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International Journal of Behavioral Medicine

Published in:

01-06-2018

Tinnitus, Traumatic Brain Injury, and Posttraumatic Stress Disorder in the Military

Published in: International Journal of Behavioral Medicine | Issue 3/2018

Abstract

Purpose

Acoustic trauma is more prevalent in military settings, especially among individuals with combat-related military occupational specialties. Gunfire, improvised explosive devices, and mortar explosions are a few examples that may cause hearing degradation and tinnitus. It is possible that the same events that are associated with auditory problems can cause traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

Method

This paper reviews the distinct and overlapping symptoms of tinnitus, TBI, and PTSD, and how these disorders interact to synergistically promote negative outcomes.

Results

Tinnitus may serve as a significant contributor to symptoms of TBI and PTSD. Therefore, tinnitus subtypes could be identified as physiologically or psychologically based, or both.

Conclusions

Additional research is warranted to determine the common and unique symptoms and associated neurological pathways of tinnitus, TBI, and PTSD. Brief treatment recommendations are provided, including a multidisciplinary approach for the physical and psychological distress associated with tinnitus.

Hazell JWP, Jastreboff PJ, Tinnitus I. Auditory mechanisms: a model for tinnitus and hearing impairment. J Otolaryngol. 1990;19(1):1–5.PubMed

Jastreboff PJ. Phantom auditory perception (tinnitus): mechanism of generation and perception. Neurosci Res. 1990; https://doi.org/10.1016/0168-0102(90)90031-9.

Kirsch CA, Blanchard EB, Parnes SM. A review of the efficacy of behavioral techniques in the treatment of subjective tinnitus. Ann Behav Med. 1989; https://doi.org/10.1207/s15324796abm1102_3.

Andersson G, Baguley DM, McKenna L, McFerran DJ. Tinnitus: a multidisciplinary approach. Whurr: London, England; 2005.

Andersson G, Vretblad P. Anxiety sensitivity in patients with chronic tinnitus. Scand J Behav Ther. 2000; https://doi.org/10.1080/028457100750066405.

Moring JC, Bowen A, Thomas J, Bira L. The emotional and functional impact of the type of tinnitus sensation. J Clin Psychol Med Settings. 2016; https://doi.org/10.1007/s10880-015-9444-5.

Lockwood AH, Salvi RJ, Coad ML, Towsley ML, Wack DS, Murphy BW. The functional neuroanatomy of tinnitus. Evidence for limbic system links and neural plasticity. Neurology. 1998; https://doi.org/10.1212/wnl.50.1.114.

Unterrainer J, Greimelm KV, Leibetsederm M, Koller T. Experiencing tinnitus: which factors are important for perceived severity of the symptom? Int J Tinnitus. 2003;9:130–3.

Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med. 2010; https://doi.org/10.1016/j.amjmed.2010.02.015.

10.

Helfer TM. Noise-induced hearing injuries, active component, U.S. Armed Forces, 2007–2010. Med Surveillance Mon Rep. 2011;18:7–10.

11.

Yong JS, Wang D. Impact of noise on hearing in the military. Mil Med Res. 2015;2:1–6.CrossRef

12.

Institute of Medicine. Treatment for posttraumatic stress disorder in military and veteran populations: final assessment. Washington, DC: The National Academies Press; 2014.

13.

Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012; https://doi.org/10.1097/TA.0b013e3182755dcc.

14.

Murray CK, Reynolds JC, Schroeder JM, Harrison MB, Evans OM, Hospenthal DR. Spectrum of care provided at an echelon II medical unit during Operation Iraqi Freedom. Mil Med. 2005; https://doi.org/10.7205/milmed.170.6.516.

15.

Owens BD, Kragh JF, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Trauma. 2008; https://doi.org/10.1097/TA.0b013e318163b875.

16.

Champion HR, Holcomb JB, Young LA. Injuries from explosions: physics, biophysics, pathology, and required research focus. J Trauma. 2009; https://doi.org/10.1097/ta.0b013e3181a27e7f.

17.

Alamgir H, Turner CA, Wong NJ, Cooper SP, Bentancourt JA, Henry J, et al. The impact of hearing impairment and noise induced hearing injury on quality of life in the active-duty military population: challenges to the study of the issue. Military Med Res. 2016; https://doi.org/10.1186/s40779-016-0082-5.

18.

Department of Veterans Affairs. Annual Benefits Report, Fiscal Year 2015. 2015. http://www.benefits.va.gov/REPORTS/abr/ABR-Compensation-FY15-05092016.pdf. Accessed 20 May 2016.

19.

