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Zhang C, Zhang J, Widmann M, Benke M, Kübler M, Dasari D, Klotz T, Gizzi L, Röhrle O, Brenner P, Wrachtrup J. Optimizing NV magnetometry for Magnetoneurography and Magnetomyography applications. Front Neurosci 2023; 16:1034391. [PMID: 36726853 PMCID: PMC9885266 DOI: 10.3389/fnins.2022.1034391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Magnetometers based on color centers in diamond are setting new frontiers for sensing capabilities due to their combined extraordinary performances in sensitivity, bandwidth, dynamic range, and spatial resolution, with stable operability in a wide range of conditions ranging from room to low temperatures. This has allowed for its wide range of applications, from biology and chemical studies to industrial applications. Among the many, sensing of bio-magnetic fields from muscular and neurophysiology has been one of the most attractive applications for NV magnetometry due to its compact and proximal sensing capability. Although SQUID magnetometers and optically pumped magnetometers (OPM) have made huge progress in Magnetomyography (MMG) and Magnetoneurography (MNG), exploring the same with NV magnetometry is scant at best. Given the room temperature operability and gradiometric applications of the NV magnetometer, it could be highly sensitive in the pT / Hz -range even without magnetic shielding, bringing it close to industrial applications. The presented work here elaborates on the performance metrics of these magnetometers to the state-of-the-art techniques by analyzing the sensitivity, dynamic range, and bandwidth, and discusses the potential benefits of using NV magnetometers for MMG and MNG applications.
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Affiliation(s)
- Chen Zhang
- Institute of Physics, University of Stuttgart, Stuttgart, Germany,Quantum Technology R&D Center, Beijing Automation Control Equipment Institute, Beijing, China,*Correspondence: Chen Zhang ✉
| | - Jixing Zhang
- Institute of Physics, University of Stuttgart, Stuttgart, Germany
| | - Matthias Widmann
- Institute of Physics, University of Stuttgart, Stuttgart, Germany
| | - Magnus Benke
- Institute of Physics, University of Stuttgart, Stuttgart, Germany
| | - Michael Kübler
- Institute of Physics, University of Stuttgart, Stuttgart, Germany
| | - Durga Dasari
- Institute of Physics, University of Stuttgart, Stuttgart, Germany
| | - Thomas Klotz
- Institute for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Stuttgart, Germany
| | - Leonardo Gizzi
- Institute for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Stuttgart, Germany,Department of Biomechatronic Systems, Fraunhofer Institute for Manufacturing Engineering and Automation IPA, Stuttgart, Germany
| | - Oliver Röhrle
- Institute for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Stuttgart, Germany
| | - Philipp Brenner
- ZEISS Innovation Hub @ KIT, Eggenstein-Leopoldshafen, Germany
| | - Jörg Wrachtrup
- Institute of Physics, University of Stuttgart, Stuttgart, Germany,Jörg Wrachtrup ✉
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Topsakal V, Heuninck E, Matulic M, Tekin AM, Mertens G, Van Rompaey V, Galeazzi P, Zoka-Assadi M, van de Heyning P. First Study in Men Evaluating a Surgical Robotic Tool Providing Autonomous Inner Ear Access for Cochlear Implantation. Front Neurol 2022; 13:804507. [PMID: 35386404 PMCID: PMC8979022 DOI: 10.3389/fneur.2022.804507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Image-guided and robot-assisted surgeries have found their applications in skullbase surgery. Technological improvements in terms of accuracy also opened new opportunities for robotically-assisted cochlear implantation surgery (RACIS). The HEARO® robotic system is an otological next-generation surgical robot to assist the surgeon. It first provides software-defined spatial boundaries for orientation and reference information to anatomical structures during otological and neurosurgical procedures. Second, it executes a preplanned drill trajectory through the temporal bone. Here, we report how safe the HEARO procedure can provide an autonomous minimally invasive inner ear access and the efficiency of this access to subsequently insert the electrode array during cochlear implantation. In 22 out of 25 included patients, the surgeon was able to complete the HEARO® procedure. The dedicated planning software (OTOPLAN®) allowed the surgeon to reconstruct a three-dimensional representation of all the relevant anatomical structures, designate the target on the cochlea, i.e., the round window, and plan the safest trajectory to reach it. This trajectory accommodated the safety distance to the critical structures while minimizing the insertion angles. A minimal distance of 0.4 and 0.3 mm was planned to facial nerve and chorda tympani, respectively. Intraoperative cone-beam CT supported safe passage for the 22 HEARO® procedures. The intraoperative accuracy analysis reported the following mean errors: 0.182 mm to target, 0.117 mm to facial nerve, and 0.107 mm to chorda tympani. This study demonstrates that microsurgical robotic technology can be used in different anatomical variations, even including a case of inner ear anomalies, with the geometrically correct keyhole to access to the inner ear. Future perspectives in RACIS may focus on improving intraoperative imaging, automated segmentation and trajectory, robotic insertion with controlled speed, and haptic feedback. This study [Experimental Antwerp robotic research otological surgery (EAR2OS) and Antwerp Robotic cochlear implantation (25 refers to 25 cases) (ARCI25)] was registered at clinicalTrials.gov under identifier NCT03746613 and NCT04102215.
