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Abe Y, Okada M, Tanaka K, Toyama K, Miyamoto Y, Hato N. The Association Between Dehydration and the Prognosis of Sudden Sensorineural Hearing Loss. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e041. [PMID: 38516543 PMCID: PMC10950149 DOI: 10.1097/ono.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/09/2023] [Indexed: 03/23/2024]
Abstract
Background There is an urgent need to identify undetermined risk factors for sudden sensorineural hearing loss (SSNHL) for the development of effective treatment strategies. SSNHL is likely associated with vascular insufficiency; however, no study has evaluated the relationship between dehydration and SSNHL. Objective This study aimed to investigate the role of dehydration in the development and prognosis of sudden sensorineural hearing loss. Study Design Retrospective case-control study. Setting Secondary referral hospital. Patients and Interventions This was a comparative study that compared dehydration parameters between healthy subjects without SSNHL (n = 94) and patients with SSNHL (n = 94). The study also evaluated the effect of dehydrated conditions on the prognosis of SSNHL. Main Outcome Measures We compared dehydration parameters, such as the blood urea nitrogen-to-creatinine ratio (BUN/Cre) and plasma osmolality (Posm), between matched healthy subjects without SSNHL and patients with SSNHL. To evaluate the effect of dehydrated conditions on the SSNHL prognosis, the SSNHL patients were divided into 2 groups based on the cutoff value obtained from the receiver operating characteristic analysis: hydrated (n = 50; BUN/Cre <21.4) and dehydrated (n = 44; BUN/Cre ≥21.4) groups. Subsequently, the severity and prognosis of SSNHL were analyzed. Results The dehydration parameters, BUN/Cre and Posm, were significantly higher in patients with SSNHL than in healthy subjects. The initial hearing levels and SSNHL grades were worse in the dehydrated group than in the hydrated group. Moreover, a dehydrated condition (BUN/Cre ≥21.4) was associated with a poor SSNHL prognosis in all models of the multiple logistic regression analysis. Conclusions The dehydration parameters of BUN/Cre and Posm were higher in patients with SSNHL than in healthy subjects. Additionally, a dehydrated condition (BUN/Cre ≥21.4) was an independent prognostic factor for SSNHL. Level of evidence: Level 4.
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Affiliation(s)
- Yasunori Abe
- Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan
- Department of Otolaryngology, Jyuzen General Hospital, Niihama, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Toon, Japan
- Integrated Medical and Agricultural School of Public Health, Ehime University, Matsuyama & Toon, Japan
| | - Kensuke Toyama
- Department of Pharmacology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoshito Miyamoto
- Department of Otolaryngology, Jyuzen General Hospital, Niihama, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan
- Integrated Medical and Agricultural School of Public Health, Ehime University, Matsuyama & Toon, Japan
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Connor S, Grzeda MT, Jamshidi B, Ourselin S, Hajnal JV, Pai I. Delayed post gadolinium MRI descriptors for Meniere's disease: a systematic review and meta-analysis. Eur Radiol 2023; 33:7113-7135. [PMID: 37171493 PMCID: PMC10511628 DOI: 10.1007/s00330-023-09651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/12/2023] [Accepted: 02/22/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Delayed post-gadolinium magnetic resonance imaging (MRI) detects changes of endolymphatic hydrops (EH) within the inner ear in Meniere's disease (MD). A systematic review with meta-analysis was conducted to summarise the diagnostic performance of MRI descriptors across the range of MD clinical classifications. MATERIALS AND METHODS Case-controlled studies documenting the diagnostic performance of MRI descriptors in distinguishing MD ears from asymptomatic ears or ears with other audio-vestibular conditions were identified (MEDLINE, EMBASE, Web of Science, Scopus databases: updated 17/2/2022). Methodological quality was evaluated with Quality Assessment of Diagnostic Accuracy