8 to 48.0), 'Non-syndromic' 22.4% (95% CI 17.1 to 28.2), and 'Postnatal' 11.3% (95% CI 7.2 to 16.2). Studies published after 2006 had a lower proportion of 'Unknown' etiology 35.3% (95% CI 28.0 to 42.8) than older 45.5% (95% CI 31.0 to 60.4). Important information was missing from several studies: 11 (69%) studies did not provide detailed description on diagnostic evaluation of the etiology of deafness and had a higher proportion of 'Unknown' etiology. CONCLUSIONS In order to ensure a higher level of comparability in future studies, we recommend agreement upon an international standard of diagnostics and the introduction of an international standard for reporting etiology.
Collapse
Affiliation(s)
| | - Anders W Jørgensen
- a Department of Otorhinolaryngology , Aarhus University Hospital , Aarhus C , Denmark
| | - Therese Ovesen
- a Department of Otorhinolaryngology , Aarhus University Hospital , Aarhus C , Denmark
| |
Collapse
|
9
|
Tsukada K, Nishio SY, Hattori M, Usami SI. Ethnic-specific spectrum of GJB2 and SLC26A4 mutations: their origin and a literature review. Ann Otol Rhinol Laryngol 2015; 124 Suppl 1:61S-76S. [PMID: 25999548 DOI: 10.1177/0003489415575060] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The mutation spectrum of the GJB2 and SLC26A4 genes, the 2 most common genes causing deafness, are known to be ethnic specific. In this study, the spectrum of the reported GJB2 and SLC26A4 mutations in different populations are reviewed and considered from a human migration perspective. METHODS Fifty-two and 17 articles on GJB2 and SLC26A4 mutations, respectively, were reviewed through the PubMed database from April 1996 to September 2014. The 4 most prevalent mutations were selected and compared. A cluster analysis was subsequently performed for these selected mutations. RESULTS The present review of frequent mutations shows the ethnic-specific GJB2 and SLC26A4 gene mutation spectrum. A cluster analysis of the GJB2 and SLC26A4 genes revealed similarities between ethnic populations. CONCLUSION The mutation spectrum reviewed in this study clearly indicated that the frequent mutations in the GJB2 and SLC26A4 genes are consistent with the founder mutation hypothesis. A comparison with the Y-chromosome phylogenetic tree indicated that these mutations may have occurred during human migration.
Collapse
Affiliation(s)
- Keita Tsukada
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ya Nishio
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuru Hattori
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
10
|
Nelson S, Andersen R, Anderssen SH. Hearing loss in children in Østfold county 2000-09. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:132-6. [PMID: 25625991 DOI: 10.4045/tidsskr.13.0556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The Directorate of Health recommends hearing screening of all neonates with the aid of otoacoustic emissions (OAE). The goal is to achieve initiation of treatment before the child is six months old. Congenital hearing loss occurs in 1-3 per 1,000 newborns, and the purpose of this study was to identify the prevalence in a large Norwegian dataset. METHOD AND MATERIAL During the period 1 January 2000-31 December 2009, all children who were born in Østfold county, 29,485 neonates in total, were offered hearing screening with the aid of otoacoustic emissions. Those children in whom no emissions were detected were referred to the hearing centre. The dataset also includes children born during the same period who had normal emissions during their neonatal period, but later were diagnosed with hearing loss. The follow-up period of these children lasted until 31 December 2013. RESULTS Altogether 568 children were referred to the hearing centre after screening. Of these, 73 children underwent brainstem response audiometry under anaesthesia, and 31 (0.11%) were diagnosed with hearing loss through absence of emissions at birth. Eleven (35%) of these received their diagnosis before the age of six months. The median age of diagnosis decreased from 13 (7-74) to 6 (3-23) months, while their number increased from nine to 22 from 2000-04 to 2005-09. Hearing loss after normal otoacoustic emissions at the neonatal stage was diagnosed in ten children (0.03%) and the median age of diagnosis among these was 36 (18-86) months. After the introduction of automated auditory brainstem response audiometry (AABR) during sleep, the use of auditory brainstem response audiometry (ABR) under narcosis fell by half. INTERPRETATION The prevalence of hearing loss is equal to other Norwegian and international figures. The age of diagnosis decreased during the period. Otoacoustic emissions appear to be an effective screening method in paediatric wards. The use of automated auditory brainstem response audiometry reduces the need for testing under narcosis.
