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Published in: European Archives of Oto-Rhino-Laryngology 5/2024

05-01-2024 | Smelling Disorder | Rhinology

Association between dietary zinc intake and olfactory dysfunction: a study based on the NHANES database

Authors: Yifang Wang, Tianping Shen, Yan Wang

Published in: European Archives of Oto-Rhino-Laryngology | Issue 5/2024

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Abstract

Objective

The primary objective of this study was to find the association between dietary zinc intake and the prevalence of olfactory disorders using data from the National Health and Nutrition Examination Survey (NHANES).

Methods

A cross-sectional study was conducted using the 2013–2014 NHANES data. A linear regression model was constructed with dietary zinc intake as the independent variable and olfactory dysfunction as the dependent variable. Initially, in the unadjusted model, weighted logistic regression analysis was carried out for continuous variables, and stratified analysis was conducted for categorical variables. Subsequently, three models were created to perform subgroup analysis by adjusting for different confounding factors, further investigating the relationship between dietary zinc intake and olfactory dysfunction. Finally, restricted cubic spline (RCS) models adjusting for all confounding factors were utilized to study the nonlinear associations of age and dietary zinc intake with olfactory dysfunction and their relevant thresholds.

Results

A total of 2958 samples were analyzed in this study. Weighted logistic regression analysis displayed a negative relationship between dietary zinc intake and the prevalence of olfactory dysfunction in the population of non-Hispanic whites and other Hispanics, as well as in individuals with body mass index (BMI) ≥ 25 kg/m2 (OR < 1, P < 0.05). The P values for the multiplicative interaction terms adjusting for all confounding factors were not significant (P for interaction > 0.05). In the three regression models adjusting for different confounding factors, dietary zinc intake was significantly negatively related to olfactory dysfunction in all populations (Crude: OR 0.63, 95% CI 0.44–0.91; Model I: OR 0.58, 95% CI 0.38–0.90; Model II: OR 0.59, 95% CI 0.35–1.00). Subgroup analysis based on BMI showed a remarkable negative relationship between dietary zinc intake and olfactory dysfunction in the group with BMI of 25–30 kg/m2 (Crude: OR 0.50, 95% CI 0.28–0.90, P = 0.012; Model I: OR 0.49, 95% CI 0.24–1.00, P = 0.021) and the group with BMI ≥ 30 kg/m2 (Crude: OR 0.55, 95% CI 0.33–0.92, P = 0.013; Model I: OR 0.51, 95% CI 0.29–0.88, P = 0.005; Model II: OR 0.51, 95% CI 0.29–0.91, P = 0.004). RCS analysis revealed a remarkable nonlinear association of age and dietary zinc intake with olfactory dysfunction (P-non-linear < 0.05). The prevalence of olfactory dysfunction was considerably higher in individuals aged 60 and above compared to those under 60 years old. Daily dietary zinc intake within the range of 9.60–17.45 mg was a protective factor for olfactory dysfunction, while intake outside this range increased the prevalence of olfactory dysfunction.