Humes LE, Joellenbeck LM, Durch JS. Noise and military service: implications for hearing loss and tinnitus. Washington, DC: The National Academies Press; 2005.

20.

Yankaskas K. Prelude: noise-induced tinnitus and hearing loss in the military. Neurosci Tinnitus. 2013;295:3–8.

21.

Henry JA, Dennis KC, Schechter MA. General review of tinnitus: prevalence, mechanisms, effects, and management. J Speech Lang Hear Res. 2005; https://doi.org/10.1044/1092-4388(2005/084).

22.

Briner W. A behavioural nosology for tinnitus. Psychol Rep. 1995; https://doi.org/10.2466/pr0.1995.77.1.27.

23.

Hesser H, Andersson G. The role of anxiety sensitivity and behavioral avoidance in tinnitus disability. Int J Audiol. 2009; https://doi.org/10.1080/14992020802635325.

24.

Kaldo V, Levin S, Widarsson J, Buhrman M, Larsen H, Andersson G, et al. Behav Ther. 2008; https://doi.org/10.1016/j.beth.2007.10.003.

25.

Sood SK, Coles RRA. Hyperacusis and phonophobia in tinnitus patients. Br J Audiol. 1988;22:228.

26.

Hesse G, Laubert A, Schaaf H, Almeling M. Integrative psychosomatic and otologic models in the therapy of chronic tinnitus. In: Abelian ME, editor. Trends in psychotherapy research. Hauppauge, NY: Nova Science Publishers, Inc; 2006. p. 53–70.

27.

Institute of Medicine. Long-term effects of blast exposure. Washington, DC: National Academies Press; 2014.

28.

Saatman KE, Duhaime AC, Bullock R, Maas AIR, Valadka A, Manley GT. Classification of traumatic brain injury for targeted therapies. J Neurotrauma. 2008; https://doi.org/10.1089/neu.2008.0586.

29.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974; https://doi.org/10.1016/s0140-6736(74)91639-0.

30.

Defense and Veterans Brain Injury Center. DoD numbers for traumatic brain injury worldwide. http://dvbic.dcoe.mil/sites/default/files/DoD-TBI-Worldwide-Totals_2015_Q1-Q4_March-30-2016_v1.0_2016-04-14.pdf. Accessed 19 May 2016.

31.

Von Holst H, Cassidy JD. Mandate of the WHO collaborating centre task force on mild traumatic brain injury. J Rehabil Med. 2004; https://doi.org/10.1080/16501960410023633.

32.

McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013; https://doi.org/10.1136/bjsports-2013-092313.

33.

McAllister TW, Arciniegas D. Evaluation and treatment of postconcussive symptoms. NeuroRehabilitation. 2002;17(4):265–83.PubMed

34.

Carroll LJ, Cassidy JD, Peloso PM, Borg J, von Holst H, Holm L, et al. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004; https://doi.org/10.1080/16501960410023859.

35.

Jury MA, Flynn MC. Auditory and vestibular sequelae to traumatic brain injury: a pilot study. NZ Med J. 2001;114:286–8.

36.

Yurgil KA, Clifford RE, Risbrough VB, Geyer MA, Huang M, Barkauskas DA, et al. Prospective associations between traumatic brain injury and postdeployment tinnitus in active-duty marines. J Head Trauma Rehab. 2016; https://doi.org/10.1097/htr.0000000000000117.

37.

Nölle C, Todt I, Seidl RO, Ernst A. Pathophysiological changes of the central auditory pathway after blunt trauma of the head. J Neurotrauma. 2004; https://doi.org/10.1089/089771504322972040.

38.

Jaramillo CA, Blessen CE, McGeary CA, McGeary DD, Robinson J, Amuan M, et al. A cohort study examining headaches among veterans of Iraq and Afghanistan wars: associations with traumatic brain injury, PTSD, and depression. Headache. 2015; https://doi.org/10.1111/head.12726.

39.

Vanderploeg RD, Belanger HG, Horner RD, Sephar AM, Powell-Cope G, Luther SL, et al. Health outcomes associated with military deployment: mild traumatic brain injury, blast, trauma, and combat associations in the Florida National Guard. Arch Phys Med Rehab. 2012; https://doi.org/10.1016/j.apmr.2012.05.024.

40.

Kennedy JE, Jaffee MS, Leskin GA, Stokes JW, Leal FO, Fitzpatrick PJ. Posttraumatic stress disorder and posttraumatic disorder-like symptoms and mild traumatic brain injury. J Rehab Res Dev. 2007; https://doi.org/10.1682/jrrd.2006.12.0166.

