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El Khoury P, Abou Hamad W, Khalaf MG, El Hadi C, Assily R, Rassi S, Khoueir N. Ipratropium Bromide Nasal Spray in Non-Allergic Rhinitis: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:3247-3255. [PMID: 37067019 DOI: 10.1002/lary.30706] [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: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE This study aims to compare the effectiveness of intranasal ipratropium bromide (INIB) to a placebo in reducing nasal symptoms, particularly rhinorrhea, and enhancing quality of life in non-allergic rhinitis (NAR) patients. STUDY DESIGN Systematic review and meta-analysis. METHODS A comprehensive review of the literature was conducted on Medline, Embase, and Cochrane libraries. Randomized controlled trials (RCTs) and non-randomized comparative parallel group trials comparing IB nasal spray to placebo were included. RESULTS Five RCTs assessed a total of 472 participants with a diagnosis of NAR. IB nasal spray 0.03% were used across all studies. IB has a better impact on decreasing rhinorrhea than the placebo, with a standardized mean difference (SMD) of 0.93 (95% CI 0.06-1.8). The mean change in rhinorrhea severity was 85% (95% CI 77-92%) and I^2 26% (p = 0.24). IB outperformed the placebo in terms of shortening the symptom's duration/day, as shown by an SMD of 0.35 (95% CI 0.15-0.55). The difference between treatments was noticeable within the first week and remained consistent throughout the treatment. Patients who were administered IB experienced a substantially greater improvement in physical and mental outcomes. Nasal adverse events with IB were generally intermittent and brief. CONCLUSION Compared with a placebo, IB nasal spray is both safe and effective in treating the rhinorrhea associated with NAR. IB significantly reduces the severity and duration of rhinorrhea. The treatment was determined to be beneficial by both patients and physicians and resulted in a better quality of life. LEVEL OF EVIDENCE 1 Laryngoscope, 133:3247-3255, 2023.
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Affiliation(s)
- Patrick El Khoury
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Walid Abou Hamad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Michel G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christopher El Hadi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ralph Assily
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Simon Rassi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadim Khoueir
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Khoueir N, Khalaf MG, Assily R, Rassi S, Hamad WA. Intranasal antihistamines in the treatment of idiopathic non-allergic rhinitis: a systematic review and meta-analysis. Rhinology 2023:3075. [PMID: 37083127 DOI: 10.4193/rhin21.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Idiopathic rhinitis (IR), previously known as vasomotor rhinitis (VMR), is the most common type of non-allergic rhinitis (NAR) which affects around 100 million people worldwide. The treatment of patients with IR is not standardized. Intranasal antihistamines (INAH) are potent drugs in the treatment of allergic rhinitis but are frequently prescribed in the treatment of IR. This systematic review of the literature and meta-analysis aims to assess the effects of INAH on IR. METHODOLOGY A comprehensive review of the literature was conducted on Medline, Embase and Cochrane library. Randomized, controlled trials and non-randomized comparative parallel group trials comparing INAH to placebo or different INAHs were included. The primary outcome was the change in disease specific quality of life questionnaires, total nasal symptom score (TNSS). The secondary outcomes were other reported nasal symptom scores, individual symptom scores and adverse events. RESULTS Six trials out of 987 assessing a total of 675 participants were deemed relevant for inclusion. Compared to placebo, INAH decreased total nasal symptom scores. One study also reported reduction of symptoms recorded on a visual analogue scale. There was no difference between the INAHs in terms of efficacy. Bitter taste sensation was the most frequently reported adverse event. CONCLUSIONS INAHs seem to have benefit over placebo on nasal symptoms improvement in the treatment of NAR. No superiority between INAHs was identified.