Conclusion

Daily dietary zinc intake within the range of 9.60–17.45 mg has a protective effect against olfactory dysfunction. Intake outside this range increases the prevalence of olfactory dysfunction. The prevalence of olfactory dysfunction is significantly higher in individuals aged 60 and above compared to those under 60 years old. For individuals with a BMI of 25–30 kg/m2 and a BMI ≥ 30 kg/m2, dietary zinc intake is negatively correlated with olfactory dysfunction. Therefore, it is recommended that these populations increase their dietary zinc intake to develop healthier lifestyles and maintain olfactory health.
Literature
1.
go back to reference Velluzzi F, Deledda A, Onida M, Loviselli A, Crnjar R, Sollai G (2022) Relationship between olfactory function and BMI in normal weight healthy subjects and patients with overweight or obesity. Nutrients 14:1262PubMedPubMedCentralCrossRef Velluzzi F, Deledda A, Onida M, Loviselli A, Crnjar R, Sollai G (2022) Relationship between olfactory function and BMI in normal weight healthy subjects and patients with overweight or obesity. Nutrients 14:1262PubMedPubMedCentralCrossRef
2.
go back to reference Kondo K, Kikuta S, Ueha R, Suzukawa K, Yamasoba T (2020) Age-related olfactory dysfunction: epidemiology, pathophysiology, and clinical management. Front Aging Neurosci 12:208PubMedPubMedCentralCrossRef Kondo K, Kikuta S, Ueha R, Suzukawa K, Yamasoba T (2020) Age-related olfactory dysfunction: epidemiology, pathophysiology, and clinical management. Front Aging Neurosci 12:208PubMedPubMedCentralCrossRef
3.
go back to reference Dong J, Pinto JM, Guo X, Alonso A, Tranah G, Cauley JA et al (2017) The prevalence of anosmia and associated factors among US Black and White older adults. J Gerontol A Biol Sci Med Sci 72:1080–1086PubMedPubMedCentralCrossRef Dong J, Pinto JM, Guo X, Alonso A, Tranah G, Cauley JA et al (2017) The prevalence of anosmia and associated factors among US Black and White older adults. J Gerontol A Biol Sci Med Sci 72:1080–1086PubMedPubMedCentralCrossRef
5.
go back to reference Bramerson A, Johansson L, Ek L, Nordin S, Bende M (2004) Prevalence of olfactory dysfunction: the skovde population-based study. Laryngoscope 114:733–737PubMedCrossRef Bramerson A, Johansson L, Ek L, Nordin S, Bende M (2004) Prevalence of olfactory dysfunction: the skovde population-based study. Laryngoscope 114:733–737PubMedCrossRef
6.
go back to reference Vennemann MM, Hummel T, Berger K (2008) The association between smoking and smell and taste impairment in the general population. J Neurol 255:1121–1126PubMedCrossRef Vennemann MM, Hummel T, Berger K (2008) The association between smoking and smell and taste impairment in the general population. J Neurol 255:1121–1126PubMedCrossRef
7.
go back to reference Landis BN, Hummel T (2006) New evidence for high occurrence of olfactory dysfunctions within the population. Am J Med 119:91–92PubMedCrossRef Landis BN, Hummel T (2006) New evidence for high occurrence of olfactory dysfunctions within the population. Am J Med 119:91–92PubMedCrossRef
8.
go back to reference Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S et al (2020) European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 58:1–464PubMedCrossRef Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S et al (2020) European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 58:1–464PubMedCrossRef
9.
go back to reference Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A et al (2022) International consensus statement on allergy and rhinology: olfaction. Int Forum Allergy Rhinol 12:327–680PubMedCrossRef Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A et al (2022) International consensus statement on allergy and rhinology: olfaction. Int Forum Allergy Rhinol 12:327–680PubMedCrossRef