Studies version 2. Results were pooled using a bivariate random-effects model for evaluation of sensitivity, specificity and diagnostic odds ratio (DOR). Meta-regression evaluated sources of heterogeneity, and subgroup analysis for individual clinical classifications was performed. RESULTS The meta-analysis included 66 unique studies and 3073 ears with MD (mean age 40.2-67.2 years), evaluating 11 MRI descriptors. The combination of increased perilymphatic enhancement (PLE) and EH (3 studies, 122 MD ears) achieved the highest sensitivity (87% (95% CI: 79.92%)) whilst maintaining high specificity (91% (95% CI: 85.95%)). The diagnostic performance of "high grade cochlear EH" and "any EH" descriptors did not significantly differ between monosymptomatic cochlear MD and the latest reference standard for definite MD (p = 0.3; p = 0.09). Potential sources of bias were case-controlled design, unblinded observers and variable reference standard, whilst differing MRI techniques introduced heterogeneity. CONCLUSIONS The combination of increased PLE and EH optimised sensitivity and specificity for MD, whilst some MRI descriptors also performed well in diagnosing monosymptomatic cochlear MD. KEY POINTS • A meta-analysis of delayed post-gadolinium magnetic resonance imaging (MRI) for the diagnosis of Meniere's disease is reported for the first time and comprised 66 studies (3073 ears). • Increased enhancement of the perilymphatic space of the inner ear is shown to be a key MRI feature for the diagnosis of Meniere's disease. • MRI diagnosis of Meniere's disease can be usefully applied across a range of clinical classifications including patients with cochlear symptoms alone.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
- Department of Neuroradiology, King's College Hospital, London, SE5 9RS, UK.
- Department of Radiology, Guy's Hospital and St Thomas' Hospital, London, SE1 9RT, UK.
| | - Mariusz T Grzeda
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, SE1 7EH, UK
| | - Babak Jamshidi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, SE1 9RT, UK
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Huang RJ, Del Risco A, Riska KM, Cooper MW, Clark NW, Kaplan SJ, Kaylie D, Francis HW. Prognosis of Acute Low-Tone Hearing Loss Without Vertigo: A Scoping Review. Laryngoscope 2023; 133:2457-2469. [PMID: 36880419 PMCID: PMC10483019 DOI: 10.1002/lary.30630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 01/24/2023] [Accepted: 02/04/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Despite its relatively high prevalence, our understanding of the natural clinical course of acute low-tone hearing loss (ALHL) without vertigo remains incomplete. The purpose of this study is to summarize the findings of studies that evaluated recovery from hearing loss (HL), recurrence and/or fluctuation of HL, and progression to Meniere's Disease (MD) of patients presenting with ALHL without vertigo. METHODS A scoping review of the English literature was performed. On May 14, 2020 and July 6, 2022, MEDLINE, Embase, and Scopus were searched to identify articles related to the prognosis of ALHL. To be included, articles had to present outcomes that were clearly distinguishable for patients with ALHL without vertigo. Two reviewers evaluated articles for inclusion and extracted data. Disagreements were adjudicated by a third reviewer. RESULTS Forty-one studies were included. There was extensive heterogeneity between studies in regard to defining ALHL, treatment methods, and time of follow-up. Most of the cohorts (39 out of 40) reported partial or complete recovery of hearing in the majority (>50%) of patients, although reports of recurrence were relatively common. Progression to MD was infrequently reported. Shorter time from onset of symptoms to treatment predicted better hearing outcomes in 6 of 8 studies. CONCLUSION The literature suggests that although the majority of patients with ALHL experience hearing improvement, recurrence and/or fluctuation are common, and progression to MD occurs in a minority of patients. Additional trials utilizing standardized inclusion and outcome criteria are needed to determine the ideal treatment for ALHL. LEVEL OF EVIDENCE NA Laryngoscope, 133:2457-2469, 2023.
