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Jafary Z, Kais A, Boss B, Kellermeyer B. A case report of otosclerosis and concomitant superior semicircular canal dehiscence. Am J Otolaryngol 2024; 45:104295. [PMID: 38640814 DOI: 10.1016/j.amjoto.2024.104295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Zulkifl Jafary
- West Virginia University, School of Medicine, Morgantown, WV, United States of America
| | - Amani Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Benjamin Boss
- Department of Audiology, Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Brian Kellermeyer
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America.
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Young A, Fechtner L, Kim C, Nayak N, Kellermeyer B, Ortega C, Rende S, Rosenberg S, Wazen J. Long-term cognition and speech recognition outcomes after cochlear implantation in the elderly. Am J Otolaryngol 2024; 45:104071. [PMID: 37793300 DOI: 10.1016/j.amjoto.2023.104071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate how cognition, as measured using the Self-Administered Gerocognitive Examination Test (SAGE), and age affect speech recognition scores in older adults (age > 65) at one year and two years after cochlear implantation. STUDY DESIGN This is a prospective study. SETTING This study was conducted at a single institution. METHODS Unilateral cochlear implantation was performed by two surgeons on adult patients (>65 years) with postlingual bilateral sensorineural hearing loss. There were 230 patients who underwent cochlear implantation from January 2016 to June 2023. Fifty-five of these patients completed the SAGE questionnaire before implantation, one year after implantation, and 2 years after implantation. Paired t-test analysis was used to evaluate pre- and post-operative speech recognition scores (CNC, AzBio in Quiet). RESULTS Patients who had normal preoperative cognition on SAGE showed greater improvement in postoperative speech recognition tests at 1 year and 2 years after implantation compared with patients who showed preoperative cognitive impairment. There were no significant differences in postoperative speech outcome between age group 1 (between 65 and 80 years old) and age group 2 (over 80 years old) cochlear implant recipients. There were no changes in cognitive SAGE scores after 2 years implantation. CONCLUSION Cognitive function, as measured by SAGE, is a more reliable predictor than age in determining speech recognition improvement after cochlear implantation. Cochlear implantation did not improve postoperative cognition.
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Affiliation(s)
- Allen Young
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA.
| | - Linnea Fechtner
- Grand Valley ENT and Facial Plastics Surgeon, 2373 G Road, Suite 270, Grand Junction, CO 81505, USA
| | - Christine Kim
- AMC Otolaryngology, 50 New Scotland Avenue, Albany, NY 12208, USA
| | - Neil Nayak
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Brian Kellermeyer
- West Virginia University Hospitals, 1 Medical Center DR, Morganton, WV 26505, USA
| | - Carmelo Ortega
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Sharon Rende
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Seth Rosenberg
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Jack Wazen
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
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Nayak N, Kellermeyer B, Dornton L, Heyd C, Kim CS, Wazen JJ. Vestibular dysfunction in cochlear implant candidates: Prevalence and outcomes. Am J Otolaryngol 2022; 43:103171. [PMID: 34509078 DOI: 10.1016/j.amjoto.2021.103171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/01/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE Cochlear implantation (CI) has been shown to reduce vestibular function postoperatively in the implanted ear. The objective of this study was to identify the prevalence of preoperative vestibular weakness in CI candidates and identify any risk factors for postoperative dizziness. STUDY DESIGN Retrospective cohort study. MATERIALS AND METHODS Patients who underwent CI and had preoperative videonystagmography (VNG) at the Silverstein Institute from January 1, 2017 to May 31, 2020 were evaluated. The primary endpoint was dizziness lasting more than one month postoperatively. RESULTS One hundred and forty nine patients were evaluated. Preoperative VNG revealed that 46 (30.9%) had reduced vestibular response (RVR) on one side and 32 (21.5%) had bilateral vestibular hypofunction (BVH). Postoperative dizziness occurred in 14 (9.4%) patients. Patients with postoperative dizziness were more likely to have abnormal preoperative VNG (RVR or BVH), compared to patients without postoperative dizziness (78.6% versus 49.6%, p = 0.0497). In cases of RVR, implantation of the weaker or stronger vestibular ear did not affect the postoperative dizziness (16.1% versus 6.7%, p = 0.38). Postoperative VNG in patients with dizziness showed decreased caloric responses in the implanted ear (28.4 to 6.4 degrees/s, p = 0.02). CONCLUSION Preoperative caloric weakness is prevalent in CI candidates and abnormal preoperative vestibular testing may be a predictor of postoperative dizziness. CI has the potential to cause vestibular injury and preoperative testing may aid in both counseling and decision-making.
