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Wang HC, Chen YC, Pan HG, Li L, Teng YS. Tracheostomy-Assisted Foreign Body Removal: Insights From a Case Series and Literature Review. EAR, NOSE & THROAT JOURNAL 2023:1455613231201015. [PMID: 37743805 DOI: 10.1177/01455613231201015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Foreign body aspiration into the trachea is a common occurrence in children. While most foreign bodies in the airways can be removed using rigid tracheoscopy, there are instances where tracheostomy or tracheotomy is needed. This article presents a series of cases in which tracheostomy was necessary to remove foreign bodies, and summarizes the relevant experiences and lessons learned. METHODS We reviewed a total of 7 cases in which tracheostomy and rigid tracheoscopy were combined for foreign body removal out of a larger cohort of 1559 cases at Shenzhen Children's Hospital in Guangdong, China over a 20-year period. RESULTS The combined use of tracheostomy and rigid tracheoscopy resulted in successful removal of foreign bodies in all 7 patients reviewed in this study. Six patients developed complications of tracheotomy, mainly including mediastinal emphysema (5/7), subcutaneous emphysema (3/7), and pneumothorax (1/7). Tracheotomy was temporary in all patients. CONCLUSION In cases where a foreign body in the trachea is too large or has irregular, sharp edges, is embedded in submucosal tissues with edema, cannot be passed smoothly through the vocal cords, or local endoscopic facilities are inadequate, a tracheotomy may be necessary. However, this approach should be used with caution, and close collaboration with anesthesiologists and careful management of intraoperative emergencies are crucial for improving the success rate of the procedure. Additionally, the complications should be noted, paying particular attention to early complications such as pneumothorax, pneumomediastinum, and bleeding.
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Affiliation(s)
- Hao-Cheng Wang
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Hong-Guang Pan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Lan Li
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
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Su S, Zhang H, Xiao L, Yao H, Ding L. Correlative Factors for Types of Tracheobronchial Foreign Bodies Encountered in Children. EAR, NOSE & THROAT JOURNAL 2023:1455613231167244. [PMID: 37010488 DOI: 10.1177/01455613231167244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE To characterize the correlative factors for types of tracheobronchial foreign bodies (TFBs) encountered in children. METHODS All included patients diagnosed with TFB underwent rigid bronchoscopy as the first surgery in the Children's Hospital of Chongqing Medical University. The data of 1026 patients aged 0-18 years were retrospectively collected between February 2019 and January 2022. RESULTS About 94.44% of the children with TFB had organic FBs, among which, peanuts were the most common FBs, followed by melon seeds and walnuts. The most common inorganic FBs included pen points or caps, plastic toys, and plastic papers. As compared to the children with organic FBs, those with inorganic FBs consisted of a higher proportion of children aged ≥3 years old, a time before surgery of >7 days, dyspnea, FBs size of >10 mm, longer operation time, more than two operation procedures, and atelectasis. On the other hand, the proportion of children with aspiration history, cough, and obstructive emphysema in the inorganic FB group was lower as compared to the organic FBs (P< .05). CONCLUSIONS The related factors related to the patient's characteristics, symptoms, operation situations, and preoperative complications can be predicted based on the identification of FB type.
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Affiliation(s)
- Shuping Su
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hengci Zhang
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbing Yao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Ding
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Ding L, Su X, Yang D, Yao H, Xiao L. Risk factors for difficult removal of tracheobronchial foreign bodies in children by rigid bronchoscopy. Int J Pediatr Otorhinolaryngol 2023; 168:111539. [PMID: 37023557 DOI: 10.1016/j.ijporl.2023.111539] [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: 02/06/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To characterize the risk factors for difficult removal of tracheobronchial foreign body (FB) by rigid bronchoscopy in children. METHODS We retrospectively analyzed clinical data of 1026 pediatric patients (age: 0-18 years) diagnosed with tracheobronchial FB between September 2018 and August 2021. All patients underwent rigid bronchoscopy as the first intervention at our hospital. RESULTS Children aged 1-3 years accounted for 83.7% cases in our cohort. The most common symptoms were cough and wheeze. FBs were more frequently found in the right bronchus, and trachea FBs accounted for only 8.19% cases. The success rate of rigid bronchoscopy in a single attempt was 97.27%. 12.18% of the cases were defined as difficult removal of FB. On univariate analysis, age, CT findings (pneumonia), type of FB, diameter of FB, FB location, granulation tissue formation, and the seniority of the surgeon were identified as risk factors for difficult removal of tracheobronchial FBs. On multivariate analysis, age ≥3 years, FB diameter ≥10 mm, FBs located in left bronchus, multiple FBs, granulation tissue, and the seniority of surgeon (<3 years, ≥5 years) were independent risk factors for difficult removal. CONCLUSIONS Age, FB diameter, location of FB, granulation tissue formation, and the seniority of the surgeon were risk factors for difficult removal of FBs by rigid bronchoscopy.
