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Yélamos Lorente MÁ, Perez-Carpena P, Lopez-Escamez JA. A Systematic Review on Heritability of Sudden Sensorineural Hearing Loss. Laryngoscope 2024; 134:3447-3457. [PMID: 38270208 DOI: 10.1002/lary.31308] [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: 10/25/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To assess the evidence supporting the heritability and genetic basis of sudden sensorineural hearing loss (SSNHL). DATA SOURCE Records were extracted from PubMed, Scopus, and Cochrane databases. REVIEW METHODS The protocol was registered on PROSPERO (CRD42022357389) and includes a systematic review on the genetic contribution to SSNHL. The search strategy yielded 1.483 articles from electronic databases. After quality assessment, 34 records were selected, including 369.650 patients with SSNHL from nine prevalence studies, two familial aggregation studies, one twin study, and 22 genetic studies. The prevalence of SSNHL was calculated from data on its incidence from population-based studies (period prevalence). To evaluate the heritability of SSNHL, the sibling recurrence risk ratio (λs) was calculated, by comparing the prevalence of SSNHL among siblings within the same generation to the estimated prevalence in the overall population. Genetic variants were grouped, based on the pathological mechanism related to SSNHL. RESULTS The prevalence of SSNHL ranged from 0.1% to 0.0003% in America to 0.12%-0.0093% in Asia. The estimated sibling recurrence risk ratio for SSNHL (λs = 20.8-83.3) supports a significant familial aggregation. Although several genetic variants were reported to be associated with SSHL in controlled studies, neither was replicated in an independent cohort. CONCLUSIONS Evidence supporting heritability of SSNHL is limited to epidemiological studies showing prevalence differences across different populations and familial aggregation. Genetic studies are of low quality and they lack replication cohort to confirm their findings. According to its low prevalence, exome or genome sequencing familial-based studies are needed to identify rare genetic variants in SSNHL. LEVEL OF EVIDENCE NA Laryngoscope, 134:3447-3457, 2024.
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Affiliation(s)
- Mª Á Yélamos Lorente
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Family and Community Medicine, Zaidin Sur Health Center (Granada), San Cecilio University Hospital, Granada, Spain
| | - Patricia Perez-Carpena
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
| | - Jose A Lopez-Escamez
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Meniere's Disease Neuroscience Research Program, Faculty of Medicine & Health, School of Medical Sciences, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Li XB, Han YX, Fu ZY, Zhang YC, Fan M, Sang SJ, Chen XX, Liang BY, Liu YC, Lu PC, Li HW, Pan HF, Yang JM. Association of sudden sensorineural hearing loss with meteorological factors: a time series study in Hefei, China, and a literature review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:42970-42990. [PMID: 38886269 PMCID: PMC11222232 DOI: 10.1007/s11356-024-33943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
Air pollution can cause disease and has become a major global environmental problem. It is currently believed that air pollution may be related to the progression of SSNHL. As a rapidly developing city in recent years, Hefei has serious air pollution. In order to explore the correlation between meteorological variables and SSNHL admissions, we conducted this study. This study investigated the short-term associations between SSNHL patients admitted to the hospital and Hefei climatic variables. The daily data on SSNHL-related hospital admissions and meteorological variables containing mean temperature (T-mean; °C), diurnal temperature range (DTR; °C), atmospheric pressure (AP; Hp), and relative humidity (RH; %), from 2014 to 2021 (2558 days), were collected. A time-series analysis integrating distributed lag non-linear models and generalized linear models was used. PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Literature published up to August 2023 was reviewed to explore the potential impact mechanisms of meteorological factors on SSNHL. The mechanisms were determined in detail, focusing on wind speed, air pressure, temperature, humidity, and air pollutants. Using a median of 50.00% as a baseline, the effect of exceedingly low T-mean in the single-day hysteresis effect model began at a lag of 8 days (RR = 1.032, 95% CI: 1.001 ~ 1.064). High DTR affected the admission rate for SSNHL on lag 0 day. The significance of the effect was the greatest on that day (RR = 1.054, 95% CI: 1.007 ~ 1.104) and then gradually decreased. High and exceedingly high RH affected the admission rate SSNHL on lag 0 day, and these effects lasted for 8 and 7 days, respectively. There were significant associations between all grades of AP and SSNHL. This is the first study to assess the effect of meteorological variables on SSNHL-related admissions in China using a time-series approach. Long-term exposures to high DTR, RH values, low T-mean values, and all AP grades enhance the incidence of SSNHL in residents. Limiting exposure to extremes of ambient temperature and humidity may reduce the number of SSNHL-related hospital visits in the region. It is advisable to maintain a suitable living environment temperature and avoid extreme temperature fluctuations and high humidity. During periods of high air pollution, it is recommended to stay indoors and refrain from outdoor exercise.
