1
|
Lassaletta L, Calvino M, Sanchez-Cuadrado I, Skarzynski PH, Cywka KB, Czajka N, Kutyba J, Tavora-Vieira D, Van de Heyning P, Mertens G, Staecker H, Humphrey B, Zernotti M, Zernotti M, Magele A, Ploder M, Zabeu JS. QoL, CIs, QALYs, and Individualized Rehabilitation: The Clinical and Practical Benefits of Regularly Assessing the Quality of Life of Adult Cochlear Implant Recipients. Int J Environ Res Public Health 2023; 20:6906. [PMID: 37887644 PMCID: PMC10605987 DOI: 10.3390/ijerph20206906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/24/2023] [Accepted: 10/01/2023] [Indexed: 10/28/2023]
Abstract
This study aimed to report quality of life (QoL) scores in unilateral cochlear implant (CI) users and to generate guidance for clinicians on using QoL measures to individualize CI counselling and rehabilitation and to increase access to CIs as a mode of rehabilitation. Participants (n = 101) were unilateral CI users with single-sided deafness (SSD; n = 17), asymmetrical hearing loss (AHL; n = 26), or bilateral hearing loss (Uni; n = 58). Generic QoL was assessed via the Health Utilities Index (HUI-3), and disease-specific QoL was assessed via the Speech, Spatial, and Qualities of Hearing scale (SSQ12) and Nijmegen CI Questionnaire (NCIQ) at preimplantation and at 6 and 12 months of CI use. All groups had significantly increased HUI-3 scores at both intervals. The SSD group showed significant benefit on the SSQ12 at visit 3, the AHL group showed significant benefit on the SSQ12 and most NCIQ subdomains at both intervals, and the Uni group showed significant benefit with both tests at both intervals. Unilateral CI recipients demonstrate improved QoL within the first 12 months of device use. Regular assessment with generic and disease-specific questionnaires has the potential to play an important role in personalizing treatment and possibly in increasing access to CI provision.
Collapse
Affiliation(s)
- Luis Lassaletta
- Department of Otorhinolaryngology, Hospital La Paz. IdiPAZ Research Institute, 28046 Madrid, Spain; (M.C.); (I.S.-C.)
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, (CIBERER-U761), 28029 Madrid, Spain
| | - Miryam Calvino
- Department of Otorhinolaryngology, Hospital La Paz. IdiPAZ Research Institute, 28046 Madrid, Spain; (M.C.); (I.S.-C.)
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, (CIBERER-U761), 28029 Madrid, Spain
| | - Isabel Sanchez-Cuadrado
- Department of Otorhinolaryngology, Hospital La Paz. IdiPAZ Research Institute, 28046 Madrid, Spain; (M.C.); (I.S.-C.)
| | - Piotr Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, World Hearing Center, 05-830 Kajetany, Poland; (P.H.S.); (K.B.C.); (N.C.); (J.K.)
| | - Katarzyna B. Cywka
- Institute of Physiology and Pathology of Hearing, World Hearing Center, 05-830 Kajetany, Poland; (P.H.S.); (K.B.C.); (N.C.); (J.K.)
| | - Natalia Czajka
- Institute of Physiology and Pathology of Hearing, World Hearing Center, 05-830 Kajetany, Poland; (P.H.S.); (K.B.C.); (N.C.); (J.K.)
| | - Justyna Kutyba
- Institute of Physiology and Pathology of Hearing, World Hearing Center, 05-830 Kajetany, Poland; (P.H.S.); (K.B.C.); (N.C.); (J.K.)
| | | | - Paul Van de Heyning
- Department of Otorhinolaryngology, Antwerp University Hospital, 2650 Antwerp, Belgium; (P.V.d.H.); (G.M.)
| | - Griet Mertens
- Department of Otorhinolaryngology, Antwerp University Hospital, 2650 Antwerp, Belgium; (P.V.d.H.); (G.M.)
| | - Hinrich Staecker
- ENT Department, University of Kansas Medical Centre, Kansas City, KS 66160, USA; (H.S.); (B.H.)
| | - Bryan Humphrey
- ENT Department, University of Kansas Medical Centre, Kansas City, KS 66160, USA; (H.S.); (B.H.)
| | - Mario Zernotti
- Department of Otorhinolaryngology, Sanatorio Allende de Córdoba, Córdoba 5000, Argentina; (M.Z.); (M.Z.)