10.
go back to reference Hummel T, Liu DT, Muller CA, Stuck BA, Welge-Lussen A, Hahner A (2023) Olfactory dysfunction: etiology, diagnosis, and treatment. Dtsch Arztebl Int 120:146–154PubMedPubMedCentral Hummel T, Liu DT, Muller CA, Stuck BA, Welge-Lussen A, Hahner A (2023) Olfactory dysfunction: etiology, diagnosis, and treatment. Dtsch Arztebl Int 120:146–154PubMedPubMedCentral
12.
13.
go back to reference Jiang Y, Gu L, Zhang Z, Zhao J, Wan C (2021) Severe zinc deficiency causes the loss and apoptosis of olfactory ensheathing cells (OECs) and olfactory deficit. J Mol Neurosci 71:869–878PubMedCrossRef Jiang Y, Gu L, Zhang Z, Zhao J, Wan C (2021) Severe zinc deficiency causes the loss and apoptosis of olfactory ensheathing cells (OECs) and olfactory deficit. J Mol Neurosci 71:869–878PubMedCrossRef
14.
go back to reference Blakemore LJ, Trombley PQ (2019) Mechanisms of zinc modulation of olfactory bulb AMPA receptors. Neuroscience 410:160–175PubMedCrossRef Blakemore LJ, Trombley PQ (2019) Mechanisms of zinc modulation of olfactory bulb AMPA receptors. Neuroscience 410:160–175PubMedCrossRef
15.
go back to reference (2016) National Health and Nutrition Examination Survey 2013–2014 Data Documentation, Codebook, and Frequencies Dietary Interview—Total Nutrient Intakes, First Day (DR1TOT_H) (2016) National Health and Nutrition Examination Survey 2013–2014 Data Documentation, Codebook, and Frequencies Dietary Interview—Total Nutrient Intakes, First Day (DR1TOT_H)
16.
go back to reference Zhao SJ, Shen YF, Li Q, He YJ, Zhang YK, Hu LP et al (2018) SLIT2/ROBO1 axis contributes to the Warburg effect in osteosarcoma through activation of SRC/ERK/c-MYC/PFKFB2 pathway. Cell Death Dis 9:390PubMedPubMedCentralCrossRef Zhao SJ, Shen YF, Li Q, He YJ, Zhang YK, Hu LP et al (2018) SLIT2/ROBO1 axis contributes to the Warburg effect in osteosarcoma through activation of SRC/ERK/c-MYC/PFKFB2 pathway. Cell Death Dis 9:390PubMedPubMedCentralCrossRef
17.
go back to reference Doty RL, Shaman P, Dann M (1984) Development of the university of pennsylvania smell identification test: a standardized microencapsulated test of olfactory function. Physiol Behav 32:489–502PubMedCrossRef Doty RL, Shaman P, Dann M (1984) Development of the university of pennsylvania smell identification test: a standardized microencapsulated test of olfactory function. Physiol Behav 32:489–502PubMedCrossRef
18.
go back to reference Rawal S, Hoffman HJ, Honda M, Huedo-Medin TB, Duffy VB (2015) The taste and smell protocol in the 2011–2014 US National Health and Nutrition Examination Survey (NHANES): test-retest reliability and validity testing. Chemosens Percept 8:138–148PubMedPubMedCentralCrossRef Rawal S, Hoffman HJ, Honda M, Huedo-Medin TB, Duffy VB (2015) The taste and smell protocol in the 2011–2014 US National Health and Nutrition Examination Survey (NHANES): test-retest reliability and validity testing. Chemosens Percept 8:138–148PubMedPubMedCentralCrossRef
19.
go back to reference Rasmussen VF, Vestergaard ET, Hejlesen O, Andersson CUN, Cichosz SL (2018) Prevalence of taste and smell impairment in adults with diabetes: a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES). Prim Care Diabetes 12:453–459PubMedCrossRef Rasmussen VF, Vestergaard ET, Hejlesen O, Andersson CUN, Cichosz SL (2018) Prevalence of taste and smell impairment in adults with diabetes: a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES). Prim Care Diabetes 12:453–459PubMedCrossRef
20.
go back to reference Crow RS, Lohman MC, Titus AJ, Cook SB, Bruce ML, Mackenzie TA et al (2019) Association of obesity and frailty in older adults: NHANES 1999–2004. J Nutr Health Aging 23:138–144PubMedPubMedCentralCrossRef Crow RS, Lohman MC, Titus AJ, Cook SB, Bruce ML, Mackenzie TA et al (2019) Association of obesity and frailty in older adults: NHANES 1999–2004. J Nutr Health Aging 23:138–144PubMedPubMedCentralCrossRef