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Kellermeyer B, Haught E, Harper T, Wetmore S. Case series of vestibular schwannoma patients with no asymmetry in hearing. Am J Otolaryngol 2021; 42:103034. [PMID: 33857780 DOI: 10.1016/j.amjoto.2021.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE (1) Describe the presenting symptoms and tumor characteristics of patients who are diagnosed with a vestibular schwannoma (VS) with normal hearing or symmetric hearing loss, and (2) report the prospective growth and treatment of each tumor. METHODS This is a retrospective cohort study of acoustic neuroma patients who were found to have a VS and normal or symmetric hearing loss at a single tertiary care academic center from 1999 to 2012. Medical records were reviewed collecting the following information: patient demographics, symptoms, MRI characteristics, and treatment modality. RESULTS 15/195 (7.7%) patients met criteria for the study. Dizziness was the most common presenting symptom occurring in 9 subjects (60%), followed by headache in 6 (40%), vision changes in 5 (33%), tinnitus in 5 (33%), and unilateral hearing loss in 1 (7%). The average tumor size was 1.07 cm (range 0.3-2.2 cm). Eight (53%) patients presented with intracanalicular tumors. Growth was observed in 6 subjects (40%) with average growth rate in those who exhibited mean growth of 1.8 mm per year. Treatment consisted of surgical removal in 4 cases (27%), gamma knife therapy in 1 (7%), and observation or loss to follow-up in 10 (66%). CONCLUSIONS The incidence of VS with normal hearing was 7.7% Patients with VSs who do not exhibit unilateral hearing loss present most commonly with dizziness. Most of our patients had small, intracanalicular tumors with the largest tumor measuring 2.2 cm in greatest dimension. Of those who were managed conservatively with repeat imaging and observation, most showed tumor growth.
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O’Brien DC, Zalzal H, Adkins D, Gates C, Gonzaga J, Sanders L, Carr MM, Kellermeyer B. Standardization and Reduction of Narcotics After Pediatric Tonsillectomy. Otolaryngol Head Neck Surg 2021; 164:932-937. [PMID: 32746739 PMCID: PMC7858697 DOI: 10.1177/0194599820946274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To measure caregiver satisfaction with a nonstandardized postoperative pain regimen after pediatric tonsillectomy. (2) To implement a quality improvement project (QIP) to reduce the number and volume of narcotics prescribed and to describe the effect on caregiver satisfaction. METHODS A prospective cohort study at a tertiary children's hospital examined postoperative narcotics prescribed to children following adenotonsillectomy. A QIP was implemented 3 months into the observation, with the goal to standardize nonnarcotic analgesics and reduce the volume of narcotics prescribed. Caregivers were called 2 to 3 weeks postoperatively to assess pain control and caregiver satisfaction. RESULTS Over an 8-month period, 118 patients were recruited (66 before the QIP, 52 after induction). Prior to the QIP, 47% of patients were prescribed postoperative narcotics, as opposed to 27% after the QIP (P < .05). There was a significant reduction in the volume of narcotics prescribed before (mean ± SD, 300 ± 150 mL) versus after (180 ± 111 mL) the initiative (P < .05). The per-kilogram dose did not change over the study time frame. On a 5-point Likert scale, there was no difference in the caregivers' satisfaction regarding pain control before (4.37 ± 0.85) versus after (4.35 ± 1.0) the project started. DISCUSSION A system shift was identified with the establishment of a posttonsillectomy pain control protocol associated with a reduction in prescribed narcotics without a significant change in caregiver satisfaction. IMPLICATIONS FOR PRACTICE Implementing a standardized plan for the use of nonnarcotic medications was associated with reduced frequency and volume of narcotics prescribed. Future work will further standardize our postoperative pain regimen.
