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Genes Brain Behav 2019 Apr 4:e12572. Epub 2019 Apr 4.

Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands.

Most people have left-hemisphere dominance for various aspects of language processing, but only roughly 1% of the adult population has atypically reversed, rightward hemispheric language dominance (RHLD). The genetic-developmental program that underlies leftward language laterality is unknown, as are the causes of atypical variation. We performed an exploratory whole-genome-sequencing study, with the hypothesis that strongly penetrant, rare genetic mutations might sometimes be involved in RHLD. Read More

Surg Laparosc Endosc Percutan Tech 2019 Mar 18. Epub 2019 Mar 18.

Departments of Hepatobiliary and Pancreatic Surgery.

Background: Situs inversus (SI) is a rare congenital anomaly characterized by the transposition of thoracic and abdominal viscera. Laparoscopic pancreaticoduodenectomy (LPD) is increasingly used in patients with periampullar and pancreatic carcinomas. For patients with SI, LPD can be more complicated because of reversed anatomy and possible other associated anomalies that have not been expected before surgery. Read More

Medicine (Baltimore) 2019 Feb;98(7):e14272

Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.

Rationale: Although endoscopic and laparoscopic techniques in situs inversus totalis (SIT) have been reported respectively, endo-laparoscopic combination therapy due to biliary lithiasis remains infrequent. We shared the experience regarding the operations with a video report and discussed the similarities and differences with the usual procedures, which proved to be challenging to some extent for SIT.

Patient Concerns: Herein we present a 72-year-old man with SIT who underwent endo-laparscopic combination therapy due to choledocholithiasis and gallbladder stone. Read More

Radiol Med 2019 Feb 1. Epub 2019 Feb 1.

Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Radiologia d'Urgenza, Ospedale Policlinico San Martino IST, Largo R. Benzi, 10, 16132, Genoa, Italy.

Aim: To describe the CT findings in eight patients with left-sided inferior vena cava (IVC) in whom the left renal artery presented a precaval course (pLRA).

Materials And Methods: We searched the teaching files of six radiology departments for patients with pLRAs. Eight patients were found, and the available imaging studies and clinical histories were reviewed. Read More

Gastroenterology 2019 03 26;156(4):879-880. Epub 2018 Oct 26.

Department of Gastroenterology, Mitoyo General Hospital, Kanonji-city, Kagawa, Japan; Department of Gastroenterology, Hata Medical Clinic, Takamatsu-city, Japan.

BMJ Case Rep 2018 Nov 28;11(1). Epub 2018 Nov 28.

Department of Surgery, Indira Gandhi Medical College, Shimla, India.

Situs inversus totalis is a rare genetic disorder. Single-incision laparoscopic cholecystectomy (SILC) in situs inversus totalis has been reported rarely. SILC has an advantage of being easier than conventional laparoscopic cholecystectomy in addition to better cosmesis and reduced postoperative pain. Read More

BMC Pulm Med 2018 Dec 18;18(1):194. Epub 2018 Dec 18.

Radiology Department, Groupe Hospitalier Cochin-Hôtel Dieu, AP-HP, Université Paris Descartes - Sorbonne Paris Cité, Paris, France.

Background: The present study aimed to develop an automated computed tomography (CT) score based on the CT quantification of high-attenuating lung structures, in order to provide a quantitative assessment of lung structural abnormalities in patients with Primary Ciliary Dyskinesia (PCD).

Methods: Adult (≥18 years) PCD patients who underwent both chest CT and spirometry within a 6-month period were retrospectively included. Commercially available lung segmentation software was used to isolate the lungs from the mediastinum and chest wall and obtain histograms of lung density. Read More

Spine (Phila Pa 1976) 2018 Nov 1. Epub 2018 Nov 1.

Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Study Design: Cross-sectional.

Objective: To analyze the thoracic center of mass (COM) position of children at different ages and evaluate its relation with the previously reported pre-existent rotational pattern of the normal spine.

Summary Of Background Data: The normal, non-scoliotic thoracic spine is known to have a rotational pattern that changes direction during growth; a transition from left-sided towards right-sided rotation with increasing age. Read More

Echocardiography 2018 11;35(11):1885-1888

Shengjing Hospital of China Medical University, Shenyang, China.

Crisscross heart(CCH) is a rare congenital anomaly. CCH is always with rare complex congenital heart malformations, and for this reason it is difficult to diagnose. We present an asymptomatic 29-year-old pregant woman with history of cardiac murmur at 28 weeks of gestation. Read More

BMJ Case Rep 2018 Oct 12;2018. Epub 2018 Oct 12.