Collapse
Affiliation(s)
- Siri Nelson
- Barneavdelingen Sykehuset Østfold Fredrikstad * Nåværende arbeidssted: Svensedammen Legesenter Drammen
| | | | | |
Collapse
|
11
|
Kvestad E, Lie KK, Eskild A, Engdahl B. Sensorineural hearing loss in children: the association with Apgar score. A registry-based study of 392,371 children in Norway. Int J Pediatr Otorhinolaryngol 2014; 78:1940-4. [PMID: 25216808 DOI: 10.1016/j.ijporl.2014.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The causes of congenital permanent hearing loss in children are insufficiently understood. We studied the association of Apgar score 5 min after birth with sensorineural hearing loss diagnosed before the age of 5 years. METHODS We performed an epidemiological cohort study with data obtained by linkage between The Medical Birth Registry of Norway and the Norwegian County Registry of Children with Hearing Loss. Cases were 327 children born in Norway during the period 1978-1998 with sensorineural hearing loss. Controls were all children in Norway without sensorineural hearing loss born in the same counties and during the same period as the cases (n=392,044). The associations of Apgar score 5 min after birth with sensorineural hearing loss were estimated as odds ratios (OR) with 95% confidence intervals (CI) by applying logistic regression analyses. RESULTS Among children with sensorineural hearing loss 0.9% (3/327) had Apgar score<3, whereas that was true for 0.1% (304/392044) of children without hearing loss (p=0.001, chi square test). The aOR for sensorineural hearing loss was 7.5 [95% CI 2.3-, 24.2] comparing Apgar score<3 to Apgar score 10, after adjustment for birthweight and concurrent birth defects. Most children with sensorineural hearing loss (90%) had Apgar score>8 five minutes after birth. CONCLUSIONS Low Apgar score was associated with childhood sensorineural hearing loss. However, most children with sensorineural hearing loss, had Apgar score>8.
Collapse
Affiliation(s)
- Ellen Kvestad
- Division of Mental Health, Norwegian Institute of Public Health, 0403 Oslo, Norway.
| | - Kari Kveim Lie
- Division of Epidemiology, Norwegian Institute of Public Health, 0403 Oslo, Norway
| | - Anne Eskild
- Department of Obstetrics and Gynecology and Institute of Clinical Medicine, Akershus University Hospital, 1478 Lørenskog, Norway; Division of Mental Health, Norwegian Institute of Public Health, 0403 Oslo, Norway
| | - Bo Engdahl
- Division of Mental Health, Norwegian Institute of Public Health, 0403 Oslo, Norway
| |
Collapse
|
12
|
Pique LM, Brennan ML, Davidson CJ, Schaefer F, Greinwald J, Schrijver I. Mutation analysis of the SLC26A4, FOXI1 and KCNJ10 genes in individuals with congenital hearing loss. PeerJ 2014; 2:e384. [PMID: 24860705 PMCID: PMC4017815 DOI: 10.7717/peerj.384] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/25/2014] [Indexed: 01/05/2023] Open
Abstract
Pendred syndrome (PDS) and DFNB4 comprise a phenotypic spectrum of sensorineural hearing loss disorders that typically result from biallelic mutations of the SLC26A4 gene. Although PDS and DFNB4 are recessively inherited, sequencing of the coding regions and splice sites of SLC26A4 in individuals suspected to be affected with these conditions often fails to identify two mutations. We investigated the potential contribution of large SLC26A4 deletions and duplications to sensorineural hearing loss (SNHL) by screening 107 probands with one known SLC26A4 mutation by Multiplex Ligation-dependent Probe Amplification (MLPA). A heterozygous deletion, spanning exons 4-6, was detected in only one individual, accounting for approximately 1% of the missing mutations in our cohort. This low frequency is consistent with previously published MLPA results. We also examined the potential involvement of digenic inheritance in PDS/DFNB4 by sequencing the coding regions of FOXI1 and KCNJ10. Of the 29 probands who were sequenced, three carried nonsynonymous variants including one novel sequence change in FOXI1 and two polymorphisms in KCNJ10. We performed a review of prior studies and, in conjunction with our current data, conclude that the frequency of FOXI1 (1.4%) and KCNJ10 (3.6%) variants in PDS/DFNB4 individuals is low. Our results, in combination with previously published reports, indicate that large SLC26A4 deletions and duplications as well as mutations of FOXI1 and KCNJ10 play limited roles in the pathogenesis of SNHL and suggest that other genetic factors likely contribute to the phenotype.