41.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2013. https://doi.org/10.1176/appi.books.9780890425596.CrossRef

42.

Zirke N, Seydel C, Arsoy D, Klapp BF, Haupt H, Szczepek AJ, et al. Analysis of mental disorders in tinnitus patients performed with composite international diagnostic interview. Qual Life Res. 2013;22(8):2095–104. https://doi.org/10.1007/s11136-012-0338-9.CrossRefPubMed

43.

Zöger S, Svedlund J, Holgers KM. Relationship between tinnitus severity and psychiatric disorders. Psychosomatics. 2006; https://doi.org/10.1176/appi.psy.47.4.282.

44.

Pattyn T, Van Den Eede F, Vanneste S, Cassiers L, Veltman DJ, Van De Heyning P, et al. Tinnitus and anxiety disorders: a review. Hear Res. 2016; https://doi.org/10.1016/j.heares.2015.08.014.

45.

Farb CR, Ledoux JE. Afferents from rat temporal cortex synapse on lateral amygdala neurons that express NMDA and AMPA receptors. Synapse. 1999; https://doi.org/10.1002/(sici)1098-2396(19990901)33:3<218::aidsyn6>3.0.co;2-146.

46.

Landgrebe M, Langguth B, Rosengarth K, Braun S, Koch A, Kleinjung T, et al. Structural brain changes in tinnitus: grey matter decrease in auditory and non-auditory brain areas. Neuroimage. 2009; https://doi.org/10.1016/j.neuroimage.2009.01.069.

47.

Møller AR. The role of neural plasticity in tinnitus. In: Møller AR, Langguth B, De Ridder D, Kleinjung T, editors. Textbook of tinnitus. Springer Science: New York, NY; 2011. p. 99–102. https://doi.org/10.1007/978-1-60761-145-5_12.CrossRef

48.

Husain FT. Neural networks of tinnitus in humans: elucidating severity and habituation. Hear Res. 2016; https://doi.org/10.1016/j.heares.2015.09.010.

49.

Liberzon I, Sripada CS. The functional neuroanatomy of PTSD: a critical review. Prog Brain Res. 2008; https://doi.org/10.1016/S0079-6123(07)67011-3.

50.

Fagelson MA, Smith SL. Tinnitus self-efficacy and other tinnitus self-report variables in patients with and without post-traumatic stress disorder. Ear Hear. 2016; https://doi.org/10.1097/AUD.0000000000000290.

51.

Hinton DE, Chhean D, Pich V, Hofmann SG, Barlow DH. Tinnitus among Cambodian refugees: relationship to PTSD severity. J Trauma Stress. 2006; https://doi.org/10.1002/jts.20115.

52.

Henry JA, Schechter MA, Zaugg TL, Griest S, Jastreboff PJ, Vernon JA, et al. Clinical trial to compare tinnitus masking and tinnitus retraining therapy. Acta Otolaryngol. 2006; https://doi.org/10.1080/03655230600895556.

53.

Fagelson MA. The association between tinnitus and posttraumatic stress disorder. Am J Audiol. 2007; https://doi.org/10.1044/1059-0889(2007/015).

54.

McKenna L. Tinnitus and insomnia. In: Tyler R, editor. Tinnitus handbook. Singular: San Diego, CA; 2000. p. 59–84.

55.

Hazell J. Support for a neurophysiological model of tinnitus. In: Reich GE, Vernon JA, editors. Proceedings of the fifth international tinnitus seminar, vol. 8. American Tinnitus Association: Portland, OR; 1995. p. 51–7. https://doi.org/10.3389/fneur.2017.00141.CrossRef

56.

Henry JL, Wilson PH. An evaluation of two types of cognitive intervention in the management of chronic tinnitus. Scand J Behav Ther. 1998; https://doi.org/10.1080/02845719808408510.

57.

Reiss S, McNally RJ. Expectancy model of fear. In: Reis S, Bootzin RR, editors. Theoretical issues in behavior therapy. San Diego, CA: Academic Press; 1985. p. 107–21.

58.

Andersson G, Westin V. Understanding tinnitus distress: introducing the concepts of moderators and mediators. Int J Audiol. 2008; https://doi.org/10.1080/14992020802301670.

59.

Jastreboff MM, Jastreboff PJ. Decreased sound tolerance and tinnitus retraining therapy (TRT). Aust N Z J Audiol. 2002;24(2):74–84. https://doi.org/10.1375/audi.24.2.74.31105.CrossRef

60.