Institute of Liver Disease & Transplantation, Gleneagles Global Health City Chennai, Chennai, Tamil Nadu, India.

Liver transplantation for biliary atresia splenic malformation syndrome associated with situs inversus totalis is a challenging task due to the complexity of associated malformations and the technical proficiency required to overcome them. We present the case of a 6-month-old infant who underwent liver transplantation for biliary atresia. A reduced left lateral segment liver graft from a live donor (his mother) was implanted. Read More

J Pediatr 2019 01 4;204:31-37. Epub 2018 Oct 4.

Department of Pediatrics, Marshfield Clinic, Marshfield, WI. Electronic address:

Objectives: To characterize the diversity and prevalence of thoraco-abdominal abnormalities in Bardet-Biedl syndrome (BBS), a model ciliopathy for understanding the role of cilia in human health.

Study Design: The Clinical Registry Investigating BBS, a worldwide registry exploring the phenotype and natural history of BBS, was used to conduct the study. Protected health information was obtained by subject or family interview and Health Insurance Portability and Accountability Act-approved release of data including imaging studies and genetic testing. Read More

Semin Thorac Cardiovasc Surg 2019 28;31(1):113-115. Epub 2018 Sep 28.

Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia. Electronic address:

Long-term outcomes in children with atrioventricular septal defect (AVSD) and univentricular palliation are of concern, with <60% survival at 25 years. Common atrioventricular valves (AVV) often become insufficient in patients with univentricular physiology, leading to heart failure. We have recently observed that outcomes of children with AVSD who reach Fontan circulation are not as bad as previously thought, provided that the AVV remains competent. Read More

J Card Surg 2018 10 11;33(10):691-692. Epub 2018 Sep 11.

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.

World J Surg Oncol 2018 Aug 20;16(1):173. Epub 2018 Aug 20.

Department of Urology, First Hospital of Shanxi Medical University, No. 85, Jiefangnan Road, Taiyuan, 030001, Shanxi, China.

Background: Situs inversus totalis is a relatively rare congenital anomaly. Performing the retrolaparoscopic adrenalectomy for the patient with situs inversus totalis is a skill-demanding and challenging surgical task, which has been even more rarely reported.

Case Presentation: We present a case with a large right adrenal mass (10. Read More

BMJ Case Rep 2018 Aug 10;2018. Epub 2018 Aug 10.

Neonatal Intensive Care Unit, St Mary's Hospital.

Int J Surg Case Rep 2018 27;50:36-41. Epub 2018 Jun 27.

Tenancingo Surgical Center (Central Quirúrgica Tenancingo), 306 Matamoros, Tenancingo, Mexico, 52400, Mexico. Electronic address:

Introduction: Gallbladders located to the left of falciform ligament, without situs inversus, are denominated sinistroposition or true left-sided gallbladders; it is considered a rare anatomic anomaly with a prevalence in between 0.1% and 0.7%. Read More

Pan Afr Med J 2018;29:160. Epub 2018 Mar 19.

Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Congenit Heart Dis 2018 Jul 22;13(4):624-627. Epub 2018 Jul 22.

Children's Heart Center Nevada, Las Vegas, Nevada, USA.

Patients: We reviewed all patients evaluated at our center with situs solitus, levocardia, and a right aortic arch that were born between January 2000 and January 2018.

Results: From our databases, we identified 204 patients. We excluded patients with a double aortic arch from analysis. Read More

Cortex 2018 Sep 16;106:12-25. Epub 2018 May 16.

Department of Radiology, Ghent University Hospital, Belgium.

Most humans show typical brain functional specialization with language and praxis favoring left hemisphere lateralization and spatial attention and face recognition showing right hemisphere dominance. Lateralization of these cognitive functions was investigated using fMRI in participants with complete visceral reversal and matched control participants. While most participants revealed typical brain organization, atypical functional segregation was significantly more frequent in participants with visceral reversal. Read More

Asian J Endosc Surg 2019 Apr 23;12(2):185-188. Epub 2018 May 23.

Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.

Situs inversus totalis (SIT) is a rare congenital anomaly characterized by complete inversion of the thoracic and abdominal organs. Many intra-abdominal and vessel anomalies have been reported in association with SIT. However, there have been no reports on the use of laparoscopic radical nephrectomy with thrombectomy for renal vein thrombus, which is considered as a safe and feasible procedure, in patients with SIT. Read More

Indian J Radiol Imaging 2018 Jan-Mar;28(1):65-69

Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

We report a case of a 4-week-old female neonate with Jeune's asphyxiating thoracic dystrophy (JATD) and coexistent situs anomaly, primarily presenting as gastric motility disorder. The child presented with abdominal distension and nonbilious vomiting since birth with failure to thrive. However, skeletal survey revealed JATD. Read More

Gen Thorac Cardiovasc Surg 2018 Nov 18;66(11):671-674. Epub 2018 Apr 18.