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Affiliation(s)
- Xiao-Bo Li
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, Anhui, 230601, People's Republic of China
| | - Yan-Xun Han
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Zi-Yue Fu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
- Department of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Yu-Chen Zhang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Min Fan
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Shu-Jia Sang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Xi-Xi Chen
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Bing-Yu Liang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Yu-Chen Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Peng-Cheng Lu
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, Anhui, 230601, People's Republic of China
| | - Hua-Wei Li
- Institute and Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Jian-Ming Yang
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, Anhui, 230601, People's Republic of China.
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3
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Ranjdoost F, Ghaffari ME, Azimi F, Mohammadi A, Fouladi-Fard R, Fiore M. Association between air pollution and sudden sensorineural hearing loss (SSHL): A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2023; 239:117392. [PMID: 37838197 DOI: 10.1016/j.envres.2023.117392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023]
Abstract
Recent studies have indicated that air pollution (AP) has harmful effects on hearing and ear diseases such as Sudden Sensorineural Hearing Loss (SSHL). The purpose of this study was to evaluate the impact of exposure to AP on SSHL incidence. Valid electronic databases were searched to retrieve studies published until December 1, 2022, using appropriate keywords. The result of the search was 1146 studies, and after screening according to the defined criteria, in total 8 studies were obtained. The risk of bias (ROB) in the studies and their quality were assessed. Finally, the meta-analysis with a significance level of 5% was performed. The findings revealed that the mean level of SO2, CO, NO2, and PM10 in the patient group was more than that of the control group, and p-values were 0.879, 0.144, 0.077, and 0.138, respectively. There was an indirect relation between air pollutants and SSHL, and PM2.5 showed a significant effect (p < 0.05). Given the limited research and the use of different statistical methods, more research is suggested to confirm this association and to determine the mechanisms by which AP exposure may cause SSHL.
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Affiliation(s)
- Fatemeh Ranjdoost
- Research Center for Environmental Pollutants, Department of Environmental Health Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, Iran.
| | - Mohammad-Ebrahim Ghaffari
- Department of Epidemiology and Biostatistics, Faculty of Health, Qom University of Medical Sciences, Qom, Iran.
| | - Faramarz Azimi
- Environmental Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Amir Mohammadi
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran; Department of Environmental Health Engineering, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
| | - Reza Fouladi-Fard
- Research Center for Environmental Pollutants, Department of Environmental Health Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, Iran; Environmental Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Maria Fiore
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, 87-95123, Catania, Italy.
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Zheng J, Zhan Y, Cheng Y, Liu C, Lu B, Yang W, Hu J. Correlation between right-to-left shunt and sudden sensorineural hearing loss: protocol for a case-control study. BMJ Open 2023; 13:e070771. [PMID: 37945293 PMCID: PMC10649378 DOI: 10.1136/bmjopen-2022-070771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Sudden sensorineural hearing loss (SSNHL) is a neurological and otolaryngological emergency during which rapid diagnosis and early treatment are of great importance. Clinical experience indicates that a considerable number of patients with SSNHL have concurrent right-to-left shunt (RLS). With limited reports, the association between SSNHL and RLS is yet unclear and there is a need for large observational studies to explore their latent relationship. METHODS AND ANALYSIS This proposed study is a prospective, observational case-control study. A total of 194 eligible participants matched in age and sex will be divided equally into two groups: 97 patients with SSNHL included in the case group and 97 individuals without SSNHL in the control group. Medical evaluations, including clinical characteristics, laboratory examination, audiological examination and ultrasonography examination, will be performed in all subjects. The primary outcome of the study is the difference in RLS rates between the groups. Differences in patent foramen ovale rates and other measured variables will be further assessed. A conditional logistic regression as a correlation analysis will be used to evaluate the relationship between RLS and SSNHL. DISCUSSION This study may provide evidence on the correlation between RLS and SSNHL in order to enrich the aetiology of SSNHL. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of Peking University Shenzhen Hospital. A written informed consent form will be signed and dated by the participants and the researchers before the study begins. The results will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2200064067.