Stephens SDG, Jaworski A, Lewis P, Aslan S. An analysis of the communication tactics used by hearingimpaired adults. Br J Audiol. 1999; https://doi.org/10.3109/03005364000000097.

61.

Budd RJ, Pugh R. Tinnitus coping style and its relationship to tinnitus severity and emotional distress. J Psychosom Res. 1996; https://doi.org/10.1016/s0022-3999(96)00171-7.

62.

Vernon JA, Meikle MB. Tinnitus masking. In: Tyler R, editor. Tinnitus Handbook. Singular: San Diego; 2000. p. 313–56.

63.

Newman CW, Sandridge SA, Jacobson GP. Psychometric adequacy of the tinnitus handicap inventory (THI) for evaluating treatment outcome. J Am Acad Audiol. 1998;9(2):153–60.PubMed

64.

Wilson PH, Henry J, Bowen M, Haralambous G. Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus. J Speech Lang Hear Res. 1991;34(1):197–201. https://doi.org/10.1044/jshr.3401.197.CrossRef

65.

Meikle MB. Methods for evaluation of tinnitus relief procedures. In: Aran JM, Dauman R, editors. Tinnitus 91: proceedings of the fourth international tinnitus seminar. Amsterdam: Kugler; 1992. p. 555–62.

66.

Department of Defense. DoD policy guidance for management of mild traumatic brain injury/concussion in the deployed setting (Department of Defense Instruction No. 6490.11). 2012. http://www.dtic.mil/whs/directives/corres/pdf/649011p.pdf. Accessed 25 May 2016.

67.

Cicerone K, Levin H, Malec J, Stuss D, Whyte J. Cognitive rehabilitation interventions for executive function: moving from bench to bedside in patients with traumatic brain injury. J Cogn Neurosci. 2006; https://doi.org/10.1162/jocn.2006.17.7.1212.

68.

Henry JA, Zaugg TL, Myers PJ, Schechter MA. Using therapeutic sound with progressive audiologic tinnitus management. Trends Amplif. 2008; https://doi.org/10.1177/1084713808321184.

69.

Jackson JL, O’Malley PG, Kroenke K. Antidepressants and cognitive-behavioral therapy for symptom syndromes. CNS Spectr. 2006;11(03):212–22. https://doi.org/10.1017/S1092852900014383.CrossRefPubMed

70.

Lindberg P, Scott B, Melin L, Lyttkens L. The psychological treatment of tinnitus: an experimental evaluation. Behav Res Ther. 1989; https://doi.org/10.1016/0005-7967(89)90143-5.

71.

Robinson SK, Viirre ES, Bailey KA, Kindermann S, Minassian AL, Goldin PR, et al. A randomized controlled trial of cognitive-behavior therapy for tinnitus. Int Tinnitus J. 2008;14(2):119–26.PubMed

72.

Zöger S, Erlandsson S, Svedlund J, Holgers K. Benefits from group psychotherapy in the treatment of severe refractory tinnitus. Audiol Med. 2008; https://doi.org/10.1080/16513860801959092.

73.

Weathers F, Litz B, Herman D, Huska J, Keane T. The PTSD checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX; 1993.

74.

Keane TM, Caddell JM, Taylor KL. Mississippi scale for combat-related posttraumatic stress disorder: three studies in reliability and validity, J Consult Clin Psychol. 1988; https://doi.org/10.1037/0022-006X.56.1.85.

75.

Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, et al. Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry. 2002;181:158–62.CrossRefPubMed

76.

Prins A, Bovin MJ, Smolenski DJ, Marx BP, Kimerling R, Jenkins-Guarnieri MA, et al. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): development and evaluations within a veteran primary care sample. J Gen Intern Med. 2016; https://doi.org/10.1007/s11606-3703-5.

77.

Resick PA, Monson CM, Chard KM. Cognitive processing therapy: veteran/military version. Washington, DC: Department of Veterans Affairs; 2008.

78.

Resick PA, Schnicke MK. Cognitive processing therapy for rape victims: a treatment manual. Newbury Park, CA: Sage Publications; 1993.

79.

Resick PA, Wachen JS, Mintz J, Young-McCaughan S, Roache JD, Borah AM, et al. A randomized clinical trial of group cognitive processing therapy compared with group present-centered therapy for PTSD among active duty military personnel. J Consult Clin Psychol. 2015; https://doi.org/10.1037/ccp0000016.

80.

Chard KM, Schumm JA, Owens GP, Cottingham SM. A comparison of OEF and OIF veterans and Vietnam veterans receiving cognitive processing therapy. J Trauma Stress. 2010; https://doi.org/10.1002/jts.20500.

