1
|
Jeong J, Lee HY, Choo OS, Kim H, Lee KY, Song JJ, Seo JH, Rah YC, Song JJ, Nam EC, Park SN, Moon IS, Shim HJ. Consensus Statements on Tinnitus Treatment: A Delphi Study by the Korean Tinnitus Study Group. J Korean Med Sci 2025; 40:e75. [PMID: 40359983 PMCID: PMC12070046 DOI: 10.3346/jkms.2025.40.e75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 11/07/2024] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Tinnitus is a bothersome condition associated with various mechanisms of action. Although treatment methods vary according to these mechanisms, standardized guidelines would benefit both patients and clinicians. We conducted a Delphi study, a method that collects expert opinions through multiple rounds of questionnaires, to reach a consensus on tinnitus treatment with professional experts. METHODS A two-round modified Delphi survey was conducted to develop a clinical consensus on tinnitus treatment. The experts scored each statement on a scale of 1 (highest disagreement) to 9 (highest agreement) for their level of agreement on tinnitus treatment. Consensus was defined when 75% or more of the participants scored 7-9, and 15% or less scored 1-3. To ensure reliability of the responses, the content validity ratio and Kendall's coefficient of concordance were evaluated. RESULTS Approximately 19 of 31 statements reached a consensus. All 3 statements reached a consensus regarding the candidates for treatment. Regarding treatment, 3 of 8 statements on medication, 2 of 2 statements on tinnitus retraining therapy/cognitive behavioral therapy, and 5 of 7 statements on auditory rehabilitation reached a positive consensus. Although all 6 statements regarding miscellaneous treatment reached a consensus, most were negatively agreed. For treatment with neuromodulation, none of the 5 statements reached a consensus. CONCLUSION The experts reached a high level of consensus on treatment candidates, tinnitus retraining therapy/cognitive behavioral therapy, and auditory rehabilitation in this modified Delphi study. The results of this study can provide beneficial and practical information for clinicians regarding the treatment of tinnitus.
Collapse
Affiliation(s)
- Junhui Jeong
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Oak-Sung Choo
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hantai Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae-Hyun Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eui-Cheol Nam
- Department of Otorhinolaryngology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Shi Nae Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
| | - Hyun Joon Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Sendesen E, Colak H. Performance of hybrid gain formula versus traditional fitting formulas in hearing aid fitting in tinnitus patients with hearing loss. Eur Arch Otorhinolaryngol 2024; 281:6295-6302. [PMID: 39069573 PMCID: PMC11564385 DOI: 10.1007/s00405-024-08846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Hearing aid fitting can be challenging when tinnitus accompanies hearing loss, as speech intelligibility and quality of life are affected by both hearing loss and tinnitus perception. However, studies focusing on the optimal hearing aid fitting for this group are scarce. Here, we aim to investigate the performance of alternative hearing aid fitting scenarios in improving hearing aid benefit and managing tinnitus. METHODS Sixty-six participants were included in the study and randomly divided into three groups based on the fitting formula: NAL-NL2, DSL pediatric and hybrid gain fitting procedure (covering NAL-NL2 for low frequencies and DSL pediatric formulas for high frequencies). Hearing aid benefit was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and speech perception in noise (SPIN). To evaluate tinnitus perception, psychoacoustic characteristics of tinnitus were determined, and the Tinnitus Handicap Inventory (THI) was gathered. RESULTS The NAL-NL2 fitting procedure showed better results in hearing aid benefit and SPIN compared to the DSL pediatric procedure. In the DSL pediatric procedure, better results were obtained in tinnitus management compared to NAL-NL2. There was no difference between the hybrid fitting procedure and DSL pediatric in tinnitus management. The hybrid fitting procedure also did not differ from NAL-NL2 in SPIN and hearing aid benefit. CONCLUSION Here, we propose a hybrid gain fitting procedure that can be a better alternative to boost hearing aid performance and tinnitus management in clinical practice.