Division of Thoracic Surgery, Kariya-Toyota General Hospital, Sumiyoshi-cho 5-15, Kariya-shi, Aichi, 448-8505, Japan.

Situs inversus totalis (SIT) is a rare anomaly. A limited number of reports document surgery for lung cancer in patients with SIT. We report the case of a 68-year-old man with SIT who underwent video-assisted thoracoscopic bisegmentectomies for synchronous double primary lung cancers. Read More

Medicine (Baltimore) 2018 Mar;97(12):e0205

Department of General Surgery, The First Affiliated Hospital of Nanchang University.

Rationale: Situs inversus totalis (SIT) is a rare anatomical variation of the internal organs, and solid pseudopapillary tumor of the pancreas (SPTP) is a rare tissue type of pancreatic tumors, classified as benign or low-grade malignancy. However, to our knowledge, a patient with SIT and SPTP is extremely rare and has never been reported.

Patient Concerns: We retrospectively analyzed a case of SIT with SPTP in a 45-year-old woman. Read More

Int J Appl Basic Med Res 2018 Jan-Mar;8(1):48-50

Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

Primary ciliary dyskinesia (PCD) is a rare disorder with impaired ciliary function resulting in a spectrum of clinical manifestations of varying severity. PCD affects approximately one in every 20,000 individuals with a reported prevalence between 1:4000 and 1:50,000. Due to its nonspecific clinical features, the condition is usually diagnosed late in its course, unless situs inversus (SI) or organ laterality defects are discovered at imaging. Read More

Clin Nucl Med 2018 Jun;43(6):439-440

From the Department of Nuclear Medicine, "Mariano Santo" Hospital, Cosenza, Italy.

A 72-year-old woman was examined by F-FDG PET/CT, showing pathologic tracer uptake in the gallbladder. PET/CT also depicted condition of situs inversus totalis, with dextrocardia, liver on the left side and spleen on the right side of the body. These findings were essential to plan and develop laparoscopic cholecystectomy, which diagnosed cholangiocarcinoma. Read More

Biomed Res Int 2018 8;2018:1854269. Epub 2018 Jan 8.

Department of Respiratory Medicine, Diagnosis and Treatment Center of Respiratory Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.

Primary ciliary dyskinesia (PCD) is a clinical rare peculiar disorder, mainly featured by respiratory infection, tympanitis, nasosinusitis, and male infertility. Previous study demonstrated it is an autosomal recessive disease and by 2017 almost 40 pathologic genes have been identified. Among them are the leucine-rich repeat- (LRR-) containing 6 (LRRC6) codes for a 463-amino-acid cytoplasmic protein, expressed distinctively in motile cilia cells, including the testis cells and the respiratory epithelial cells. Read More

Thorax 2018 10 28;73(10):980-982. Epub 2018 Feb 28.

Department of Paediatrics, University Hospital of Verona, Verona, Italy.

Cilia have multiple functions including olfaction. We hypothesised that olfactory function could be impaired in primary ciliary dyskinesia (PCD). Olfaction, nasal nitric oxide (nNO) and sinus CT were assessed in patients with PCD and non-PCD sinus disease, and healthy controls (no CT scan). Read More

Mult Scler Relat Disord 2018 Apr 14;21:69-70. Epub 2018 Feb 14.

MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran. Electronic address:

Fingolimod, taken orally once per day, is approved for the treatment of relapsing-remitting multiple sclerosis (MS). It should be stopped at least two months before conception as it is not considered safe during pregnancy or when breast feeding. In vitro and animal studies have found a possibly increased risk of congenital abnormalities following exposure to Fingolimod. Read More

Ann Thorac Surg 2018 03;105(3):e113-e115

Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman.

Major aortopulmonary collateral arteries can influence the postoperative course of arterial switch operation, with heart failure being the common clinical presentation. A relatively rare presentation of an aortopulmonary collateral artery in the form of persistent postoperative pulmonary hemorrhage was encountered after an uneventful arterial switch operation in a neonate with transposition of the great arteries, intact interventricular septum, and situs inversus totalis. The aortopulmonary collateral artery was coil embolized with a successful outcome. Read More

Nucl Med Rev Cent East Eur 2018 ;21(1):50-52

Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Dextrocardia, although a rare cardiac abnormality, carries the same risk for cardiac events as other people. SPECT Myocardial perfusion imaging is a potentially helpful diagnostic tool in patients with dextrocardia. Because of swapping of lateral and septal walls on SPECT slices, although visual analysis is possible, quantitation is substantially limited. Read More

Surg Case Rep 2018 Feb 13;4(1):16. Epub 2018 Feb 13.