Collapse
Affiliation(s)
- Lynn M Pique
- Department of Pathology, Stanford University Medical Center , Stanford, CA , USA
| | - Marie-Luise Brennan
- Department of Pediatrics, Stanford University Medical Center , Stanford, CA , USA
| | | | - Frederick Schaefer
- Molecular Genetics, Center for Genetic Testing at Saint Francis Hospital , Tulsa, OK , USA
| | - John Greinwald
- Divisions of Human Genetics and Otolaryngology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA
| | - Iris Schrijver
- Department of Pathology, Stanford University Medical Center , Stanford, CA , USA ; Department of Pediatrics, Stanford University Medical Center , Stanford, CA , USA
| |
Collapse
|
13
|
Skou AS, Tranebjærg L, Jensen T, Hasle H. Mitochondrial 12S ribosomal RNA A1555G mutation associated with cardiomyopathy and hearing loss following high-dose chemotherapy and repeated aminoglycoside exposure. J Pediatr 2014; 164:413-5. [PMID: 24252789 DOI: 10.1016/j.jpeds.2013.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/04/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
A 19-month-old girl with the A1555G mitochondrial mutation in the 12S ribosomal RNA gene and acute myelogenous leukemia developed dilated cardiomyopathy and bilateral sensorineural hearing loss before undergoing allogeneic stem cell transplantation. She had received gentamicin during episodes of febrile neutropenia. Testing for the A1555G mutation is recommended in patients frequently treated with aminoglycosides.
Collapse
Affiliation(s)
- Anne-Sofie Skou
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Lisbeth Tranebjærg
- Department of Audiology, HS Bispebjerg Hospital, Copenhagen, Denmark; Wilhelm Johannsen Center for Functional Genome Research, Department of Cellular and Molecular Medicine, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Tim Jensen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
| |
Collapse
|
14
|
Abstract
Hearing loss is the most frequently occurring congenital sensory defect in humans. It is believed that between one and five of every 1000 children born suffers from hearing loss of at least 40 dB. The economic consequences of deafness are staggering and affect not only the individual patient but also society as a whole. A genetic cause is suspected in 50 %-70 % of cases of congenital hearing loss. To date over 130 loci have been associated with genetic hearing loss, with some loci containing more than one gene and others containing as yet unidentified genes. The present article is intended to provide some insight into the complex background issues involved and offer guidance on appropriate decision-making with regard to genetic testing in affected patients. Part 1 is concerned with non-syndromic hearing loss, while part 2 deals with syndromic hearing loss.