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Affiliation(s)
- Vedat Topsakal
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- *Correspondence: Vedat Topsakal
| | - Emilie Heuninck
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Ahmet M. Tekin
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | | | - Paul van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Hermann J, Mueller F, Schneider D, O'Toole Bom Braga G, Weber S. Robotic Milling of Electrode Lead Channels During Cochlear Implantation in an ex-vivo Model. Front Surg 2021; 8:742147. [PMID: 34859039 PMCID: PMC8631814 DOI: 10.3389/fsurg.2021.742147] [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: 07/15/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Robotic cochlear implantation is an emerging surgical technique for patients with sensorineural hearing loss. Access to the middle and inner ear is provided through a small-diameter hole created by a robotic drilling process without a mastoidectomy. Using the same image-guided robotic system, we propose an electrode lead management technique using robotic milling that replaces the standard process of stowing excess electrode lead in the mastoidectomy cavity. Before accessing the middle ear, an electrode channel is milled robotically based on intraoperative planning. The goal is to further standardize cochlear implantation, minimize the risk of iatrogenic intracochlear damage, and to create optimal conditions for a long implant life through protection from external trauma and immobilization in a slight press fit to prevent mechanical fatigue and electrode migrations. Methods: The proposed workflow was executed on 12 ex-vivo temporal bones and evaluated for safety and efficacy. For safety, the difference between planned and resulting channels were measured postoperatively in micro-computed tomography, and the length outside the planned safety margin of 1.0 mm was determined. For efficacy, the channel width and depth were measured to assess the press fit immobilization and the protection from external trauma, respectively. Results: All 12 cases were completed with successful electrode fixations after cochlear insertions. The milled channels stayed within the planned safety margins and the probability of their violation was lower than one in 10,000 patients. Maximal deviations in lateral and depth directions of 0.35 and 0.29 mm were measured, respectively. The channels could be milled with a width that immobilized the electrode leads. The average channel depth was 2.20 mm, while the planned channel depth was 2.30 mm. The shallowest channel depth was 1.82 mm, still deep enough to contain the full 1.30 mm diameter of the electrode used for the experiments. Conclusion: This study proposes a robotic electrode lead management and fixation technique and verified its safety and efficacy in an ex-vivo study. The method of image-guided robotic bone removal presented here with average errors of 0.2 mm and maximal errors below 0.5 mm could be used for a variety of other otologic surgical procedures.