21.
go back to reference Tian X, Xue B, Wang B, Lei R, Shan X, Niu J et al (2022) Physical activity reduces the role of blood cadmium on depression: a cross-sectional analysis with NHANES data. Environ Pollut 304:119211PubMedCrossRef Tian X, Xue B, Wang B, Lei R, Shan X, Niu J et al (2022) Physical activity reduces the role of blood cadmium on depression: a cross-sectional analysis with NHANES data. Environ Pollut 304:119211PubMedCrossRef
22.
go back to reference Dong X, Li S, Sun J, Li Y, Zhang D (2020) Association of Coffee, decaffeinated coffee and caffeine intake from coffee with cognitive performance in older adults: National Health and Nutrition Examination Survey (NHANES) 2011–2014. Nutrients 12:840PubMedPubMedCentralCrossRef Dong X, Li S, Sun J, Li Y, Zhang D (2020) Association of Coffee, decaffeinated coffee and caffeine intake from coffee with cognitive performance in older adults: National Health and Nutrition Examination Survey (NHANES) 2011–2014. Nutrients 12:840PubMedPubMedCentralCrossRef
23.
go back to reference Benowitz NL, Bernert JT, Foulds J, Hecht SS, Jacob P, Jarvis MJ et al (2020) Biochemical verification of tobacco use and abstinence: 2019 update. Nicotine Tob Res 22:1086–1097PubMedCrossRef Benowitz NL, Bernert JT, Foulds J, Hecht SS, Jacob P, Jarvis MJ et al (2020) Biochemical verification of tobacco use and abstinence: 2019 update. Nicotine Tob Res 22:1086–1097PubMedCrossRef
24.
go back to reference Hu Z, Li Y, Yang Y, Yu W, Xie W, Song G et al (2021) Serum lipids mediate the relationship of multiple polyaromatic hydrocarbons on non-alcoholic fatty liver disease: a population-based study. Sci Total Environ 780:146563PubMedCrossRef Hu Z, Li Y, Yang Y, Yu W, Xie W, Song G et al (2021) Serum lipids mediate the relationship of multiple polyaromatic hydrocarbons on non-alcoholic fatty liver disease: a population-based study. Sci Total Environ 780:146563PubMedCrossRef
25.
go back to reference Attems J, Walker L, Jellinger KA (2015) Olfaction and aging: a mini-review. Gerontology 61:485–490PubMedCrossRef Attems J, Walker L, Jellinger KA (2015) Olfaction and aging: a mini-review. Gerontology 61:485–490PubMedCrossRef
26.
go back to reference Liu G, Zong G, Doty RL, Sun Q (2016) Prevalence and risk factors of taste and smell impairment in a nationwide representative sample of the US population: a cross-sectional study. BMJ Open 6:e013246PubMedPubMedCentralCrossRef Liu G, Zong G, Doty RL, Sun Q (2016) Prevalence and risk factors of taste and smell impairment in a nationwide representative sample of the US population: a cross-sectional study. BMJ Open 6:e013246PubMedPubMedCentralCrossRef
27.
go back to reference Markovic K, Reulbach U, Vassiliadu A, Lunkenheimer J, Lunkenheimer B, Spannenberger R et al (2007) Good news for elderly persons: olfactory pleasure increases at later stages of the life span. J Gerontol A Biol Sci Med Sci 62:1287–1293PubMedCrossRef Markovic K, Reulbach U, Vassiliadu A, Lunkenheimer J, Lunkenheimer B, Spannenberger R et al (2007) Good news for elderly persons: olfactory pleasure increases at later stages of the life span. J Gerontol A Biol Sci Med Sci 62:1287–1293PubMedCrossRef
28.
go back to reference Sultan-Styne K, Toledo R, Walker C, Kallkopf A, Ribak CE, Guthrie KM (2009) Long-term survival of olfactory sensory neurons after target depletion. J Comp Neurol 515:696–710PubMedPubMedCentralCrossRef Sultan-Styne K, Toledo R, Walker C, Kallkopf A, Ribak CE, Guthrie KM (2009) Long-term survival of olfactory sensory neurons after target depletion. J Comp Neurol 515:696–710PubMedPubMedCentralCrossRef
30.