| | - Maximo Zernotti
- Department of Otorhinolaryngology, Sanatorio Allende de Córdoba, Córdoba 5000, Argentina; (M.Z.); (M.Z.)
| | - Astrid Magele
- ENT Department, Universitätsklinikum St. Pölten, 3100 St. Pölten, Austria; (A.M.)
| | - Marlene Ploder
- ENT Department, Universitätsklinikum St. Pölten, 3100 St. Pölten, Austria; (A.M.)
| | - Julia Speranza Zabeu
- Hospital de Reabilitacão de Anomalias Craniofaciais da Universidade de Sao Paulo, Campus Bauru, Bauru 17012-230, Brazil;
| |
Collapse
|
2
|
Skarzynski PH, Krol B, Skarzynski H, Cywka KB. Implantation of two generations of Bonebridge after mastoid obliteration with bioactive glass S53P4. Am J Otolaryngol 2022; 43:103601. [PMID: 35981433 DOI: 10.1016/j.amjoto.2022.103601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE After radical surgery for chronic cholesteatoma (CWD mastoidectomy), patients have the option to have the posterior wall of their external auditory canal surgically reconstructed with S53P4 bioactive glass. The procedure eliminates some of the restrictions related to having a postoperative cavity and extends the options for a hearing prosthesis. If classic reconstruction is not possible and a hearing aid is not used, we suggest use of a Bonebridge implant. METHODS This study describes, over 18 months of follow-up, 16 patients after a two-stage surgical procedure: obliteration of the mastoid cavity with bioactive glass followed by Bonebridge implantation. There were 7 patients who received the first generation implant (BCI 601) and 9 who used the second (BCI 602). Before and after implantation, pure tone audiometry, sound field thresholds, and free-field audiometry were performed. Speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test. Subjective assessment of benefits was done using the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire. RESULTS During the observation period, no serious complications were found. The study demonstrated the safety and validity of the procedures and confirmed the safety of using S53P4 bioactive glass in otosurgery (antibacterial effect, nonrecurrence of cholesteatoma, and no effect on the inner ear). The audiological benefits expected from using the Bonebridge implant processor were also confirmed. CONCLUSION It is concluded that, after reconstructing the posterior wall of the external auditory canal with bioactive glass, two-stage implantation of a Bonebridge implant in a typical site is a safe solution for patients who have difficult anatomical conditions following their CWD mastoidectomy.
Collapse
Affiliation(s)
- Piotr H Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland; Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; Institute of Sensory Organs, Kajetany, Warsaw, Poland.
| | - Bartlomiej Krol
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
| | - Henryk Skarzynski
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
| | - Katarzyna B Cywka
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
| |
Collapse
|
3
|
Cywka KB, Skarzynski PH, Krol B, Hatzopoulos S, Skarzynski H. Evaluation of the Bonebridge BCI 602 active bone conductive implant in adults: efficacy and stability of audiological, surgical, and functional outcomes. Eur Arch Otorhinolaryngol 2022; 279:3525-3534. [PMID: 35182185 PMCID: PMC9130189 DOI: 10.1007/s00405-022-07265-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/10/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE (1) To assess the effectiveness and safety of a bone-conduction implant, the Bonebridge BCI 602, in adults with conductive or mixed hearing loss. (2) To investigate whether the Bonebridge BCI 602 is at least as effective as the Bonebridge BCI 601 in such patients. METHODS The study group included 42 adults who had either conductive or mixed hearing loss. All patients underwent Bonebridge BCI 602 implant surgery. Before and after implantation, pure-tone audiometry, speech recognition tests (in quiet and noise), and free-field audiometry were performed. Word recognition scores were evaluated using the Polish Monosyllabic Word Test. Speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test. Subjective assessment of benefits was done using the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire. RESULTS The APHAB questionnaire showed that difficulties in hearing decreased after BCI 602 implantation. Both word recognition in quiet and speech reception threshold in noise were significantly better after BCI 602 implantation and remained stable for at least 12 months. A significant advantage of the device is a reduced time for surgery while maintaining safety. In this study, the mean time for BCI 602 implantation was 28.3 min ± 9.4. CONCLUSIONS The second-generation Bonebridge BCI 602 implant is an effective hearing rehabilitation device for patients with conductive or mixed hearing loss. Patient satisfaction and audiological results confirm its efficacy and safety. Its new shape and dimensions allow it to be used in patients previously excluded due to insufficient or difficult anatomical conditions. The new BCI 602 implant is as effective as its predecessor, the BCI 601.