Department of Gastrointestinal Surgery, Tenri Yorozu Sōdanjo Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.

Background: Situs inversus is a rare congenital condition that is currently classified into two types: complete situs inversus (situs inversus totalis, SIT) and partial situs inversus (situs inversus partialis, SIP). In SIP patients, some organs are inverted and others are in their expected position, and individual patient variation in organ position increases surgical difficulty. Several surgeons have performed laparoscopic or robotic surgeries in situs inversus patients, but almost all were SIT patients. Read More

PLoS One 2018 6;13(2):e0191457. Epub 2018 Feb 6.

Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.

Objectives: Among patients with non-cystic fibrosis bronchiectasis, 1-18% have an underlying diagnosis of primary ciliary dyskinesia (PCD) and it is suspected that there is under-recognition of this disease. Our intention was to evaluate the specific features of PCD seen on computed tomography (CT) in the cohort of bronchiectasis in order to facilitate the diagnosis.

Materials And Methods: One hundred and twenty-one CTs performed in patients with bronchiectasis were scored for the involvement, type, and lobar distribution of bronchiectasis, bronchial dilatation, and bronchial wall thickening. Read More

JACC Cardiovasc Imaging 2018 Sep 17;11(9):1360-1362. Epub 2018 Jan 17.

Asian Cardiovasc Thorac Ann 2018 Feb 16;26(2):142-145. Epub 2018 Jan 16.

1 Department of Cardiovascular Surgery, 16811 Coruna University Hospital , Coruna, Spain.

Dextrocardia with situs solitus and severe mitral regurgitation is a rare clinical presentation which posse a surgical challenge and requires specific preoperative planning. A 54-year-old women with this anatomy, multiple thoracic procedures, and severe mitral valve regurgitation underwent successful mitral valve replacement with a 27-mm mechanical prosthesis through a left thoracotomy under ventricular fibrillation, on the basis of computed tomography findings. We emphasize the importance of preoperative planning and a surgical approach through a left thoracotomy and under ventricular fibrillation. Read More

J Med Case Rep 2018 Jan 10;12(1). Epub 2018 Jan 10.

Department of Radiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Kartagener's syndrome is a subset of primary ciliary dyskinesia, an autosomal recessive inherited disorder characterized by the clinical triad of chronic sinusitis, bronchiectasis, and situs inversus. Abnormal ciliary structure or function leading to impaired ciliary motility is the main pathophysiologic problem in Kartagener's syndrome.

Case Presentation: A 24-year-old man from Gondar town, North-West Ethiopia, presented to University of Gondar Hospital with recurrent episodes of nasal congestion with itching and paranasal discomfort, and productive cough for more than a decade. Read More

Medicine (Baltimore) 2017 Dec;96(48):e8947

Hangzhou First People's Hospital, Nanjing Medical University, Zhejiang Chinese Medical University, Shangcheng District, Hangzhou, Zhejiang, China.

Background: Premature ventricular contractions (PVCs) originating from aortic sinus cusps is not infrequent and can be eliminated effectively by radiofrequency ablation with rare complications. However, after a review of the medical literature, and to our knowledge, this is the first case of successful idiopathic aortic sinus cusps-PVC-ablation using a 3-dimensional (3D) mapping system in an adult with dextrocardia.

Methods: A 62-year-old male with dextrocardia and situs inversus underwent catheter ablation of frequent PVCs. Read More

Brain Struct Funct 2018 May 4;223(4):1937-1952. Epub 2018 Jan 4.

School of Clinical Sciences, Clinical Research Imaging Centre (CRIC), University of Edinburgh, Edinburgh, UK.

Magnetic resonance imaging was used to investigate brain structural and functional asymmetries in 15 participants with complete visceral reversal (situs inversus totalis, SIT). Language-related brain structural and functional lateralization of SIT participants, including peri-Sylvian gray and white matter asymmetries and hemispheric language dominance, was similar to those of 15 control participants individually matched for sex, age, education, and handedness. In contrast, the SIT cohort showed reversal of the brain (Yakovlevian) torque (occipital petalia and occipital bending) compared to the control group. Read More

Tex Heart Inst J 2017 12 19;44(6):416-419. Epub 2017 Dec 19.