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Affiliation(s)
- N Khoueir
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
| | - M G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
| | - R Assily
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
| | - S Rassi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
| | - W A Hamad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
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Haddad R, Ismail S, Khalaf MG, Matar N. Lipoinjection for Unilateral Vocal Fold Paralysis Treatment: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:1630-1640. [PMID: 34894158 DOI: 10.1002/lary.29965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Lipoinjection is one of the available treatments for unilateral vocal fold paralysis. OBJECTIVE To evaluate lipoinjection predictability, and analyze the differences in safety and efficacy of the different techniques. STUDY DESIGN Systematic review and meta-analysis. METHODS AND RESULTS A systematic review on Medline, Cochrane, and Scopus databases included 49 articles analyzing the data of 1,166 patients, concerning technical details and voice parameters changes. Lipoinjection used a mean volume of 1.3 mL, 95% confidence interval (CI) (0.92, 1.69)-average overcorrection of 30%. Meta-analysis of pre- and postoperative voice parameters' means showed a significant improvement at 6 months of mean phonation time (preoperative: 5.12, 95% CI [4.48, 5.76]-6 months: 10.46, 95% CI [9.18, 11.75]), Jitter (preoperative: 2.71, 95% CI [2.08, 3.33])-6 months: 1.37, 95% CI [1.05, 1.70]), Shimmer (preoperative: 4.55, 95% CI [3.04, 6.07]-6 months: 2.57, 95% CI [1.69, 3.45]), grade (preoperative: 2.15, 95% CI [1.73, 2.57]-6 months: 0.12, 95% CI [0.97, 1.43]), breathiness (preoperative: 2.012, 95% CI [1.48, 2.55]-6 months: 0.99, 95% CI [0.58, 1.40]), and asthenia (preoperative: 1.90, 95% CI [1.33, 2.47]-6 months: 0.75, 95% CI [0.17, 1.33]) of GRBAS (Grade, Roughness, Breathiness, Asthenia and Strain), and Voice Handicap Index-30 (preoperative: 72.06, 95% CI [54.35, 89.76]-6 months: 26.24, 95% CI [19.58, 32.90]). Subgroup analysis by harvesting technique concluded in no statistically significant difference between them. Few complications were reported. Reintervention was only required for 86 patients. CONCLUSION Lipoinjection seems a safe therapeutic option for unilateral vocal fold paralysis, with available data showing an efficacy lasting 6 months to 1 year. Laryngoscope, 2021.
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Affiliation(s)
- Ralph Haddad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Salim Ismail
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Michel G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nayla Matar
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Khoueir N, Rassi J, Richa T, Helou D, Khalaf MG, Rassi S. Coblation intra-capsular tonsillectomy: A prospective tertiary center trial. Int J Pediatr Otorhinolaryngol 2021; 150:110890. [PMID: 34411867 DOI: 10.1016/j.ijporl.2021.110890] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is a growing interest in intra-capsular coblation tonsillectomy (ICT) for the treatment of obstructive sleep apnea (OSA) in children. Literature remains controversial regarding which intra-capsular tonsillectomy (IT) technique is most effective and with least morbidity. Therefore, the aims of this study are to objectively measure the post-operative morbidity and the effectiveness of the ICT technique. MATERIALS AND METHODS 107 children undergoing ICT (with or without adenoidectomy) for upper airway obstruction due to tonsillar hypertrophy at a tertiary center university hospital were prospectively enrolled from March 2016 to March 2018. Efficacy of the surgery was assessed by a pre-and post-operative Obstructive Sleep Apnea score (OSA-18). Post-operative morbidity was measured based on the Parent's Post-operative Pain Measure questionnaire (PPPM), type and duration of administered pain medication, time before resuming a full diet and a normal activity, readmission for dehydration and post-operative bleeding incidence. RESULTS After a mean follow-up of 21.6 months, OSA-18 mean total score was 78.77 (SD = 15.74) before ICT and 23.7 (SD = 9.25) after surgery, with a significant difference between pre-operative and post-operative scores (p < 0.001). Mean PPPM scores were low at all evaluation points (5.89, 2.42 and 0.83 at days 2, 5 and 10 respectively). Analgesic use was restricted to acetaminophen in nearly all children for a mean duration of 1.93 days. They resumed a normal diet after 2.42 days and a normal activity (including return to school) after 2.7 days. No hospital readmission nor post-operative hemorrhage were reported. CONCLUSION Intra-capsular tonsillectomy by coblation is an effective and safe procedure that provides rapid post-operative recovery with minimal analgesic requirements, thus deserving a wider application in treating upper airway obstruction due to tonsillar hypertrophy in children.
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Affiliation(s)
- Nadim Khoueir
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
| | - Joe Rassi
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
| | - Tony Richa
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
| | - Diane Helou
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
| | - Michel G Khalaf
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon.
| | - Simon Rassi
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
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Khoueir N, Khoury PE, Khalaf MG. Mononostril endoscopic repair of a clival meningocele: The gasket seal technique with nasoseptal flap. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 4:137-138. [PMID: 34083171 DOI: 10.1016/j.anorl.2020.12.017] [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: 11/04/2020] [Revised: 11/14/2020] [Accepted: 12/23/2020] [Indexed: 10/21/2022]
Affiliation(s)
- N Khoueir
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, P.O.Box: 166830, Ashrafieh, Beirut, Lebanon
| | - P E Khoury
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, P.O.Box: 166830, Ashrafieh, Beirut, Lebanon.
| | - M G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, P.O.Box: 166830, Ashrafieh, Beirut, Lebanon
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Matar N, Khalaf MG, Assily R. Type 1 Thyroplasty without arytenoid adduction procedure with video. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 2:59-60. [PMID: 34049828 DOI: 10.1016/j.anorl.2020.12.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/29/2020] [Accepted: 12/23/2020] [Indexed: 11/18/2022]
Affiliation(s)
- N Matar
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
| | - M G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon.