Collapse
Affiliation(s)
- W F Burke
- Klinik für Hals-Nasen-Ohren-Heilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | | | | |
Collapse
|
15
|
Chan DK, Chang KW. GJB2-associated hearing loss: Systematic review of worldwide prevalence, genotype, and auditory phenotype. Laryngoscope 2013; 124:E34-53. [DOI: 10.1002/lary.24332] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Dylan K. Chan
- Department of Otolaryngology-Head and Neck Surgery; University of California; San Francisco U.S.A
| | - Kay W. Chang
- Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford California U.S.A
| |
Collapse
|
16
|
Rendtorff ND, Schrijver I, Lodahl M, Rodriguez-Paris J, Johnsen T, Hansén EC, Nickelsen LAA, Tümer Z, Fagerheim T, Wetke R, Tranebjaerg L. SLC26A4mutation frequency and spectrum in 109 Danish Pendred syndrome/DFNB4 probands and a report of nine novel mutations. Clin Genet 2013; 84:388-91. [DOI: 10.1111/cge.12074] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 11/28/2022]
Affiliation(s)
- ND Rendtorff
- Wilhelm Johannsen Centre for Functional Genome Research, Department of Cellular and Molecular Medicine; The Panum Institute, University of Copenhagen; Copenhagen Denmark
| | - I Schrijver
- Department of Pathology
- Department of Pediatrics; Stanford University School of Medicine; Stanford CA USA
| | - M Lodahl
- Wilhelm Johannsen Centre for Functional Genome Research, Department of Cellular and Molecular Medicine; The Panum Institute, University of Copenhagen; Copenhagen Denmark
| | | | | | - EC Hansén
- Audiologiska Klinikken Örebro Universitetssjukhuset; Örebro Sweden
| | - LAA Nickelsen
- Wilhelm Johannsen Centre for Functional Genome Research, Department of Cellular and Molecular Medicine; The Panum Institute, University of Copenhagen; Copenhagen Denmark
| | - Z Tümer
- Center for Applied Human Molecular Genetics; Kennedy Center; Glostrup Denmark
| | - T Fagerheim
- Division of Child and Adolescent Health, Department of Medical Genetics; University Hospital of North Norway; Tromsø Norway
| | - R Wetke
- Øre-Naese-Hals-Sygdomme, Afdeling H; Århus Sygehus; Århus Denmark
| | - L Tranebjaerg
- Wilhelm Johannsen Centre for Functional Genome Research, Department of Cellular and Molecular Medicine; The Panum Institute, University of Copenhagen; Copenhagen Denmark
- Department of Audiology; H:S Bispebjerg Hospital; Copenhagen Denmark
| |
Collapse
|
17
|
Carlsson PI, Karltorp E, Carlsson-Hansén E, Åhlman H, Möller C, Vondöbeln U. GJB2 (Connexin 26) gene mutations among hearing-impaired persons in a Swedish cohort. Acta Otolaryngol 2012; 132:1301-5. [PMID: 23039283 DOI: 10.3109/00016489.2012.701018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The most common mutation in the Swedish population was Connexin 26 (C×26) 35delG, which indicates that the percentage of Swedish persons with C×26 mutations and polymorphisms in the GJB2 gene among non-syndromic hearing-impaired (HI) persons is comparable to the rest of Europe. The results strongly support a Swedish policy to offer all children with diagnosed hearing impairment genetic tests for the C×26 35delG mutation. OBJECTIVES The aim of the present study was to search for mutations in the GBJ2 gene among Swedish persons with non-syndromic hearing impairment to further clarify how common these mutations are in Sweden, one of the northernmost countries in Europe. METHODS Seventy-nine patients with non-syndromic hearing impairment participated in the study. For 87% of the participants, a pure tone audiogram showed a severe or profound hearing impairment. Dried blood spots on filter paper, taken at 3-5 days of age in the Swedish nationwide neonatal screening programme for congenital disorders and saved in a biobank, were used for the molecular genetic analyses. RESULTS The total number of subjects with one or two pathologic mutations or a mutation of unknown consequence found in the GJB2 gene was 28 of 79 (35%). Nineteen (19) persons (24%) were homozygotes for the 35delG mutation.
Collapse
Affiliation(s)
- Per-Inge Carlsson
- Department of Otorhinolaryngology, Central Hospital, Karlstad, Sweden.
| | | | | | | | | | | |
Collapse
|
18
|
Faundes V, Pardo RA, Castillo Taucher S. Genética de la sordera congénita. Med Clin (Barc) 2012; 139:446-51. [DOI: 10.1016/j.medcli.2012.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 02/14/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
|
19
|
Heman-Ackah SE, Roland JT, Haynes DS, Waltzman SB. Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria. Otolaryngol Clin North Am 2012; 45:41-67. [PMID: 22115681 DOI: 10.1016/j.otc.2011.08.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.
Collapse
Affiliation(s)
- Selena E Heman-Ackah
- Department of Otolaryngology, New York University Cochlear Implant Center, New York University School of Medicine, 660 First Avenue, 7th Floor, New York, NY 10016, USA
| | | | | | | |
Collapse
|