Aneurysm of the sinus of Valsalva, a rare cardiac condition, results from dilation of an aortic sinus. Sudden aneurysm rupture can trigger rapidly progressive heart failure. We discuss the case of a 57-year-old woman with situs ambiguus, isolated levocardia, and polysplenia who presented with acute-onset heart failure. Read More

Circulation 2017 12;136(24):2386-2388

Department of Cardiology, AZ Sint-Jan Brugge-Oostende AV, Belgium (R.C., M.D., S.K., Y.V., R.T.)

Asian Cardiovasc Thorac Ann 2018 Nov 6;26(9):690-693. Epub 2017 Mar 6.

GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.

Situs inversus with dextrocardia and Lutembacher syndrome is a rare cardiac anomaly. It is associated with other complex cardiac anomalies and anatomical defects. A 30-year-old woman with this condition underwent mitral valve replacement and closure of a secundum atrial septal defect. Read More

Ann Emerg Med 2017 Dec;70(6):e49-e50

Department of Emergency Medicine, Adiyaman University Medical Faculty, Adiyaman, Turkey.

BMC Cardiovasc Disord 2017 11 16;17(1):281. Epub 2017 Nov 16.

Center for Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.

Background: Percutaneous coronary interventions of chronic total occlusion represent one of the most challenging issues in interventional cardiology. A Caucasian patient with dextrocardia presented with an in-stent chronic total occluded right coronary artery, a constellation which has not been described previously in the literature.

Case Presentation: A 69-year-old man with pre-known situs inversus totalis and a long history of coronary artery disease with multiple interventions and stent-implantations presented to our department suffering from episodes of chest pain under exercise. Read More

J Korean Med Sci 2017 Dec;32(12):2069-2072

Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea.

Congenital cardiovascular anomalies, such as dextrocardia, persistent left superior vena cava (SVC), and pulmonary artery (PA) sling, are rare disorders. These congenital anomalies can occur alone, or coincide with other congenital malformations. In the majority of cases, congenital anomalies are detected early in life by certain signs and symptoms. Read More

Cardiol J 2017 ;24(5):586-587

Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.

NA. Read More

Circulation 2017 10;136(17):1662-1664

From Department of Ultrasonography (Y.L.), Cardiovascular Institute (R.L.), and Department of Radiology (X.Z.), First Affiliated Hospital of Jinzhou Medical University, Liaoning Province, China.

Int J Surg Case Rep 2017 16;41:93-96. Epub 2017 Oct 16.

Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Japan.

Introduction: Situs inversus totalis (SIT) is a rare congenital anomaly in which the left and right aspects of the thoracic and intra-abdominal organs are inverted, like a mirror image. Surgical procedures in a patients with SIT is difficult as their anatomy is abnormal. In particular, laparoscopic procedures are considered more difficult in patients with SIT because of the mirror-image anatomy. Read More

BMJ Case Rep 2017 Oct 10;2017. Epub 2017 Oct 10.

Department of Cardiology, Texas Children's Hospital, Houston, Texas, USA.

Ductal origin of pulmonary artery is a rare anomaly that is frequently misdiagnosed. Patients may present with exertional dyspnoea, recurrent respiratory infections and pulmonary hypertension. The presence of pulmonary hypertension can adversely affect clinical outcome in these patients; hence, early identification and intervention is the key to improve survival. Read More

Top Companion Anim Med 2017 Jun 9;32(2):61-65. Epub 2017 Mar 9.

Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.

A 4-year-old cocker spaniel, male, of 12kg body weight was presented because of the onset of polyuria or polydipsia. From the first months of its life, the dog had exhibited constant serous to mucopurulent nasal discharge, productive cough, sneezing, reverse sneezing, otitis, and recurrent episodes of fever. The respiratory signs had been treated several times with antibiotics, without ever achieving a complete resolution. Read More

BMC Vet Res 2017 Sep 29;13(1):292. Epub 2017 Sep 29.

Division of Basic Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan.

Background: Laterality disorders of the abdominal organs include situs inversus totalis that mirrors the arrangements of all internal organs and heterotaxy syndrome (situs ambiguus) in which the thoracic or abdominal organs are abnormally arranged. Heterotaxy is often accompanied by multiple congenital malformations, and it generally comprises asplenia and polysplenia syndromes. To our knowledge, polysplenia syndrome has been reported in only three cattle, and computerized tomographic (CT) images of these animals were not obtained. Read More

Medicine (Baltimore) 2017 Sep;96(39):e8209

Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Rationale: Situs inversus totalis (SIT) is a rare congenital anomaly characterized by complete inversion of the abdominal and thoracic organs, and often involves multiple genetic mutations. The most suitable surgical technique for patients with multiple vessel and organ variations as well as SIT remains unclear. Furthermore, there has been insufficient clinical evidence that demonstrates which surgical techniques achieve the best outcomes. Read More