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Affiliation(s)
- Jianrong Zheng
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Department of Clinical Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Ying Zhan
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yajing Cheng
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Cong Liu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Bihua Lu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Weiqiang Yang
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jun Hu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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5
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Alhussaini MA, Mohamed SA, El-Razek MAA, Mohamed ES, Gad MOA. Predictive factors for recovery in idiopathic sudden sensory neural hearing loss. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Idiopathic sudden sensorineural hearing loss (ISSNHL) is considered a clinical symptom of various conditions. Circulatory disorders, viral infection, labyrinthine membrane rupture, and autoimmune reactions are considered as the common causes, but the exact cause remains unestablished. Various drugs and methods have been used empirically for the treatment of ISSHL. The current study aimed at evaluation factors contributing to the success of standardized medical therapy in cases of ISSNHL.
Methods
In period between 2019 and 2021, a total 40 patients with ISSNHL were enrolled. All patients were subjected to history taking, physical and ENT evaluation. Patients were managed according to the recent guidelines for managing ISSNHL included systemic steroid and salvage therapy.
Results
Mean age of studied patients was 42.55 ± 13.14 years with range between 19 and 70 years. Out of the studied patients; 26 (65%) patients were males and 14 (35%) patients were females. Majority (80%) of patients had no comorbidities. Based on the current study, we found that only 12 (30%) patients were improved while 28 (70%) patients were not improved. It was found that majority (58.3%) of improved patients was females. Frequency of vertigo was significantly higher among patients who were not improved. Three (10.7%) patients of not-improved group and 5 (41.7%) patients of improved group had low lymphocyte:monocytes ratio.
Conclusion
Patients with ISSNHL, the presence of vertigo and late onset of presentation may carry a risk for poor prognosis. Multiple centers studies with large number of patients are warranted to confirm such findings.
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Affiliation(s)
- Olaf Michel
- Brussel UZ-VUB, Universitair Ziekenhuis - Vrije Universiteit, Laarbeeklaan 101, 1090 Brüssel, Belgien
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Early S, van der Valk JC, Frijns JHM, Stankovic KM. Accelerated Long-Term Hearing Loss Progression After Recovery From Idiopathic Sudden Sensorineural Hearing Loss. Front Neurol 2021; 12:738942. [PMID: 34956043 PMCID: PMC8693444 DOI: 10.3389/fneur.2021.738942] [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: 07/09/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background and Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) is characterized by rapid onset, typically unilateral presentation, and variable recovery. This case-control observational study aimed to improve patient counseling by objectively characterizing long-term hearing loss progression following ISSNHL, using sequential audiometry in the largest-to-date cohort of patients with ISSNHL. Methods: Patients diagnosed with ISSNHL at a tertiary referral hospital from 1994 through 2018 with sequential audiometry were studied. Case controls with sensorineural hearing loss (SNHL) were matched by age, sex, baseline hearing status, and frequency of sequential audiometry. Hearing loss progression was quantified using Kaplan–Meier (K–M) analysis to account for variable follow-up duration. A subgroup analysis was performed by age, sex, preexisting comorbidities, ISSNHL-associated symptoms, ISSNHL treatment, and degree of post-ISSNHL hearing recovery. Results: A total of 660 patients were identified with ISSNHL. In patients with post-ISSNHL recovery to good hearing [pure tone average (PTA) <30 dB and word recognition score (WRS) > 70%], median time to progression to non-serviceable (PTA > 50 dB or WRS <50%) SNHL was 16.4 years. In patients with incomplete post-ISSNHL hearing recovery, contralateral ears were also at significantly higher risk of SNHL progression over the following 12-year period. Male sex was associated with increased risk of SNHL progression [odds ratio (OR) 3.45 male vs. female] at 5-year follow up. No other subgroup factors influenced the likelihood of SNHL progression. Discussion and Conclusion: Patients should be counseled on continued risk to long-term hearing after stabilization of hearing post-ISSNHL, with particular emphasis on greater risk to the contralateral ear in those with incomplete ipsilateral recovery.