Collapse
Affiliation(s)
- Eser Sendesen
- Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Hasan Colak
- Biosciences institute, Newcastle University, Newcastle Upon Tyne, UK.
| |
Collapse
|
3
|
Kosugi Y, Miwa T, Haruta Y, Hashimoto K, Kato S. Optimizing Tinnitus Management: The Important Role of Hearing Aids with Sound Generators. Audiol Res 2024; 14:674-683. [PMID: 39194413 DOI: 10.3390/audiolres14040057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/26/2024] [Accepted: 08/05/2024] [Indexed: 08/29/2024] Open
Abstract
Hearing aids (HAs), especially those with sound generators (SGs), are used in the management of tinnitus. However, their comparative efficacies and long-term outcomes remain unknown. Therefore, we investigated the efficacy and long-term outcomes of tinnitus therapy using various HA SG models. We retrospectively reviewed 666 patients with chronic tinnitus characterized by persistent symptoms for >6 months. At the initial visit, the patients received educational counselling on tinnitus (Utsunomiya method) and completed a comprehensive questionnaire comprising the tinnitus handicap inventory, a visual analog scale, the state-trait anxiety inventory, and the emotional intelligence scale. The scores were compared among various models of HA SGs and SGs. The patients underwent follow-ups for up to 2 years. Our results indicated that tinnitus retraining therapy using SGs and conventional HAs effectively managed chronic tinnitus. The prolonged use of HAs appeared to exacerbate tinnitus symptoms, emphasizing the superior long-term effectiveness of SG HAs, particularly ZEN (Widex ZEN, WS Audiology, Lynge, Denmark). Our findings indicate that HAs are useful in the first year, but their prolonged use may exacerbate tinnitus symptoms, whereas HA SGs are effective in the long term. Future studies should account for the variations in tinnitus treatment effects based on the type of sound employed.
Collapse
Affiliation(s)
- Yuki Kosugi
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Toru Miwa
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
- Department of Otolaryngology-Head and Neck Surgery, Graduate of School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuka Haruta
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Kosuke Hashimoto
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shoko Kato
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| |
Collapse
|
4
|
Vajsakovic D, Teng A, Searchfield GD. A Review of Auditory Rehabilitation Uses in Hearing Aid-Based Therapy for Tinnitus (2013-2024). Semin Hear 2024; 45:306-316. [PMID: 40256367 PMCID: PMC12007085 DOI: 10.1055/s-0045-1804913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2025] Open
Abstract
The weight of evidence supports hearing aids playing an important role in tinnitus management. Less information is available about the role of auditory rehabilitation (AR) in the hearing aid therapy process. The research question was "what role has amplification and AR played in the management of tinnitus." To identify relevant studies, database searches of Scopus (keywords), Embase (keywords), and PubMed (title and abstract) were carried out in April/May 2024 using the following search terms [tinnitus] and [amplification] or [hearing aids]. Articles were excluded if not written in English or unavailable in full text. Reviews and protocols were excluded. Once duplicates were removed, 495 articles were screened with 58 articles being included in the review. After cataloguing, articles were divided into those that described use of AR in their methods and those that did not. AR was subcategorized into four categories and described as (1) instruction, (2) counseling, (3) sensory management, (4) perceptual training. Articles published in the last 12 years support the use of hearing aids. The use of AR in addition to amplification was common but its content, application, and contribution to outcomes were ambiguous. Augmentation of amplification benefits for tinnitus through AR presents an opportunity for future research. In future research, each AR component needs to be described in greater detail and the relative merits of different types of AR and their role in personalized therapy needs to be ascertained.
Collapse
Affiliation(s)
- Dunja Vajsakovic
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrew Teng
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Grant D. Searchfield
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
5
|
Wang X, Guo L, Tian R, Fei Y, Ji J, Diao C, Zuo L, Zeng Y, Guo Q, Chen K, Zheng Y. Hearing Aids Combined With Educational Counseling Versus Educational Counseling Alone for Tinnitus Treatment in Patients With Hearing Loss: A Longitudinal Follow-Up Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-13. [PMID: 37267442 DOI: 10.1044/2023_jslhr-22-00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The effect of hearing aids (HAs) and educational counseling (EC) or their combination on tinnitus is ambiguous. This study aimed to investigate whether the combined use of HAs and EC is more effective than EC alone on tinnitus relief. METHOD A total of 72 adults with chronic, bothersome tinnitus and coexisting sensorineural hearing loss completed at least 1-month and 3-month follow-up. After receiving EC and HA prescriptions, 21 participants selected to purchase HAs (i.e., the HA + EC group), whereas the remaining 51 refused to use HAs despite recommendations (i.e., the EC group). Tinnitus severity was measured by Tinnitus Handicap Inventory (THI), Tinnitus Evaluation Questionnaire (TEQ), and Visual Analog Scale (VAS) for loudness. The primary outcome measure was THI, and tinnitus relief was defined as a 20-point or more reduction in THI. A generalized linear mixed model was used to confirm that the heterogeneity in baseline characteristics between groups did not interfere with the results. RESULTS The THI, TEQ, and VAS scores decreased significantly after treatments, and both groups yielded a similar trend of reduction. There were no significant differences in the incidence of tinnitus relief and time-to-event curves between the two groups. In addition, the length of follow-up did not affect treatment effectiveness. CONCLUSION There was insufficient evidence to support the superiority of the combined use of HA and EC for tinnitus over EC with no device.