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Affiliation(s)
- Daniel C. O’Brien
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Habib Zalzal
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - David Adkins
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Christopher Gates
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Joedell Gonzaga
- Ambulatory Pharmacy Services, West Virginia University, Morgantown, West Virginia, USA
| | - Logan Sanders
- Ambulatory Pharmacy Services, West Virginia University, Morgantown, West Virginia, USA
| | - Michele M. Carr
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Brian Kellermeyer
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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Kellermeyer B, Lange L, Wazen JJ. Post-operative infection rates in linear vs. punch technique for bone anchored hearing systems. Am J Otolaryngol 2020; 41:102745. [PMID: 33198052 DOI: 10.1016/j.amjoto.2020.102745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/12/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE This study investigates the post-operative infection rates between two surgical approaches: linear incision and the punch technique for bone anchored hearing systems. Secondarily, it investigates the impact of smoking, comorbid disease, and operative conditions on post-operative skin reactions and infections. METHODS A retrospective study was conducted at a single tertiary care institution. A single surgeon completed either of the two techniques on adult patients with mixed, conductive hearing loss, or single sided-deafness. Patients included had at least 6 months follow-up, and were evaluated for preexisting illnesses, perioperative complications, length of surgery, and post-operative complications including infection after surgery. Post-operative soft tissue around the abutment was assessed with Holgers Classification scale. RESULTS Fifty-one patients were included in this study, 28 female and 23 males with an average age of 68.8. Thirty-three patients underwent linear incision surgery and 18 had the punch technique. Overall 9 patients (17.6%) had post-operative infections requiring topical or oral antibiotic treatment. Six (18.2%) were in the linear group and 3 (16.7%) in the punch group. There was no statistically significantly difference (p = 1). A multivariate analysis compared age, sex, obesity, DM, operative time, skin thickness, and abutment size to post-operative skin infection rates requiring treatment. Only DM was statistically correlative with infection (p = 0.02). CONCLUSION No significant differences in post-operative infections were identified comparing linear incision and the punch techniques. Patients with diabetes had a higher incidence of post-operative skin infections rates.
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Affiliation(s)
- Brian Kellermeyer
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America.
| | - Linda Lange
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America
| | - Jack J Wazen
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America
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Silverstein H, Kellermeyer B, Martinez U. Minimally invasive surgery for the treatment of hyperacusis: New technique and long term results. Am J Otolaryngol 2020; 41:102319. [PMID: 31727335 DOI: 10.1016/j.amjoto.2019.102319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A minimally invasive surgery developed by the senior author has previously been reported to significantly improve sound tolerance after surgery. This report compares the new versus original surgical technique used and long-term results of all patients who have undergone minimally invasive surgery for hyperacusis. STUDY DESIGN A prospective, IRB approved clinical research trial at a single institution with surgery performed by the author (HS). SETTING All patients were evaluated and treated at a tertiary level otologic referral center. SUBJECTS AND METHODS 47 subjects were enrolled from 2014 through 2019, 40 met inclusion criteria including adequate follow-up in the analysis. All subjects underwent oval and round window reinforcement. 20 subjects underwent surgery before 2017 with the original technique of round window reinforcement. 20 subjects underwent new technique with additional oval window and stapes reinforcement. RESULTS 80% of subjects who underwent the new surgical technique had improvement in hyperacusis symptoms after surgery compared to 60% of subjects who underwent the original technique. Long term follow-up showed sustained results with both techniques with a mean follow-up of 2 years after surgery. CONCLUSIONS The most recent, newer technique employed appears to have an 80% success rate in improving sound tolerance with small changes to hearing. The improvement in hyperacusis symptoms after surgery is significant and now found to be sustainable with a mean follow-up of 2 years after initial surgery. Psychological measures of anxiety and depression also were found to be significantly improved after surgery in the newer technique group.
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Affiliation(s)
- Herbert Silverstein
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States.