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Affiliation(s)
- Samuel Early
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego Medical Center, San Diego, CA, United States
| | - Jens C van der Valk
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Leiden University Medical Center, Leiden, Netherlands
| | - Johan H M Frijns
- Leiden University Medical Center, Leiden, Netherlands.,Department of Otolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden, Netherlands
| | - Konstantina M Stankovic
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
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Zhang J, Ji S, Ma X, Yu L, Jing Y. Association between meteorological factors and audiogram configurations in patients with sudden sensorineural hearing loss: a cross-sectional study. BMJ Open 2021; 11:e045768. [PMID: 34862274 PMCID: PMC8647400 DOI: 10.1136/bmjopen-2020-045768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We aimed to determine the association between meteorological factors and sudden sensorineural hearing loss (SSNHL) audiogram configurations. DESIGN Retrospective review of medical records from 1 October 2007 to 31 December 2018. SETTING A tertiary hospital. PARTICIPANTS 510 patients with SSNHL who had data on the exact date of SSNHL onset and underwent audiological evaluation within 14 days were included. PRIMARY AND SECONDARY OUTCOME MEASURES Daily values of meteorological factors, including maximum and minimum temperature, mean temperature and its day-to-day change, diurnal temperature range, atmospheric pressure, mean and maximum wind speed and relative humidity, and seasonal distributions. RESULTS Among the 510 patients (259 women (50.8%); mean (SD) age, 46.4 (15.5) years), 108 (21.2%) displayed ascending patterns, 143 (28.0%) displayed descending patterns, 129 (25.3%) displayed flat patterns and 130 (25.5%) displayed profound patterns of audiograms. The diurnal temperature range on the day of SSNHL onset in patients with profound patterns was significantly higher than that in patient with ascending (mean difference (MD), 2.2°C; 95% CI, 0.7°C to 3.7°C; p=0.001) and descending (MD, 1.5°C; 95% CI, 0.1°C to 2.9°C; p=0.031) patterns. The relative humidity was the highest on the day of SSNHL onset in patients with ascending patterns and showed a significant difference compared with that in patients with profound patterns (MD, 8.0%; 95% CI, 0.7% to 15.3%; p=0.026). Seasonal distribution did not differ among patients with different audiogram configurations. CONCLUSIONS Profound audiogram patterns correlated with high diurnal temperature range, while ascending audiogram patterns correlated with high relative humidity in patients with SSNHL. No correlation was observed between seasons and audiogram configurations.
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Affiliation(s)
- Jilei Zhang
- Otorhinolaryngology Department, Peking University People's Hospital, Beijing, China
| | | | - Xin Ma
- Otorhinolaryngology Department, Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Otorhinolaryngology Department, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Otorhinolaryngology Department, Peking University People's Hospital, Beijing, China
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Chien WC, Wang CH, Tang SE, Wu SY, Jhou FY, Chung CH. Comparison of the incidence of sudden sensorineural hearing loss in Northern Taiwan and Southern Taiwan (2000–2015). JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmedsci.jmedsci_267_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Idiopathic Sudden Sensorineural Hearing Loss Is Not a Sentinel Event for Acute Myocardial Infarction. Otol Neurotol 2019; 39:e518-e523. [PMID: 29912831 DOI: 10.1097/mao.0000000000001868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Given ongoing debate about the suggested association, the primary objective was to determine if idiopathic sudden sensorineural hearing loss (ISSNHL) was a sentinel event for acute myocardial infarction (AMI) in adults. STUDY DESIGN Case-control study. SETTING United States MarketScan administrative health claims database. PATIENTS Aged 18 years or older, had a diagnosis of ISSNHL on or after January 1st, 2011 and had sufficient follow-up data available to assess for AMI occurrence. INTERVENTION N/A. MAIN OUTCOME MEASURES Incidence rates (per 1,000 patient years) of AMI for cases and controls were computed. Adjusted and unadjusted Cox proportional hazards models were created to explore possible associations between ISSNHL and initial AMI. RESULTS A total of 10,749 ISSNHL cases and 10,749 matched controls were included. There were no significant differences in the incidence rate of AMI between ISSNHL cases (8.29 events/1,000 person-years) and controls (9.25 events/1,000 person-years), nor were there differences within age groups, sex, or comorbidity status (overall incidence rate ratio 0.90; 95% confidence interval [CI] 0.70-1.15 p = 0.39). The unadjusted and adjusted Cox proportional hazards models did not demonstrate an association between ISSNHL and initial AMI (hazard ratio [HR]: 0.90, 95% CI: 0.70-1.15; HR: 0.86, 95% CI: 0.67-1.10, respectively). CONCLUSIONS ISSNHL is not a predictor of an initial AMI in adult patients from the United States. Considerable inconsistencies in associations between cardiovascular risk factors and ISSNHL exist in the literature. Further work is needed to confirm or refute direct associations between cardiovascular disease risk factors and ISSNHL before definitive mechanistic conclusions can be made.