| | - R Assily
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
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Cherfane P, Smaily H, Khalaf MG, Ghaoui N, Melkane AE. Otolaryngologic manifestations of diffuse idiopathic skeletal hyperostosis (Forestier's disease): A systematic review of the literature. Joint Bone Spine 2021; 88:105218. [PMID: 34020047 DOI: 10.1016/j.jbspin.2021.105218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/08/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH) is a common, yet underreported, disease affecting the elderly population. From an otolaryngologic perspective, DISH may manifest with dysphagia, dysphonia, or even dyspnea. The purpose of this study was to identify all published cases of dysphagia and other associated upper airway symptoms resulting from DISH in the last decade and to establish subsequently a management algorithm. METHODS A comprehensive review of the literature was conducted in May 2020 on Medline and Embase databases following the PRISMA statement for systematic reviews and meta-analysis. RESULTS Sixty-three articles, consisting of 50 case-reports and 13 case-series, met the inclusion criteria. A total of 236 cases of DISH were reported from 2010 to date. Otolaryngology instrumental evaluation, by fiberoptic laryngoscopy and fiberoptic endoscopic evaluation of swallowing, was frequently reported. Surgery was the most common treatment strategy for the management of dysphagia in 58.9% of patients, while conservative treatment was used in 41.1%. Tracheotomy for acute airway obstruction relief was performed in 6% of patients. No correlation was found between the type of treatment and dysphagia improvement. CONCLUSIONS Forestier's disease is currently a growing source of complications in elderly, mostly dysphagia and less commonly upper airway obstruction. The management of these complications requires a multidisciplinary team and a thorough approach, where the otolaryngologist plays a pivotal role.
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Affiliation(s)
- Patrick Cherfane
- Department of Otolaryngology - Head and Neck Surgery, Hôtel Dieu de France Hospital, Saint-Joseph University, 166830 Beirut, Lebanon
| | - Hussein Smaily
- Department of Otolaryngology - Head and Neck Surgery, Hôtel Dieu de France Hospital, Saint-Joseph University, 166830 Beirut, Lebanon
| | - Michel G Khalaf
- Department of Otolaryngology - Head and Neck Surgery, Hôtel Dieu de France Hospital, Saint-Joseph University, 166830 Beirut, Lebanon
| | - Nohra Ghaoui
- Department of Otolaryngology - Head and Neck Surgery, Hôtel Dieu de France Hospital, Saint-Joseph University, 166830 Beirut, Lebanon
| | - Antoine E Melkane
- Department of Otolaryngology - Head and Neck Surgery, Hôtel Dieu de France Hospital, Saint-Joseph University, 166830 Beirut, Lebanon.
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Khalaf MG, Nassereddine H, Chahine G, Melkane AE. An unusual metastatic submandibular gland tumor. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:411-412. [PMID: 33676880 DOI: 10.1016/j.anorl.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 10/22/2022]
Affiliation(s)
- M G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
| | - H Nassereddine
- Department of Pathology, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
| | - G Chahine
- Department of Hematology and Oncology, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
| | - A E Melkane
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon.
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Khalaf MG, Haddad R, Akiki M, Khazen J, Melkane AE. Multifocal adult rhabdomyoma of the head and neck: case report and systematic review of the literature. Int J Oral Maxillofac Surg 2020; 50:327-334. [PMID: 32773112 DOI: 10.1016/j.ijom.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/15/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022]
Abstract
Adult-type rhabdomyoma (ARM) is the most frequent extracardiac subtype of rhabdomyoma. In very rare instances ARM presents as multiple cervical lesions, an entity known as multifocal ARM. The aim of this study was to review the clinical characteristics and the best therapeutic options for multifocal ARM. The case of a 73-year-old patient recently diagnosed with multifocal ARM and managed in our institution is reported, followed by a systematic review of the literature. The review was conducted using the PubMed, Scopus, and Google Scholar databases, according to the PRISMA guidelines. All case reports and case series related to multifocal ARM written in English or French were included. A total of 29 cases were included in the qualitative analysis. Mean age at presentation was 65.0 years and the male to female ratio was 13.5:1. Dysphagia was the most common presenting symptom. ARM was most frequently found in the submandibular spaces. In conclusion, multifocal ARM are benign tumours with a predilection for the head and neck region. They become symptomatic with gradual compression of the adjacent structures. No cases of malignant transformation were reported in the literature. We suggest a 'watchful wait' approach for small asymptomatic tumours and excision of large symptomatic ones.
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Affiliation(s)
- M G Khalaf
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
| | - R Haddad
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
| | - M Akiki
- Department of Pathology, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
| | - J Khazen
- Department of Pathology, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon
| | - A E Melkane
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon.
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