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Affiliation(s)
- Ling Ding
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiujing Su
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dazhi Yang
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbing Yao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Wang ML, Png LH, Ma J, Lin K, Sun MH, Chen YJ, Tang XC, Bi XY, Gao YQ, Zhang TS. The Role of CT Scan in Pediatric Airway Foreign Bodies. Int J Gen Med 2023; 16:547-555. [PMID: 36814890 PMCID: PMC9939907 DOI: 10.2147/ijgm.s398727] [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: 12/16/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Objective We aim to determine the utility of CT scan as a method to accurately confirm pediatric airway foreign bodies (AFBs), the current gold standard of which is chest X-ray as the primary imaging modality in the investigation screening of AFBs with progression to microlaryngobronchoscopy. Methods A retrospective cohort study of children diagnosed with suspected AFBs between July 2019 and June 2020 was conducted. The primary outcome of missed AFBs from radiologic investigations was recorded. Results A total of 226 children with an average age of 1.94 years were included in this study. One hundred and two children were eventually admitted to the hospital for microlaryngobronchoscopy. A total of 89 cases were initially examined by chest X-ray with the diagnosis confirmed in 26 cases. The initial examination was chest CT scan in 105 cases, of which the diagnosis was confirmed in 46 cases. The initial examination was chest CT scan with airway reconstruction in 32 cases, and the diagnosis was confirmed in 17 cases. Patients with negative chest CT scan with airway reconstruction were observed to have resolution of symptoms with no further need for bronchoscopy. Conclusion Chest CT scan with airway reconstruction had the highest rate of confirmed diagnosis of pediatric AFBs on initial scanning, followed by chest CT scan, and finally chest X-ray with fluoroscopy; there was no missed diagnosis in chest CT scan with airway reconstruction. Chest CT scan with airway reconstruction can accurately and quickly detect AFBs and reduce unnecessary bronchoscopy.
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Affiliation(s)
- Mei-Lan Wang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Lu Hui Png
- Department of Otorhinolaryngology – Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore,Correspondence: Lu Hui Png; Tie-Song Zhang, Email ;
| | - Jing Ma
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Ken Lin
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Mei-hua Sun
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Yi-Jun Chen
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming Medical University, Kunming, People’s Republic of China
| | - Xian-Chao Tang
- Department of Radiology, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Xian-Yun Bi
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Ying-Qin Gao
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Tie-Song Zhang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
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Parvar SY, Sarasyabi MS, Moslehi MA, Priftis KN, Cutrera R, Chen M, Lili Z, Gonuguntla HK, Joseph T, Alajmi M, Alshammari S, Singh V, Parakh A, Indawati W, Triasih R, Fasseeh N. The characteristics of foreign bodies aspirated by children across different continents: A comparative review. Pediatr Pulmonol 2023; 58:408-424. [PMID: 36373422 DOI: 10.1002/ppul.26242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Foreign body aspiration (FBA) is a common issue in pediatric emergencies, with regional variations. Various cultures and foods, parents' and physicians' inadequate experience, and lack of bronchoscopy equipment are some attributable factors in the regional variation of FBA. AIM To more accurately represent the demographic characteristics of aspirated foreign bodies (FBs) across various continents, this review attempted to provide organized information based on the reviewed articles. METHODOLOGY A search was conducted in PubMed/PubMed Central, EMBASE, and google scholar. From the 36 included articles, information on age, gender, bronchoscopy type, type of FB, location, history of choking, and time elapsed between aspiration and admission were extracted. RESULTS A total of 14,469 cases were evaluated. According to the findings, children under two accounted for more than 75% of FBAs. Nuts and seeds were the most common FBs in most countries, whereas plastic and metal objects had higher rates in Brazil, and calcified objects were more prevalent in Thailand. The right bronchus was the most frequent location, and rigid bronchoscopy was the most often utilized type of bronchoscope. In addition, a significant percentage of patients were referred to the emergency rooms in the first 12-24 h following the aspiration incident. Moreover, Asian patients reported more choking history, and Europeans had fewer witnesses of FBA. CONCLUSIONS There is a lack of standardized reporting systems and organized guidelines in pediatric FBA. To select the ideal time for endoscopies and create educational programs, a collaboration between experienced researchers, pediatric pulmonologists, radiologists, and otolaryngologists is required.