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Kuo CY, Chung CH, Wang CH, Chien WC, Chen HC. Increased incidence in hospitalised patients with sudden sensorineural hearing loss: a 14-year nationwide population-based study. Int J Audiol 2019; 58:769-773. [PMID: 31195853 DOI: 10.1080/14992027.2019.1627009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To conduct a 14-year nationwide study on the epidemiologic incidence in patients with sudden sensorineural hearing loss (SSNHL). Design: Retrospective cross-sectional design. Study sample: Data of patients hospitalised with the diagnosis of SSNHL from 2000 to 2013, extracted from the Taiwan National Health Insurance Research Database. Results: In total, 31,258 patients were included. The mean age was 50.30 ± 16.70 years. Males (53.5%) were more commonly diagnosed with SSNHL than females (46.5%). The patients most commonly presented with SSNHL were in the age group of 45-64 years. The crude incidence of SSNHL from 2000 to 2013 was 9.76 per 100,000 people per year. The annual incidence rate shows a steady increased from 5.15 in 2000 to 13.97 per 100,000 people in 2013 with a statistical significance (p < 0.001). Conclusion: This 14-year nationwide study indicated an increased incidence rate of SSNHL. This necessitates the development of additional treatment modalities to enhance the prognosis and the clarification of the underlying mechanism of this enigmatic disease.
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Affiliation(s)
- Chao-Yin Kuo
- Department of Otolaryngology-Head and Neck surgery, Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan.,School of Public Health, National Defense Medical Center , Taipei , Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck surgery, Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan.,School of Public Health, National Defense Medical Center , Taipei , Taiwan
| | - Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck surgery, Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan
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Air pollution increases the risk of SSNHL: A nested case-control study using meteorological data and national sample cohort data. Sci Rep 2019; 9:8270. [PMID: 31164673 PMCID: PMC6547844 DOI: 10.1038/s41598-019-44618-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/21/2019] [Indexed: 01/12/2023] Open
Abstract
This study aimed to evaluate the impact of weather conditions and air pollution on the onset of sudden sensorineural hearing loss (SSNHL). The Korean Health Insurance Review and Assessment Service - National Sample Cohort (HIRA-NSC) from 2002 through 2013 was used. A total of 5,200 participants with SSNHL were matched 1:4 for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 20,800 control participants. Meteorological data included daily mean temperature (°C), daily highest temperature (°C), daily lowest temperature (°C), daily temperature difference (°C), relative humidity (%), ambient atmospheric pressure (hPa), pressure, SO2 (ppm), NO2 (ppm), O3 (ppm), CO (ppm), and PM10 (μg/m3) of a mean of 60 days, 30 days, 14 days, 7 days, and 3 days before SSNHL were analyzed. Hourly measurements were taken from 94 places to assess the temperature, humidity, and atmospheric pressure and from 273 places to determine SO2, NO2, O3, CO, and PM10. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of meteorological data for SSNHL were analyzed using unconditional logistic regression analyses. Subgroup analyses were conducted by age and sex. The mean NO2 and O3 concentrations 14 days before the index date were different in the SSNHL group compared to those in the control group (P < 0.001 for NO2 and P = 0.021 for O3). The adjusted 14-day OR for NO2 (0.1 ppm) exposure was 3.12 in the SSNHL group compared to that in the control group (95% CI = 2.16–4.49, P < 0.001). The increased odds of NO2 exposure for 14 days in the SSNHL group persisted in the age group older than 30 years for both sexes. Other meteorological conditions did not show differences between the SSNHL and control groups. SSNHL was associated with high concentrations of NO2.
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Effects of meteorological factor and air pollution on sudden sensorineural hearing loss using the health claims data in Busan, Republic of Korea. Am J Otolaryngol 2019; 40:393-399. [PMID: 30956004 DOI: 10.1016/j.amjoto.2019.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Specific meteorological factors, including air pollution in the form of particulate matter (PM), affect the development of otologic disease and have adverse effects on the cardiovascular and respiratory systems. This study investigated relationships between the development of sudden sensorineural hearing loss(SSNHL) and meteorological factor with air pollution including PM. MATERIALS AND METHODS The daily patient number in 2015 admitted to the hospital with SSNHL were extracted from the Health Insurance Review and Assessment Service Bigdata in Busan. The meteorological factors and air pollution data of Busan area were obtained from meteorological stations in Busan. The relationship between the number of hospitalizations and the climatic factors was checked. RESULTS SSNHL patient group showed more common in women, and the highest rates were observed in patients in their 50s. The daily mean patient numbers were 2.27. The number of SSNHL patients in spring was statistically significantly higher than that in summer. The mean daily PM10 and PM2.5 concentrations were 48.0 and 29.4 μg/m3, respectively. The mean wind speed, maximum wind speed and daily atmospheric pressure range was weakly positively associated with SSNHL patient number. There were weak negative correlations between maximum PM2.5 and SSNHL admissions. The mean temperature and wind chill index showed non-significantly negative relationships with SSNHL admissions. CONCLUSIONS In Busan area, statistically significant weak relationships were detected between the daily numbers of patients admitted to the hospital with SSNHL and meteorological data, including PM level. Further investigation of these associations is required.