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Affiliation(s)
- Ryan J. Huang
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Amanda Del Risco
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Kristal M. Riska
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | - Matthew W. Cooper
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Nicholas W. Clark
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Samantha J. Kaplan
- Duke Medical Center Library, Duke University School of Medicine, Durham, NC
| | - David Kaylie
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Howard W. Francis
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
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Sone M, Kobayashi M, Yoshida T, Naganawa S. Pathophysiological analysis of idiopathic sudden sensorineural hearing loss by magnetic resonance imaging: A mini scoping review. Front Neurol 2023; 14:1193104. [PMID: 37153681 PMCID: PMC10159174 DOI: 10.3389/fneur.2023.1193104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To summarize the pathophysiological analysis of idiopathic sudden sensorineural hearing loss (ISSNHL) by magnetic resonance imaging (MRI), focusing on the findings of high signal or endolymphatic hydrops (EH) in the inner ear. Methods We summarize the published studies of our research group regarding the pathophysiological analysis of ISSNHL on MRI and review related clinical articles that have reported significantly high signal or the existence of EH in ears with ISSNHL. Results Pre-contrast high signal on MRI may indicate minor hemorrhage or increased permeability of surrounding vessels to the perilymph, whereas post-contrast high signal indicates breakdown of the blood-labyrinth barrier, in which irreversible changes would lead to poor prognosis. In some cases of ISSNHL, primary EH could be pre-existing and may be a risk factor for the onset of ISSNHL. Conclusion Analysis of ISSNHL by cutting-edge MRI evaluation could provide useful information for elucidating its pathophysiology and for predicting prognosis in this disease.
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Affiliation(s)
- Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- *Correspondence: Michihiko Sone,
| | - Masumi Kobayashi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Castellucci A, Botti C, Delmonte S, Bettini M, Lusetti F, Brizzi P, Ruberto R, Gamberini L, Martellucci S, Malara P, Armato E, Renna L, Ghidini A, Bianchin G. Vestibular assessment in sudden sensorineural hearing loss: Role in the prediction of hearing outcome and in the early detection of vascular and hydropic pathomechanisms. Front Neurol 2023; 14:1127008. [PMID: 36873440 PMCID: PMC9975513 DOI: 10.3389/fneur.2023.1127008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Predicting hearing outcome in sudden sensorineural hearing loss (SSNHL) is challenging, as well as detecting the underlying pathomechanisms. SSNHL could be associated with vestibular damage since cochleo-vestibular structures share the same vascularization, along with being in close anatomical proximity. Whereas viral inflammations and autoimmune/vascular disorders most likely represent the involved aetiologies, early-stage Menière's disease (MD) can also present with SSNHL. Since an early treatment could beneficially influence hearing outcome, understanding the possible etiology plays a pivotal role in orienting the most appropriate treatment. We aimed to evaluate the extent of vestibular damage in patients presenting with SSNHL with or without vertigo, investigate the prognostic role of vestibular dysfunctions on hearing recovery and detect specific lesion patterns related to the underlying pathomechanisms. Methods We prospectively evaluated 86 patients with SSNHL. Audio-vestibular investigation included pure-tone/speech/impedance audiometry, cervical/ocular-VEMPs, vHIT and video-Frenzel examination. White matter lesions (WML) were evaluated on brain-MRI. Patients were followed-up and divided into "SSNHL-no-vertigo," "SSNHL+vertigo" and "MD" subgroups. Results Hearing was more impaired in "SSNHL+vertigo" patients who exhibited either down-sloping or flat-type audiograms, and was less impaired in "MD" where low frequencies were mostly impaired (p < 0.001). Otolith receptors were more frequently involved than semicircular canals (SCs). Although the "SSNHL-no-vertigo" subgroup exhibited the lowest vestibular impairment (p < 0.001), 52% of patients developed otolith dysfunctions and 72% developed nystagmus. Only "MD" subjects showed anterior SC impairment and upbeating spontaneous/positional nystagmus. They more frequently exhibited cervical-VEMPs frequency tuning (p = 0.036) and ipsilesional spontaneous nystagmus (p < 0.001). "SSNHL+vertigo" subjects presented with more frequently impaired cervical-VEMPs and posterior SC and with higher number of impaired receptors (p < 0.001). They mainly exhibited contralesional spontaneous and vibration-induced nystagmus (p < 0.05) and only they showed the highest WML score and "vascular" lesion patterns (p < 0.001). Concerning the outcomes, hearing was better in "MD" and worse in "SSNHL+vertigo" (p < 0.001). Hearing recovery was mostly affected by cervical-VEMPs impairment and the number of involved receptors (p < 0.05). Patients with "vascular" lesion patterns presented with the highest HL degree and WML score (p ≤ 0.001), while none of them exhibited a complete hearing recovery (p = 0.026). Conclusions Our data suggest that vestibular evaluation in SSNHL can provide useful information on hearing recovery and underlying aetiologies.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Ph.D. Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Delmonte