Collapse
Affiliation(s)
- Xunyi Wang
- Hearing Center/Hearing & Speech Laboratory, Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu
| | - Lanxin Guo
- Hearing Center/Hearing & Speech Laboratory, Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu
| | - Run Tian
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu
| | - Yingping Fei
- Hearing Center/Hearing & Speech Laboratory, Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu
| | - Jinfeng Ji
- Hearing Center/Hearing & Speech Laboratory, Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu
| | - Cong Diao
- Hearing Center/Hearing & Speech Laboratory, Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu
| | - Lin Zuo
- West China Medical School, Sichuan University, Chengdu
| | - Yuxiao Zeng
- West China Medical School, Sichuan University, Chengdu
| | - Qingxin Guo
- West China Medical School, Sichuan University, Chengdu
| | - Ke Chen
- Hearing Center/Hearing & Speech Laboratory, Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu
| | - Yun Zheng
- Hearing Center/Hearing & Speech Laboratory, Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu
| |
Collapse
|
6
|
Jacquemin L, Gilles A, Shekhawat GS. Hearing more to hear less: a scoping review of hearing aids for tinnitus relief. Int J Audiol 2022; 61:887-895. [PMID: 34865589 DOI: 10.1080/14992027.2021.2007423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE As tinnitus is often associated with hearing loss, hearing aids have been proposed for tinnitus relief in literature for more than 70 years. There is a need for recent literature to be reviewed and guide decision making in tinnitus management. This scoping review aims to provide an update of the available evidence on hearing aids for tinnitus, focussing on the effect of sound amplification or combination devices (i.e. amplification and sound generation within one device). DESIGN Research studies were included if they investigated hearing aids or combination devices for tinnitus and were published after 2011. STUDY SAMPLE A total of 28 primary research studies were selected. RESULTS Positive results of hearing aids in tinnitus patients were shown in 68% of the studies, whereas 14% demonstrated no change in tinnitus distress. However, the quality of the evidence across studies was variable. CONCLUSIONS Scientific support for hearing aids and combination devices for tinnitus relief was found. The standalone effect of sound amplification and the added value of sound generators and adjustment of sound processing strategies needs further investigation. Stronger methodology in future studies is needed to reach consensus on how to optimise hearing solutions in a multidisciplinary approach.
Collapse
Affiliation(s)
- Laure Jacquemin
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, Antwerp University, Wilrijk, Belgium
| | - Annick Gilles
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, Antwerp University, Wilrijk, Belgium
- Department of Education, Health & Social Work, University College Ghent, Ghent, Belgium
| | - Giriraj Singh Shekhawat
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
- Tinnitus Research Initiative, Regensburg, Germany
- Ear Institute, University College London, London, UK
| |
Collapse
|
7
|
Waechter S, Jönsson A. Hearing Aids Mitigate Tinnitus, But Does It Matter if the Patient Receives Amplification in Accordance With Their Hearing Impairment or Not? A Meta-Analysis. Am J Audiol 2022; 31:789-818. [PMID: 35973434 DOI: 10.1044/2022_aja-22-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of the present meta-analysis is to explore the potential effects of objective verification of hearing aid amplification on tinnitus-related outcomes. METHOD Twenty-seven studies reporting tinnitus outcomes pre and post hearing aid fitting were identified through a systematic literature search. From these studies, data from 1,400 participants were included in the present meta-analysis. Studies were divided into subgroups based on whether they had reported performing objective verification of the participants' hearing aid amplification or not. Outcome measures were tinnitus distress and tinnitus loudness. RESULTS Meta-analyses of all included studies indicated verified amplification to result in significantly enhanced reduction of tinnitus loudness (p < .00001), while the enhanced reduction of tinnitus distress only approached statistical significance (p = .07). However, when excluding an outlier from the subgroup of studies using unverified amplification, individuals receiving verified amplification showed significantly greater reduction of tinnitus distress (p = .02). In addition, analyses of longitudinal effects revealed that the reductions of tinnitus distress decreased over time among individuals receiving unverified amplification but increased over time among individuals receiving verified amplification. CONCLUSIONS The present meta-analysis indicates verified hearing aid amplification to be superior to unverified amplification in terms of reduction of tinnitus loudness and distress. The longitudinal increase of mitigation of tinnitus distress with verified amplification only may reflect improved neural reorganization and/or better adherence to hearing aid use, with verified compared to unverified amplification. Due to the low cost of hearing aid verification compared to the high societal cost of tinnitus, objective verification of hearing aid amplification for tinnitus patients is recommended.