| | - Brian Kellermeyer
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States
| | - Ulyseius Martinez
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States
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O'Brien DC, Kellermeyer B, Chung J, Carr MM. Experience with key indicator cases among otolaryngology residents. Laryngoscope Investig Otolaryngol 2019; 4:387-392. [PMID: 31453346 PMCID: PMC6703116 DOI: 10.1002/lio2.274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/30/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To describe the resident experience with respect to key indicator cases for each year of training. Study Design Multi‐institution, cross‐sectional assessment. Methods Using an electronic survey, current otolaryngology residents were solicited to complete a survey regarding their experiences with the key indicator cases to that point. The survey was sent to this cohort in the winter of 2017–2018. Results Three hundred and three residents responded, with 293 completing the survey. Twenty‐three percent were PGY1, 19% PGY2, 21% PGY3, 18% PGY4, and 19% PGY5 or higher. The majority of residents progress from resident assistant as a PGY2, to resident surgeon as a PGY3 and self‐assessed competent surgeon as a PGY4 for the majority of the key indicator cases. Less than 50% of the surveyed PGY5 residents had reached independent practice in all the key indicator cases, with stapedectomy (16%), rhinoplasty (18%), and paramedian forehead flap (14.5%) being the cases least frequently performed independently. Ninety‐five percent of the respondent residents felt their program provided adequate training, but 20% of the respondents were either unsure or believed that they would be unable to perform all the key indicator cases by the completion of their training. Conclusions The majority of otolaryngology residents feel confident in their training, but experience with certain cases lags behind and may not currently be taught as resident level cases. These findings raise the question of whether the current key indicator cases are the best option for assessing breadth and depth of residency training. Level of Evidence NA
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Affiliation(s)
- Daniel C O'Brien
- Department of Otolaryngology-Head and Neck Surgery University of West Virginia Morgantown West Virginia U.S.A
| | | | - Jeffson Chung
- Department of Otolaryngology-Head and Neck Surgery University of West Virginia Morgantown West Virginia U.S.A
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery University of West Virginia Morgantown West Virginia U.S.A
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Abstract
OBJECTIVE Hyperacusis is a reduction of normal tolerances for everyday sounds. Although several publications have been produced demonstrating that minimally invasive surgical procedures may improve patient symptoms, the precise etiology of hyperacusis often remains elusive. This study describes 21 patients, 7 of whom stapes hypermobility is believed to be a mechanical genesis of their hyperacusis symptoms. STUDY DESIGN A prospective, repeated-measure single-arm design was used for this study. SETTING All patients were evaluated and treated at a tertiary level otologic referral center. SUBJECTS AND METHODS 21 patients (Cohort A) with severe hyperacusis underwent oval and round window reinforcement. Seven patients (Cohort B) intraoperatively appeared to have subjective hypermobility of the stapes. Additional reinforcement of the stapes superstructure was performed in these patients. RESULTS In Cohort A, loudness discomfort level (LDL) values improved on average from 72.7 dB to 81.9 dB. Hyperacusis questionnaire (HQ) scores improved from 30.1 to 14.7. Numeric Rating Scale scores (0-10) decreased from 8.5 to 4.0. In Cohort B, values similarly improved from an average of 72.4 dB to 88.2 dB. HQ scores improved from 35.8 to 18.9. Numeric Rating Scale scores fell from 10.0 to 3.7. Postoperatively there were no complaints of hearing loss. Sixteen out of 21(76%) reported improved quality of life and diminished symptoms of hyperacusis. CONCLUSION It is possible that patients suffering from hyperacusis may have a mechanical cause for their symptoms. Further research is necessary to clarify stapes mobility in patients with these symptoms. Excess temporalis tissue reinforcement of the stapes along with round window reinforcement shows promise as a minimally invasive surgical option for patients suffering from hyperacusis.
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Affiliation(s)
- Herbert Silverstein
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America.
| | - Joshua Smith
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America
| | - Brian Kellermeyer
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America
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Shapiro S, Pharaon M, Kellermeyer B. Cost-effectiveness of Gene Expression Classifier Testing of Indeterminate Thyroid Nodules Utilizing a Real Cohort Comparator. Otolaryngol Head Neck Surg 2017; 157:596-601. [PMID: 28828911 DOI: 10.1177/0194599817725709] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To predict the cost-effectiveness of implementing routine gene expression classifier testing for thyroid nodules with indeterminate fine-needle aspiration cytology, by utilizing a real cohort of patients as a comparator. Study Design Cost-effectiveness analysis of a retrospective cohort compared with a simulated cohort. Setting Tertiary academic medical center. Subjects and Methods We reviewed the records of all patients who underwent ultrasound-guided fine-needle aspiration from 2010 to 2014 at a tertiary academic medical center. All patients with Bethesda class III or IV cytopathology had the details of their management catalogued over the subsequent 2 years of care. These patients were assigned to the standard-of-care arm of the study. We compared the third-party payer costs of care and the proportion of patients who underwent surgery with a simulated cohort who underwent gene expression classifier testing after an initial indeterminate fine-needle aspiration (molecular test arm). Results The cost of managing 1 nodule over 2 years was $2399 higher (range, $397-$4399) for the molecular test group than the standard of care group. The molecular test group had a 13.1% decrease (base parameters; range, 0.73%-45.09%) in the number of patients undergoing surgery. Conclusion When applied to a real cohort of patients, routine gene expression classifier is predicted to reduce the number of patients undergoing surgery but will increase cost of care. Cost-effectiveness is heavily dependent on prevalence of malignancy and gene expression classifier specificity.
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Affiliation(s)
- Scott Shapiro
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Majed Pharaon
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
| | - Brian Kellermeyer
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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