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Yen TT, Lin CH, Shiao JY, Liang KL. Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: A nationwide population-based study. Acta Otolaryngol 2016; 136:446-50. [PMID: 27052963 DOI: 10.3109/00016489.2015.1123292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONCLUSION Sudden sensorineural hearing loss (SSNHL) in pregnancy is rare. It usually occurs in the third trimester. SSNHL in pregnancy does not increase risks during delivery or subsequent stroke. OBJECTIVES This study aimed to investigate the incidence and to determine the factors associated with SSNHL in pregnancy. METHOD Data were retrieved from Taiwan's National Health Insurance Database (NHIRD), covering the years 2000-2009. Patients admitted for SSNHL during pregnancy were enrolled. An age-matched controlled cohort was randomly selected from pregnant women without SSNHL in the NHIRD. The clinical characteristics of both cohorts were collected for further analyses. RESULTS Thirty-three patients with SSNHL in pregnancy were enrolled. The estimated incidence of SSNHL in pregnancy in Taiwan was 2.71 per 100,000 pregnancies. The incidence of SSNHL in pregnancy was lower than that of the general female population. The incidence of SSNHL in the third trimester was higher compared to the other two. The incidence of SSNHL occurring in the 30-39 years old age group was higher than other groups. Women with better socioeconomic status had a higher incidence of SSNHL. There were no identified systemic diseases before SSNHL. Two patients had pre-eclampsia and one patient had premature delivery. Nevertheless, SSNHL in pregnancy did not increase the risk for stroke.
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Affiliation(s)
- Ting-Ting Yen
- a Department of Otolaryngology , Taichung Veterans General Hospital , Taichung , Taiwan
- b Graduate Institute of Natural Healing Sciences, Nanhua University , Cha-Yi , Taiwan
- c Department of Medicine , National Yang-Ming Medical University , Taipei , Taiwan
| | - Ching-Heng Lin
- d Department of Medical Research , Taichung Veterans General Hospital , Taichung , Taiwan
| | - Jiun-Yih Shiao
- a Department of Otolaryngology , Taichung Veterans General Hospital , Taichung , Taiwan
- c Department of Medicine , National Yang-Ming Medical University , Taipei , Taiwan
| | - Kai-Li Liang
- a Department of Otolaryngology , Taichung Veterans General Hospital , Taichung , Taiwan
- c Department of Medicine , National Yang-Ming Medical University , Taipei , Taiwan
- e School of Medicine, Chung Shan Medical University , Taichung , Taiwan
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Seo JH, Jeon EJ, Park YS, Kim J, Chang KH, Yeo SW. Meteorological conditions related to the onset of idiopathic sudden sensorineural hearing loss. Yonsei Med J 2014; 55:1678-82. [PMID: 25323908 PMCID: PMC4205711 DOI: 10.3349/ymj.2014.55.6.1678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the effect of meteorological factors on the onset of idiopathic sudden sensorineural hearing loss (ISSHL). MATERIALS AND METHODS Meteorological data from 2005 to 2011 were obtained from the web-based "Monthly Weather Reports of the Meteorological Administration" database. Patients with ISSHL who visited our hospital during this same period and presented the precise day on which hearing loss developed were included in this retrospective study. Twelve meteorological factors were analyzed between the days when ISSHL onset was observed as well as the days when ISSHL did not occur. The weather conditions occurring 1-7 days before ISSHL onset were also analyzed to assess any possible delayed effects of meteorological factors on the onset of ISSHL. RESULTS During the study period, 607 patients were included for the study. Although mean and maximal wind velocities were higher for the days when ISSHL occurred than the days without ISSHL onset, after adjusting the value for multiple comparisons, we cannot find any significant relationship between any of meteorological factors and the onset of ISSHL. However, in analysis of time lag effect of the weather conditions, we found that there was still a significant difference in maximum wind speed on 5 days before ISSHL onset even after applying Bonferroni correction. CONCLUSION The result of this study suggests that stronger wind speed may be related to the occurrence of ISSHL.