Collapse
Affiliation(s)
- Sebastian Waechter
- Department of Logopedics, Phoniatrics and Audiology, Lund University, Sweden
| | - Anders Jönsson
- Department of Logopedics, Phoniatrics and Audiology, Lund University, Sweden
| |
Collapse
|
8
|
Hearing Aid Effects and Satisfaction in Patients with Tinnitus. J Clin Med 2022; 11:jcm11041096. [PMID: 35207368 PMCID: PMC8875221 DOI: 10.3390/jcm11041096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate the effectiveness of and satisfaction with hearing aids as a treatment option for tinnitus with hearing loss. Methods: This retrospective study used the tinnitus handicap inventory (THI), the satisfaction with amplification in daily life (SADL) questionnaire, and a medical chart review. A total of 116 patients treated between August 2018 and December 2020 were included. All patients with tinnitus and hearing loss underwent the same counseling sessions. Sixty patients chose to have hearing aids fitted (aided group), whereas 56 patients chose not to (non-aided group). Both the groups had similar audiometric configurations, durations of tinnitus, and ages. Structured interviews were performed, with various measures evaluated using the visual analog scale (VAS) and the THI questionnaire, before and six months after fitting the hearing aids. The SADL questionnaire was administered 6 months after fitting the hearing aids. Results: The patients’ THI scores reduced 6 months after the counseling, but the improvement in the THI scores was only significant in the group that received hearing aids. There were significant differences between the VAS scores of the two groups, and the changes in the VAS scores in the groups were statistically different. Subjective satisfaction with a hearing aid increased with improvements to tinnitus-related discomfort. Conclusion: The study’s results indicated that patients with hearing loss and tinnitus can be treated with hearing aids and counseling.
Collapse
|
9
|
Kikidis D, Vassou E, Markatos N, Schlee W, Iliadou E. Hearing Aid Fitting in Tinnitus: A Scoping Review of Methodological Aspects and Effect on Tinnitus Distress and Perception. J Clin Med 2021; 10:2896. [PMID: 34209732 PMCID: PMC8269061 DOI: 10.3390/jcm10132896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023] Open
Abstract
Current evidence on efficacy of hearing aids (HAs) on tinnitus perception and annoyance is considered insufficient due to the heterogeneity of tinnitus characteristics and of methods used in the relevant clinical studies. This is a scoping review focused on the methodological aspects of clinical studies evaluating the value of HA fitting as part of tinnitus management over the past 10 years. Thirty-four studies were included in the review, showing important heterogeneity in almost all aspects of inclusion criteria, comparators, outcome measures, follow-up time and HA fitting procedures. Although all studies show that HA fitting has a positive impact on tinnitus perception in patients with hearing loss, the methodological heterogeneity does not allow robust conclusions. Future studies taking into account the different nature and goals of each tinnitus therapeutic modality and adapting their methods, endpoints and timelines according to them could lay the groundwork for obtaining high-quality evidence on whether and how HA fitting shall be implemented in tinnitus management strategies.
Collapse
Affiliation(s)
- Dimitrios Kikidis
- First Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece; (E.V.); (N.M.); (E.I.)
| | - Evgenia Vassou
- First Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece; (E.V.); (N.M.); (E.I.)
| | - Nikolaos Markatos
- First Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece; (E.V.); (N.M.); (E.I.)
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, Universität Regensburg, 93053 Regensburg, Germany;
| | - Eleftheria Iliadou
- First Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece; (E.V.); (N.M.); (E.I.)
| |
Collapse
|