go back to reference Frasnelli J, Hummel T (2003) Age-related decline of intranasal trigeminal sensitivity: is it a peripheral event? Brain Res 987:201–206PubMedCrossRef Frasnelli J, Hummel T (2003) Age-related decline of intranasal trigeminal sensitivity: is it a peripheral event? Brain Res 987:201–206PubMedCrossRef
31.
go back to reference Wang J, Sun X, Yang QX (2017) Early aging effect on the function of the human central olfactory system. J Gerontol A Biol Sci Med Sci 72:1007–1014PubMed Wang J, Sun X, Yang QX (2017) Early aging effect on the function of the human central olfactory system. J Gerontol A Biol Sci Med Sci 72:1007–1014PubMed
32.
go back to reference Tanaka H, Mori E, Sekine R, Yonezawa N, Tei M, Otori N (2023) Relationship between the severity of olfactory dysfunction and serum zinc levels. Eur Arch Otorhinolaryngol 280:3229–3236PubMedCrossRef Tanaka H, Mori E, Sekine R, Yonezawa N, Tei M, Otori N (2023) Relationship between the severity of olfactory dysfunction and serum zinc levels. Eur Arch Otorhinolaryngol 280:3229–3236PubMedCrossRef
33.
go back to reference Fitzek M, Patel PK, Solomon PD, Lin B, Hummel T, Schwob JE et al (2022) Integrated age-related immunohistological changes occur in human olfactory epithelium and olfactory bulb. J Comp Neurol 530:2154–2175PubMedPubMedCentralCrossRef Fitzek M, Patel PK, Solomon PD, Lin B, Hummel T, Schwob JE et al (2022) Integrated age-related immunohistological changes occur in human olfactory epithelium and olfactory bulb. J Comp Neurol 530:2154–2175PubMedPubMedCentralCrossRef
34.
go back to reference Abbott LC, Nigussie F (2020) Adult neurogenesis in the mammalian dentate gyrus. Anat Histol Embryol 49:3–16PubMedCrossRef Abbott LC, Nigussie F (2020) Adult neurogenesis in the mammalian dentate gyrus. Anat Histol Embryol 49:3–16PubMedCrossRef
35.
go back to reference Balu R, Strowbridge BW (2007) Opposing inward and outward conductances regulate rebound discharges in olfactory mitral cells. J Neurophysiol 97:1959–1968PubMedCrossRef Balu R, Strowbridge BW (2007) Opposing inward and outward conductances regulate rebound discharges in olfactory mitral cells. J Neurophysiol 97:1959–1968PubMedCrossRef
36.
go back to reference Davidson TM, Smith WM (2010) The Bradford Hill criteria and zinc-induced anosmia: a causality analysis. Arch Otolaryngol Head Neck Surg 136:673–676PubMedCrossRef Davidson TM, Smith WM (2010) The Bradford Hill criteria and zinc-induced anosmia: a causality analysis. Arch Otolaryngol Head Neck Surg 136:673–676PubMedCrossRef
37.
go back to reference Alexander TH, Davidson TM (2006) Intranasal zinc and anosmia: the zinc-induced anosmia syndrome. Laryngoscope 116:217–220PubMedCrossRef Alexander TH, Davidson TM (2006) Intranasal zinc and anosmia: the zinc-induced anosmia syndrome. Laryngoscope 116:217–220PubMedCrossRef
38.
go back to reference Yoshida K, Gi M, Fujioka M, Teramoto I, Wanibuchi H (2019) Long-term administration of excess zinc impairs learning and memory in aged mice. J Toxicol Sci 44:681–691PubMedCrossRef Yoshida K, Gi M, Fujioka M, Teramoto I, Wanibuchi H (2019) Long-term administration of excess zinc impairs learning and memory in aged mice. J Toxicol Sci 44:681–691PubMedCrossRef
39.
go back to reference Hsieh H, Vignesh KS, Deepe GS Jr, Choubey D, Shertzer HG, Genter MB (2016) Mechanistic studies of the toxicity of zinc gluconate in the olfactory neuronal cell line Odora. Toxicol In Vitro Int J Publ Assoc BIBRA 35:24–30CrossRef Hsieh H, Vignesh KS, Deepe GS Jr, Choubey D, Shertzer HG, Genter MB (2016) Mechanistic studies of the toxicity of zinc gluconate in the olfactory neuronal cell line Odora. Toxicol In Vitro Int J Publ Assoc BIBRA 35:24–30CrossRef
40.