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Affiliation(s)
- Jae-Hyun Seo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Ju Jeon
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Yong-Soo Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junhyun Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Hong Chang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Won Yeo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Masuda M, Kanzaki J. Cause of idiopathic sudden sensorineural hearing loss: The stress response theory. World J Otorhinolaryngol 2013; 3:42-57. [DOI: 10.5319/wjo.v3.i3.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/14/2013] [Accepted: 07/25/2013] [Indexed: 02/06/2023] Open
Abstract
The stress response theory is a relatively new concept about the cause of idiopathic sudden sensorineural hearing loss (ISHL). A number of possible etiologies have been proposed in the literature, as discussed in this paper, but each proposed etiology has been both supported and refuted in the literature. However, the stress response theory can integrate hypotheses that have been advocated so far. The word “stress” refers to a constellation of physical and psychological stimuli including systemic viral and bacterial illness, systemic inflammatory disorders, and physical, mental or metabolic stress. Numerous studies have demonstrated adverse effects of systemic stress on health. Stress causes changes in the immune system and cytokine network through activation of the hypothalamus-pituitary-adrenal axis and the sympathetic nervous system. Several types of catecholamine and cytokine receptors are in the cochlea cells other than capillary cells, and then they can respond to systemic stressors. However, there are few studies examining how systemic stress is associated with cochlear dysfunction. The stress response theory addresses this question. In the theory, a variety of stressors and risk factors contribute to the onset of ISHL in varying degrees. The lateral wall of the cochlea has very unique responses to systemic stressors. It plays a critical role in causing ISHL. Systemic stressors converge at the lateral wall and trigger pathological activation of nuclear factor κ-light-chain-enhancer of activated B cells, a transcriptional factor known as a stress sensor. This activation enhances local expression of genes associated with immune and inflammatory system, resulting in cochlear dysfunction. We review the original stress response theory advocated by Adams et al and the integrative stress response theory that integrates our knowledge about the etiologies of ISHL so far.
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Karli R, Alacam H, Unal R, Kucuk H, Aksoy A, Ayhan E. Mean platelet volume: is it a predictive parameter in the diagnosis of sudden sensorineural hearing loss? Indian J Otolaryngol Head Neck Surg 2013; 65:350-3. [PMID: 24427597 DOI: 10.1007/s12070-013-0648-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/16/2013] [Indexed: 12/29/2022] Open
Abstract
The mean platelet volume (MPV) is associated with increased platelet reactivity and increased atherothrombosis. High MPV values are a risk factor for thrombotic vascular diseases. Our aim was to investigate whether a relationship exists between sudden sensorineural hearing loss (SSHL) and a high MPV value. The records of 46 patients who were admitted to the ENT (ear nose throat) ward for SSHL and received medical treatment and 46 patients in a control group were retrospectively screened. The correlation among the levels of the MPV, the number of platelets, and SSHL were evaluated in the two groups. The ages, genders, and the platelet count values of the patients showed a normal distribution in both groups. No significant difference was found for the MPV values between the groups. The MPV is not a predictive parameter in the diagnosis of SSHL.
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Affiliation(s)
- Rifat Karli
- Department of Otorhinolaryngology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Hasan Alacam
- Department of Clinical Biochemistry, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Recep Unal
- Department of Otorhinolaryngology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Harun Kucuk
- Department of Otorhinolaryngology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ahmet Aksoy
- Department of Otorhinolaryngology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Emre Ayhan
- Department of Otorhinolaryngology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Chu CH, Liu CJ, Fuh JL, Shiao AS, Chen TJ, Wang SJ. Migraine is a risk factor for sudden sensorineural hearing loss: a nationwide population-based study. Cephalalgia 2012. [PMID: 23197354 DOI: 10.1177/0333102412468671] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The pathophysiology of idiopathic sudden sensorineural hearing loss (SSNHL) is poorly understood. Few case reports have proposed a possible link between migraine and SSNHL. OBJECTIVES This study aimed to explore the risk of idiopathic SSNHL in patients with migraine in a nationwide, population-based cohort study. METHODS We identified patients with migraine from the Taiwan National Health Insurance Research Database (NHIRD) between 2000 and 2009. Each migraine patient was matched with four randomly selected subjects without migraine for age, sex, and comorbidities. Both cohorts were followed up until the end of 2009. We compared the incidence rates of SSNHL in the two cohorts and identified the risk factors. RESULTS A total of 10,280 migraine patients and 41,120 matched controls were enrolled with a median follow-up of five years. The migraine cohort had a greater risk of developing SSNHL than the matched cohort (81.6 vs. 45.7 per 100,000 person-years, incidence rate ratio (IRR) = 1.8; 95% confidence interval (CI) 1.22-2.61, p = 0.002). The Cox proportional hazards analysis revealed that among migraine subjects, comorbidity with hypertension was associated with a trend of developing SSNHL (hazard ratio (HR) = 1.92, 95% CI 0.97-3.79, p = 0.06). CONCLUSIONS This population-based study demonstrates that migraine is associated with an increased risk of idiopathic SSNHL, which, however, is a rare condition.