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Affiliation(s)
- Jan Hermann
- ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Fabian Mueller
- ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Daniel Schneider
- ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Gabriela O'Toole Bom Braga
- ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland
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Auinger AB, Dahm V, Liepins R, Riss D, Baumgartner WD, Arnoldner C. Robotic Cochlear Implant Surgery: Imaging-Based Evaluation of Feasibility in Clinical Routine. Front Surg 2021; 8:742219. [PMID: 34660683 PMCID: PMC8511493 DOI: 10.3389/fsurg.2021.742219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/30/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Robotic surgery has been proposed in various surgical fields to reduce recovery time, scarring, and to improve patients' outcomes. Such innovations are ever-growing and have now reached the field of cochlear implantation. To implement robotic ear surgery in routine, it is of interest if preoperative planning of a safe trajectory to the middle ear is possible with clinically available image data. Methods: We evaluated the feasibility of robotic cochlear implant surgery in 50 patients (100 ears) scheduled for routine cochlear implant procedures based on clinically available imaging. The primary objective was to assess if available high-resolution computed tomography or cone beam tomography imaging is sufficient for planning a trajectory by an otological software. Secondary objectives were to assess the feasibility of cochlear implant surgery with a drill bit diameter of 1.8 mm, which is the currently used as a standard drill bit. Furthermore, it was evaluated if feasibility of robotic surgery could be increased when using smaller drill bit sizes. Cochlear and trajectory parameters of successfully planned ears were collected. Measurements were carried out by two observers and the interrater reliability was assessed using Cohen's Kappa. Results: Under the prerequisite of the available image data being sufficient for the planning of the procedure, up to two thirds of ears were eligible for robotic cochlear implant surgery with the standard drill bit size of 1.8 mm. The main reason for inability to plan the keyhole access was insufficient image resolution causing anatomical landmarks not being accurately identified. Although currently not applicable in robotic cochlear implantation, narrower drill bit sizes ranging from 1.0 to 1.7 mm in diameter could increase feasibility up to 100%. The interrater agreement between the two observers was good for this data set. Discussion: For robotic cochlear implant surgery, imaging with sufficient resolution is essential for preoperative assessment. A slice thickness of <0.3 mm is necessary for trajectory planning. This can be achieved by using digital volume tomography while radiation exposure can be kept to a minimum. Furthermore, surgeons who use the software tool, should be trained on a regular basis in order to achieve planning consistency.
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Affiliation(s)
- Alice Barbara Auinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Valerie Dahm
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Rudolfs Liepins
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Baumgartner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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Panara K, Shahal D, Mittal R, Eshraghi AA. Robotics for Cochlear Implantation Surgery: Challenges and Opportunities. Otol Neurotol 2021; 42:e825-e835. [PMID: 33993143 DOI: 10.1097/mao.0000000000003165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recent advancements in robotics have set forth a growing body of evidence for the clinical application of the robotic cochlear implantation (RCI), with many potential benefits. This review aims to summarize these efforts, provide the latest developments in this exciting field, and explore the challenges associated with the clinical implementation of RCI. DATA SOURCES MEDLINE, PubMed, and EMBASE databases. STUDY SELECTION A search was conducted using the keywords "robotics otolaryngology," "robotic cochlear implant," "minimally-invasive cochlear implantation," "minimally-invasive mastoidectomy," and "percutaneous cochlear implant" with all of their synonyms. Literature selection criteria included articles published in English, and articles from 1970 to present. RESULTS The use of robotics in neurotology is a relatively new endeavor that continues to evolve. Robotics is being explored by various groups to facilitate in the various steps of cochlear implant surgery, including drilling a keyhole approach to the middle ear for implants, inner ear access, and electrode insertion into the cochlea. Initial clinical trials have successfully implanted selected subjects using robotics. CONCLUSIONS The use of robotics in cochlear implants remains in its very early stages. It is hoped that robotics will improve clinical outcomes. Although successful implants with robots are reported in the literature, there are some challenges that need to be addressed before this approach can become an acceptable option for the conventional cochlear implant surgery, such as safety, time, efficiency, and cost. However, it is hoped that further advancements in robotic technology will help in overcoming these barriers leading to successful implementation for clinical utility.