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Margherita Bettini
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Lusetti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pasquale Brizzi
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosanna Ruberto
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lisa Gamberini
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | - Enrico Armato
- ENT Unit, SS. Giovanni e Paolo Hospital, Venice, Italy
| | - Luigi Renna
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Bianchin
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Robles-Bolivar P, Bächinger D, Parra-Perez AM, Román-Naranjo P, Escalera-Balsera A, Gallego-Martinez A, Eckhard AH, Lopez-Escamez JA. A novel nonsense variant in the CENPP gene segregates in a Swiss family with autosomal dominant low-frequency sensorineural hearing loss. Eur J Hum Genet 2022; 30:1301-1305. [PMID: 36071244 PMCID: PMC9626507 DOI: 10.1038/s41431-022-01184-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 02/04/2023] Open
Abstract
Low-frequency sensorineural hearing loss (SNHL) is a rare hearing impairment affecting frequencies below 1000 Hz, previously associated with DIAPH1, WSF1, MYO7A, TNC, SLC26A4 or CCDC50 genes. By exome sequencing, we report a novel nonsense variant in CENPP gene, segregating low-frequency SNHL in five affected members in a Swiss family with autosomal dominant inheritance pattern. Audiological evaluation showed up-sloping audiometric configuration with mild-to-moderate losses below 1000 Hz, that progresses to high-frequencies over time. Protein modeling shows that the variant truncates five amino acids at the end, losing electrostatic interactions that alter protein stability. CENPP gene is expressed in the supporting cells of the organ of Corti and takes part as a subunit of the Constitutive Centromere Associated Network in the kinetochore, that fixes the centromere to the spindle microtubules. We report CENPP as a new candidate gene for low-frequency SNHL. Further functional characterization might enable us to elucidate its molecular role in SNHL.
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Affiliation(s)
- Paula Robles-Bolivar
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Avenida de la Ilustración, 114, 18016, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, 28029, Madrid, Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs, Granada, Hospital Universitario Virgen de las Nieves, Universidad de Granada, 18014, Granada, Spain
| | - David Bächinger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alberto M Parra-Perez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Avenida de la Ilustración, 114, 18016, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, 28029, Madrid, Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs, Granada, Hospital Universitario Virgen de las Nieves, Universidad de Granada, 18014, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, 18011, Granada, Spain
| | - Pablo Román-Naranjo
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Avenida de la Ilustración, 114, 18016, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, 28029, Madrid, Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs, Granada, Hospital Universitario Virgen de las Nieves, Universidad de Granada, 18014, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, 18011, Granada, Spain
| | - Alba Escalera-Balsera
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Avenida de la Ilustración, 114, 18016, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, 28029, Madrid, Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs, Granada, Hospital Universitario Virgen de las Nieves, Universidad de Granada, 18014, Granada, Spain
| | - Alvaro Gallego-Martinez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Avenida de la Ilustración, 114, 18016, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, 28029, Madrid, Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs, Granada, Hospital Universitario Virgen de las Nieves, Universidad de Granada, 18014, Granada, Spain
| | - Andreas H Eckhard
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jose A Lopez-Escamez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Avenida de la Ilustración, 114, 18016, Granada, Spain.
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, 28029, Madrid, Spain.
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs, Granada, Hospital Universitario Virgen de las Nieves, Universidad de Granada, 18014, Granada, Spain.
- Division of Otolaryngology, Department of Surgery, University of Granada, 18011, Granada, Spain.
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