Collapse
Affiliation(s)
- Katarzyna B Cywka
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - Piotr H Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Nadarzyn, 05-830, Warsaw/Kajetany, Poland.
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
- Institute of Sensory Organs, Kajetany/Warsaw, Poland.
| | - Bartlomiej Krol
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | | | - Henryk Skarzynski
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| |
Collapse
|
4
|
Cywka KB, Skarżyński H, Król B, Skarżyński PH. The Bonebridge BCI 602 Active Transcutaneous Bone Conduction Implant in Children: Objective and Subjective Benefits. J Clin Med 2021; 10:jcm10245916. [PMID: 34945210 PMCID: PMC8707547 DOI: 10.3390/jcm10245916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: the Bonebridge hearing implant is an active transcutaneous bone conduction implant suitable for various types of hearing loss. It was first launched in 2012 as the BCI 601, with a newer internal part (BCI 602) released in 2019. With the new size and shape, the BCI 602 can be used in patients previously excluded due to insufficient anatomical conditions, especially in patients with congenital defects of the outer and middle ear. Objectives: the purpose of this study is to evaluate the objective and subjective benefits of the new Bonebridge BCI 602 in children who have hearing impairment due to conductive or mixed hearing loss. Safety and effectiveness of the device was assessed. Methods: the study group included 22 children aged 8–18 years (mean age 14.7 years) who had either conductive or mixed hearing loss. All patients were implanted unilaterally with the new Bonebridge BCI 602 implant. Pure tone audiometry, speech recognition tests (in quiet and noise), and free-field audiometry were performed before and after implantation. Word recognition scores were evaluated using the Demenko and Pruszewicz Polish Monosyllabic Word Test, and speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test. The subjective assessment of benefits was carried outusing the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire. Results: after implantation of the Bonebridge BCI 602 all patients showed a statistically significant improvement in hearing and speech understanding. The mean word recognition score (WRS) changed from 12.1% before implantation to 87.3% after 6 months. Mean speech reception threshold (SRT) before implantation was +4.79 dB SNR and improved to −1.29 dB SNR after 6 months. All patients showed stable postoperative results. The APHAB questionnaire showed that difficulties in hearing decreased after implantation, with a statistically significant improvement in global score. Pre-operative scores (M = 35.7) were significantly worse than post-operative scores at 6 months (M = 25.7). Conclusions: the present study confirms that the Bonebridge BCI 602 is an innovative and effective solution, especially for patients with conductive and mixed hearing loss due to anatomical ear defects. The Bonebridge BCI 602 system provides valuable and stable audiological and surgical benefits. Subjective assessment also confirms the effectiveness of the BCI 602. The BCI 602 offers the same amplification as the BCI601, but with a smaller size. The smaller dimensions make it an effective treatment option for a wider group of patients, especially children with congenital defects of the outer and middle ear.
Collapse
Affiliation(s)
- Katarzyna B. Cywka
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (K.B.C.); (B.K.)
| | | | - Bartłomiej Król
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (K.B.C.); (B.K.)
| | - Piotr H. Skarżyński
- Institute of Sensory Organs, 05-830 Warsaw, Poland;
- World Hearing Center, Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland
- Heart Failure and Cardiac Rehabilitation Department, Second Faculty of the Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence: ; Tel.: +48-223-560-366
| |
Collapse
|
5
|
Król B, Cywka KB, Skarżyńska MB, Skarżyński PH. Mastoid obliteration with S53P4 bioactive glass after canal wall down mastoidectomy: Preliminary results. Am J Otolaryngol 2021; 42:102895. [PMID: 33429176 DOI: 10.1016/j.amjoto.2020.102895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bioactive glass (S53P4), abbreviated BG, currently seems to be the best material for reconstructing the posterior wall of the auditory canal and obliterating the postoperative cavity. PURPOSE The aim of the study was to report preliminary results of otosurgery involving obliteration of the mastoid cavity after canal wall down mastoidectomy. METHODS 11 adult patients who had had a history of chronic otitis media with cholesteatoma in one or both ears and previous canal wall down mastoidectomy. The duration of the follow-up was 6 months, with routine visits after 7 days, then 1, 3, and 6 months after surgery. The patient's medical history, noting other diseases potentially affecting the healing process, was analyzed. Healing, audiometric results, reduction of the volume of the cavity after surgery, and reduction of bacterial flora growth were assessed. RESULTS There was not worsening in the audiological evaluation. Healing period was uneventful. There was a reduction in volume of the postoperative cavity, no development of pathological flora, and no recurrence of cholesteatoma. CONCLUSION Obliteration of the mastoid process with S53P4 bioactive glass is a safe and effective method of treatment. Such a procedure should be considered as a treatment for patients after canal wall down surgery (CWD).