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Affiliation(s)
| | | | - Mohammad Ashkan Moslehi
- Pediatric Interventional Pulmonology Division, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kostas N Priftis
- Children's Respiratory and Allergy Unit at National and Kapodistrian University of Athens, Zografou, Greece
| | - Renato Cutrera
- Pediatric Respiratory Department, Bambino Gesù Pediatric University Hospital, Rome, Italy
| | - Meng Chen
- Pediatric Interventional Respiratory Division, Qilu Children University Hospital, Shandong University, Jinan, China
| | - Zhong Lili
- Pediatric Respiratory Department, The Children's Medical Center of Hunan Provincial People's Hospital, Hunan University of Medical Sciences, Changsha, Hunan, China
| | - Hari K Gonuguntla
- Division of Interventional Pulmonology, Yashoda Hospitals, Hyderabad, India
| | - Tinku Joseph
- Interventional Pulmonology Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Mohsen Alajmi
- Pediatric Respirology and Interventional Pulmonology, Ahmadi Hospital, Al Ahmadi, Kuwait
| | - Salman Alshammari
- Department of Pediatrics, Pediatric Intensive Care Unit, Adan Hospital, Hadiya, Kuwait
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital, Delhi, India
| | - Ankit Parakh
- Pediatric Respiratory Division, BLK Max Hospital, New Delhi, India
| | - Wahyuni Indawati
- Child Health Department, Respirology Division, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rina Triasih
- Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada Dr. Sarjito Hospital, Yogyakarta, Indonesia
| | - Nader Fasseeh
- Respiratory and Allergy Unit, Faculty of Medicine, Alexandria Universty, Alexandria, Egypt
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Dubey NK, Upadhyay A, Raghuwanshi N, Godha S, Mundra R. Title-Optical Forceps: The Real Boon for Surgeon, Residents and Patients with Foreign Body Aspiration. Indian J Otolaryngol Head Neck Surg 2022; 74:5354-5360. [PMID: 36742834 PMCID: PMC9895720 DOI: 10.1007/s12070-021-02596-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Management of aspirated foreign bodies in children becomes very challenging in absence of most appropriate instruments. Rigid bronchoscopy has evolved in the long course of history. The advent of Hopkins rod telescope and optical forceps has enhanced the efficacy as well as the safety of removing tracheobronchial foreign bodies. Total 36 children of age less than 16 year with confirmed diagnosis of airway F.B. were included in the study. Two types of forceps were used: (1)Optical forceps combined with Hopkins rod lens telescope[n = 25] (2)Standard forceps [n = 11]. Most common age group was 1-5 year [n = 26] with male preponderance [n = 20]. Most common site was right bronchus in 13 cases (RMB-11, RBI-1, RLLB-1) followed by Left main bronchus in 11 cases, trachea in 10 cases, bilateral bronchus and sub-glottis each in 1 case. Vegetative F.B. were found in majority of cases [n = 26]. Mean grasping attempt, Mean bronchoscopic insertion and Mean time taken from insertion of forceps to removal of F.B. were less in optical forceps as compared to standard forceps with significant p-value. Optical forceps have advantage of high resolution & magnified view of airway, spring action in handle and better tactile sensation. These helps in correctly identifying the type, size and site of tracheobronchial foreign body. Precise grasping attempts with optical forceps reduces the chances of complications. Optical forceps have given the new dimension to the Rigid Bronchoscopy and proved to be the real boon for surgeons, residents and patients with F.B. aspiration.
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Affiliation(s)
| | | | | | - Surbhi Godha
- Department Of E.N.T., M.G.M. Medical College, Indore, India
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Ding L, Su S, Chen C, Yao H, Xiao L. Tracheobronchial Foreign Bodies in Children: Experience From 1,328 Patients in China. Front Pediatr 2022; 10:873182. [PMID: 35722476 PMCID: PMC9199421 DOI: 10.3389/fped.2022.873182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the clinical characteristics of tracheobronchial foreign body (FB) cases in a pediatric Chinese population. METHODS The clinical data of pediatric patients aged 0-18 years old diagnosed with a tracheobronchial FB in the Children's Hospital of Chongqing Medical University between September 2018 and August 2021 were analyzed retrospectively. RESULTS Among 1,328 included cases, 92.09% of patients were <3 years old, the male to female ratio was 1.86:1. The prevalence of tracheobronchial FB was similar between patients living in rural and urban areas and tracheobronchial FBs were more common in winter. The most common presenting symptoms were cough and wheezing. The most common CT findings was local obstruction or tracheobronchial narrowing, followed by obstructive emphysema of lung and pneumonia. The 11.3% of cases that did not report FB aspiration on admission had a longer time to hospital admission and longer hospitalization time than cases reporting FB aspiration (P < 0.05). The most common FB type was nuts (81.17%). FBs were more frequently located in the right bronchus, and 64 (4.82%) cases involved multiple FBs. FBs were expelled by coughing in only 4.07% of cases. For the other cases, FB removal by first bronchoscopy in our hospital was successful and complete in 96.86% of cases. 1.51% of patients had hypoxic ischemic encephalopathy (HIE) and the location of FBs was a possible risk factor for HIE (P < 0.05). CONCLUSIONS Tracheobronchial FBs occurred most commonly in children <3 years old. If asphyxia occurs in children which FBs aspirated, emergency treatment is needed to reduce the occurrence of HIE. Rigid bronchoscopy remains the first-line method for FB removal in children.
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Affiliation(s)
- Ling Ding
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Shuping Su
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Cheng Chen
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Hongbing Yao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
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