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Affiliation(s)
- Chia-Huei Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan
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Greco A, Fusconi M, Gallo A, Marinelli C, Macri G, De Vincentiis M. Sudden sensorineural hearing loss: An autoimmune disease? Autoimmun Rev 2011; 10:756-61. [DOI: 10.1016/j.autrev.2011.05.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
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Lin HC, Chao PZ, Lee HC. Sudden sensorineural hearing loss increases the risk of stroke: a 5-year follow-up study. Stroke 2008; 39:2744-8. [PMID: 18583554 DOI: 10.1161/strokeaha.108.519090] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE No previous study has investigated the incidence or risk of cerebrovascular diseases developing after the sudden sensorineural hearing loss (SSNHL). This study sets out to estimate the risk of stroke development among SSNHL patients during a 5e-year follow-up period after hospitalization for acute episodes of SSNHL. METHODS Our study design features a study cohort and a comparison cohort. The study cohort consists of all patients hospitalized with a principal diagnosis of sudden hearing loss (n=1,423), whereas the control cohort comprised all patients hospitalized for an appendectomy in 1998 (n=5692) as a surrogate for the general population. Each patient was tracked from hospitalization in 1998 until the end of 2003. Cox proportional hazard regressions were performed as a means of computing the 5-year stroke-free survival rates after adjustment for possible confounding factors. RESULTS Of the total sample, 621 patients (8.7%) had strokes during the 5-year follow-up period: 180 (12.7% of the SSNHL patients) from the study cohort and 441 (7.8% of patients undergoing an appendectomy) from the control cohort. After adjusting for other factors, the hazard of stroke during the 5-year follow-up period was 1.64-times (95% CI, 1.31 to 2.07; P<0.001) greater for SSNHL patients than for appendectomy patients. CONCLUSIONS Our findings suggest that SSNHL can be an early warning sign of impending stroke. We suggest that SSNHL patients should undergo a comprehensive hematologic and neurological examination to help clinicians identify those potentially at risk for stroke developing in the near future.
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Affiliation(s)
- Herng-Ching Lin
- Department of Psychiatry, School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
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Chen YK, Lin HC, Chen CS, Yeh SD. Seasonal variations in urinary calculi attacks and their association with climate: a population based study. J Urol 2007; 179:564-9. [PMID: 18082222 DOI: 10.1016/j.juro.2007.09.067] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE In this nationwide population based study we used 5-year data on urinary calculi patient visits to emergency departments in Taiwan to investigate the seasonal variation in urinary calculi attacks and the association with 5 climatic parameters. MATERIALS AND METHODS Comprehensive details on total admissions to emergency departments were obtained from the Taiwan National Health Insurance Research Database (1999 to 2003), providing monthly urinary calculi attack rates per 100,000 of the population. Subgroups of urinary calculi incidences were created based on gender and 3 age groups (18 to 44, 45 to 64 and 65 years old or older). Following adjustment for time trend effects, evaluation of the monthly urinary calculi attack rates and the effects of climatic factors was performed using auto-regressive integrated moving average regression methodology. RESULTS The seasonal trends in the monthly urinary calculi attack rates revealed a peak in July to September, followed by a sharp decline in October, with the auto-regressive integrated moving average tests for seasonality demonstrating significance for each gender group, for each age group and for the whole sample (all p <0.001). Although significant associations were found between ambient temperature, atmospheric pressure and hours of sunshine vis-à-vis monthly urinary calculi attack rates for the total population, after adjustment for trends and seasonality, ambient temperature was found to be the sole major factor having any positive association with the monthly attack rates. CONCLUSIONS We conclude that seasonal variations do exist in the monthly urinary calculi attack rates for all age and gender populations, and that following time series statistical adjustment, only ambient temperature had any consistent association with monthly attack rates.
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Affiliation(s)
- Yi-Kuang Chen
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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Yen YT, Li YC, Lin MC, Hsu CY. Applying the grid computation in long-term retrospective health insurance data analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2006; 9:275. [PMID: 16903998 DOI: 10.1111/j.1524-4733.2006.00110.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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