Collapse
Affiliation(s)
- B Król
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland; Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - K B Cywka
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - M B Skarżyńska
- Institute of Sensory Organs, Kajetany, Poland; World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland; Center of Hearing and Speech Medincus, Kajetany, Poland
| | - P H Skarżyński
- Institute of Sensory Organs, Kajetany, Poland; World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland; Heart Failure and Cardiac Rehabilitation Department, 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; Center of Hearing and Speech Medincus, Kajetany, Poland.
| |
Collapse
|
6
|
Król B, Porowski M, Cywka KB, Skarżyńska MB, Skarżyński PH. Mastoid Obliteration with S53P4 Bioactive Glass Can Make Bonebridge Implantation Feasible: A Case Report. Am J Case Rep 2020; 21:e925914. [PMID: 33168798 PMCID: PMC7666435 DOI: 10.12659/ajcr.925914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patient: Male, 41-year-old Final Diagnosis: Bilateral otitis media with cholesteatoma Symptoms: Hearing loss Medication: — Clinical Procedure: — Specialty: Otolaryngology
Collapse
Affiliation(s)
- Bartłomiej Król
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.,Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - Marek Porowski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.,Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - Katarzyna B Cywka
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - Magdalena B Skarżyńska
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.,Institute of Sensory Organs, Warsaw/Kajetany, Poland.,Center of Hearing and Speech Medincus, Warsaw/Kajetany, Poland
| | - Piotr Henryk Skarżyński
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.,Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.,Center of Hearing and Speech Medincus, Warsaw/Kajetany, Poland.,Department of Heart Failure and Cardiac Rehabilitation, 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
7
|
Skarżyński PH, Ratuszniak A, Król B, Kozieł M, Osińska K, Cywka KB, Sztabnicka A, Skarżyński H. The Bonebridge in Adults with Mixed and Conductive Hearing Loss: Audiological and Quality of Life Outcomes. Audiol Neurootol 2019; 24:90-99. [PMID: 31141814 DOI: 10.1159/000499363] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Considering that hearing loss has a significant impact on social functioning, everyday activity and a person's emotional state, one of the most important goals of hearing rehabilitation with bone conduction devices is improvement in a patient's quality of life. OBJECTIVES To measure self-assessed quality of life in patients implanted with the Bonebridge, a bone conduction device. METHOD Prospective, observational, longitudinal study with one treatment group. Twenty-one patients with mixed or conductive hearing loss were included, and each individual served as its own control. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to measure patient-reported quality of life before intervention and at 3 and 6 months after activation of the device. At the same time frames, pure-tone audiometry and speech understanding in quiet and in noise were tested. RESULTS Hearing-specific quality of life increased significantly after intervention and remained stable up to 6 months. Both word recognition in quiet and speech reception threshold in noise were significantly better after 6 months compared to before surgery. Outcomes of aided speech understanding were independent of initial bone conduction thresholds and equally high (word recognition score >75%) across the device's indication range. CONCLUSIONS The Bonebridge provides not only significant audiological benefit in both speech understanding in quiet and in noise, but also increases self-perceived quality of life in patients suffering from mixed and conductive hearing loss. Together with a very low rate and minor nature of adverse events, it is the state-of-the-art solution for hearing rehabilitation in patients with mixed or conductive hearing loss up to a bone conduction threshold of 45 dB HL.
Collapse
Affiliation(s)
- Piotr H Skarżyński
- Heart Failure and Cardiac Rehabilitation Department, Second Faculty of the Medical University of Warsaw, Warsaw, Poland, .,Institute of Sensory Organs, Kajetany, Poland, .,Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland,
| | - Anna Ratuszniak
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Bartłomiej Król
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | | | - Kamila Osińska
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Katarzyna B Cywka
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Anna Sztabnicka
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Henryk Skarżyński
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| |
Collapse
|