81.

Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. J Consult Clin Psychol. 2006; https://doi.org/10.1037/0022-006x.74.5.898.

82.

Foa EB, Hembree EA, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences. New York, NY: Oxford University Press; 2007.

83.

Foa EB, Rothbaum BO. Treating the trauma of rape: cognitive-behavioral therapy for PTSD. New York, NY: Guilford Press; 1998.

84.

Peterson AL, Foa EB, Riggs DS. Prolonged exposure therapy for combat-related PTSD. In: Moore BA, Penk W, editors. Treating PTSD in military personnel: a clinical handbook. Guilford: New York, NY; 2011. p. 42–58.

85.

Blount TH, Cigrang JA, Foa EB, Ford HL, Peterson AL. Intensive outpatient prolonged exposure for combat-related PTSD: a case study. Cogn Behav Pract. 2014; https://doi.org/10.1016/j.cbpra.2013.05.004.

86.

Cigrang JA, Peterson AL, Schobitz RP. Three American troops in Iraq: evaluation of a brief exposure therapy treatment. Pragmatic Case Stud Psychother. 2005; 10.14713/pcsp.v1i2.857.

87.

Rauch SAM, Defever E, Favorite T, Duroe A, Garrity C, Martis B, et al. Prolonged exposure for PTSD in a Veterans Health Administration PTSD clinic. J Trauma Stress. 2009; https://doi.org/10.1002/jts.20380.

88.

Cigrang JA, Rauch SAM, Avila LL, Bryan CJ, Goodie JL, Hryshko-Mullen A, et al. Treatment of active-duty military with PTSD in primary care: Early findings. Psychol Serv. 2011; https://doi.org/10.1037/a0022740.

89.

Cigrang JA, Rauch SAM, Mintz J, Brundige A, Avila LL, Bryan CJ, Goodie JL, Peterson AL, and the STRONG STAR Consortium. J Anxiety Disord. 2015. https://doi.org/10.1016/j.janxdis.2015.10.003.

90.

Hesser H, Pereswetoff-Morath CE, Andersson G. Consequences of controlling background sounds: the effect of experiential avoidance on tinnitus interference. Rehabil Psychol. 2009; https://doi.org/10.1037/a0017565.

91.

Westin V, Hayes SC, Andersson G. Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact. Behav Res Ther. 2008; https://doi.org/10.1016/j.brat.2008.08.008.

92.

Anson K, Ponsford J. Coping and emotional adjustment following traumatic brain injury. J Head Trauma Rehabil. 2006; https://doi.org/10.1097/00001199-200605000-00005.

93.

Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. Second ed. New York, NY: Guilford Press; 2011.

94.

Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: an experiential approach to behavior change. New York, NY: Guilford Press; 1999.

95.

Westin VZ, Schulin M, Hesser H, Karlsson M, Noe RZ, Olofsson U, et al. Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial. Behav Res Ther. 2011; https://doi.org/10.1016/j.brat.2011.08.001.

96.

Hesser H, Gustafsson T, Lundén C, Henrikson O, Fattahi K, Johnsson E, et al. A randomized controlled trial of Internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus. J Consult Clin Psychol. 2012; https://doi.org/10.1037/a0027021.

97.

Thompson BL, Luoma JB, LeJeune JT. Using acceptance and commitment therapy to guide exposure-based interventions for posttraumatic stress disorder. J Contemp Psychother. 2013; https://doi.org/10.1007/s10879-013-9233-0.

98.

Kangas M, McDonald S. Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury. Neuropsychol Rehabil. 2011; https://doi.org/10.1080/09602011.2010.540920.

99.

Soo C, Tate RL, Lane-Brown A. A systematic review of acceptance and commitment therapy (ACT) for managing anxiety: applicability for people with acquired brain injury? Brain Impair. 2011; https://doi.org/10.1375/brim.12.1.54.

100.

Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in US soldiers returning from Iraq. N Eng J Med. 2008; https://doi.org/10.1056/nejmoa072972.

101.

Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Eng J Med. 2004; https://doi.org/10.1056/nejmoa040603.

102.

Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annu Rev Public Health. 2008; https://doi.org/10.1146/annurev.publhealth.29.020907.090847.

Title: Tinnitus, Traumatic Brain Injury, and Posttraumatic Stress Disorder in the Military
Publication date: 01-06-2018
Published in: International Journal of Behavioral Medicine / Issue 3/2018
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-017-9702-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Tinnitus, Traumatic Brain Injury, and Posttraumatic Stress Disorder in the Military

Abstract

Purpose

Method

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Method

Results

Conclusions

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