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Affiliation(s)
- Kush Panara
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - David Shahal
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - Rahul Mittal
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - Adrien A Eshraghi
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
- Department of Neurological Surgery
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
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Tekin AM, Matulic M, Wuyts W, Assadi MZ, Mertens G, van Rompaey V, Li Y, van de Heyning P, Topsakal V. A New Pathogenic Variant in POU3F4 Causing Deafness Due to an Incomplete Partition of the Cochlea Paved the Way for Innovative Surgery. Genes (Basel) 2021; 12:genes12050613. [PMID: 33919129 PMCID: PMC8143104 DOI: 10.3390/genes12050613] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 12/20/2022] Open
Abstract
Incomplete partition type III (IP-III) is a relatively rare inner ear malformation that has been associated with a POU3F4 gene mutation. The IP-III anomaly is mainly characterized by incomplete separation of the modiolus of the cochlea from the internal auditory canal. We describe a 71-year-old woman with profound sensorineural hearing loss diagnosed with an IP-III of the cochlea that underwent cochlear implantation. Via targeted sequencing with a non-syndromic gene panel, we identified a heterozygous c.934G > C p. (Ala31Pro) pathogenic variant in the POU3F4 gene that has not been reported previously. IP-III of the cochlea is challenging for cochlear implant surgery for two main reasons: liquor cerebrospinalis gusher and electrode misplacement. Surgically, it may be better to opt for a shorter array because it is less likely for misplacement with the electrode in a false route. Secondly, the surgeon has to consider the insertion angles of cochlear access very strictly to avoid misplacement along the inner ear canal. Genetic results in well describes genotype-phenotype correlations are a strong clinical tool and as in this case guided surgical planning and robotic execution.
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Affiliation(s)
- Ahmet M. Tekin
- Department of Otorhinolaryngology, Head and Neck Surgery, Brussels Health Campus, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.T.); (M.M.)
| | - Marco Matulic
- Department of Otorhinolaryngology, Head and Neck Surgery, Brussels Health Campus, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.T.); (M.M.)
| | - Wim Wuyts
- Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, 2650 Antwerp, Belgium;
| | | | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium; (G.M.); (V.v.R.); (P.v.d.H.)
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Vincent van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium; (G.M.); (V.v.R.); (P.v.d.H.)
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Yongxin Li
- Department of Otolaryngology, Head and Neck Surgery, Capital Medical University, Beijing 100730, China;
| | - Paul van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium; (G.M.); (V.v.R.); (P.v.d.H.)
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology, Head and Neck Surgery, Brussels Health Campus, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.T.); (M.M.)
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UZ Brussel, Brussels Health Campus, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-24776882; Fax: +32-24776880
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Topsakal V, Matulic M, Assadi MZ, Mertens G, Rompaey VV, Van de Heyning P. Comparison of the Surgical Techniques and Robotic Techniques for Cochlear Implantation in Terms of the Trajectories Toward the Inner Ear. J Int Adv Otol 2020; 16:3-7. [PMID: 32209514 PMCID: PMC7224420 DOI: 10.5152/iao.2020.8113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The ideal outcome of cochlear implant surgery involves the insertion of the array inside the scala tympani of the cochlea with the least mechanical trauma. Recently, round window insertion and the direction in which the cochlea is approached have gained attention in this respect. The Angles of Cochlear Approach (ACA) can be defined with a plane in the plane of the basal turn, termed the in-plane angle, and the plane orthogonal to this plane, termed the out-plane angle. The aim of this study was to compare the trajectory angles for different surgical techniques of Veria, suprameatal, pericanal, and multiple posterior tympanotomy (PT) approaches, including an optimal trajectory that is simulated for robotic surgery. MATERIALS AND METHODS The trajectories of these surgical techniques were simulated on the same high-resolution computed tomography scan. The simulated trajectory angles were analyzed with dedicated software for medical images, defining the ACA and distances to critical otological structures. RESULTS The ACA are the smallest for surgical techniques that pass thought the PT. However, performing a surgical PT can include variability in the ACA, ranging from almost 0° to 20.8° in an out-plane angle, depending on how close a surgeon would approach the facial nerve. The Veria, Suprameatal approach (SMA), and peri-canal approaches have larger ACA and minimal distances to the ossicular chain and the ear canal. The maximum distance to the facial nerve and the widest out-plane angle is observe with a pericanal approach. The optimal PT approach refers to the trajectory without collisions and with the best possible ACA that can be planned. CONCLUSION Different surgical approaches yield important differences in the ACA. PT allows better ACA with maximum distances to the critical structures. However, the optimal PT trajectory simulated for robotic keyhole surgery is a further improvement on the trajectories through the facial recess.
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Affiliation(s)
- Vedat Topsakal
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital (UZA), Edegem, Belgium;Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Marco Matulic
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | | | - Griet Mertens
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital (UZA), Edegem, Belgium;Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital (UZA), Edegem, Belgium;Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital (UZA), Edegem, Belgium;Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
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