go back to reference Manzerra P, Behrens MM, Canzoniero LM, Wang XQ, Heidinger V, Ichinose T et al (2001) Zinc induces a Src family kinase-mediated up-regulation of NMDA receptor activity and excitotoxicity. Proc Natl Acad Sci USA 98:11055–11061PubMedPubMedCentralCrossRef Manzerra P, Behrens MM, Canzoniero LM, Wang XQ, Heidinger V, Ichinose T et al (2001) Zinc induces a Src family kinase-mediated up-regulation of NMDA receptor activity and excitotoxicity. Proc Natl Acad Sci USA 98:11055–11061PubMedPubMedCentralCrossRef
41.
go back to reference Frazzini V, Rockabrand E, Mocchegiani E, Sensi SL (2006) Oxidative stress and brain aging: is zinc the link? Biogerontology 7:307–314PubMedCrossRef Frazzini V, Rockabrand E, Mocchegiani E, Sensi SL (2006) Oxidative stress and brain aging: is zinc the link? Biogerontology 7:307–314PubMedCrossRef
42.
go back to reference Poessel M, Freiherr J, Wiencke K, Villringer A, Horstmann A (2020) Insulin resistance is associated with reduced food odor sensitivity across a wide range of body weights. Nutrients 12:2201PubMedPubMedCentralCrossRef Poessel M, Freiherr J, Wiencke K, Villringer A, Horstmann A (2020) Insulin resistance is associated with reduced food odor sensitivity across a wide range of body weights. Nutrients 12:2201PubMedPubMedCentralCrossRef
43.
go back to reference Sun C, Tang K, Wu J, Xu H, Zhang W, Cao T et al (2019) Leptin modulates olfactory discrimination and neural activity in the olfactory bulb. Acta Physiol (Oxf) 227:e13319PubMedCrossRef Sun C, Tang K, Wu J, Xu H, Zhang W, Cao T et al (2019) Leptin modulates olfactory discrimination and neural activity in the olfactory bulb. Acta Physiol (Oxf) 227:e13319PubMedCrossRef
44.
go back to reference Gschwend O, Beroud J, Vincis R, Rodriguez I, Carleton A (2016) Dense encoding of natural odorants by ensembles of sparsely activated neurons in the olfactory bulb. Sci Rep 6:36514PubMedPubMedCentralCrossRef Gschwend O, Beroud J, Vincis R, Rodriguez I, Carleton A (2016) Dense encoding of natural odorants by ensembles of sparsely activated neurons in the olfactory bulb. Sci Rep 6:36514PubMedPubMedCentralCrossRef
46.
go back to reference Tschop M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML (2001) Circulating ghrelin levels are decreased in human obesity. Diabetes 50:707–709PubMedCrossRef Tschop M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML (2001) Circulating ghrelin levels are decreased in human obesity. Diabetes 50:707–709PubMedCrossRef
47.
go back to reference Seo HS, Guarneros M, Hudson R, Distel H, Min BC, Kang JK et al (2011) Attitudes toward olfaction: a cross-regional study. Chem Senses 36:177–187PubMedCrossRef Seo HS, Guarneros M, Hudson R, Distel H, Min BC, Kang JK et al (2011) Attitudes toward olfaction: a cross-regional study. Chem Senses 36:177–187PubMedCrossRef
48.
go back to reference Merriman C, Huang Q, Rutter GA, Fu D (2016) Lipid-tuned zinc transport activity of human ZnT8 protein correlates with risk for type-2 diabetes. J Biol Chem 291:26950–26957PubMedPubMedCentralCrossRef Merriman C, Huang Q, Rutter GA, Fu D (2016) Lipid-tuned zinc transport activity of human ZnT8 protein correlates with risk for type-2 diabetes. J Biol Chem 291:26950–26957PubMedPubMedCentralCrossRef
49.
go back to reference Liu M, Zhu H, Zhai T, Pan H, Wang L, Yang H et al (2019) Serum zinc-alpha2-glycoprotein levels were decreased in patients with premature coronary artery disease. Front Endocrinol (Lausanne) 10:197PubMedCrossRef Liu M, Zhu H, Zhai T, Pan H, Wang L, Yang H et al (2019) Serum zinc-alpha2-glycoprotein levels were decreased in patients with premature coronary artery disease. Front Endocrinol (Lausanne) 10:197PubMedCrossRef
Metadata
Title
Association between dietary zinc intake and olfactory dysfunction: a study based on the NHANES database
Authors
Yifang Wang
Tianping Shen
Yan Wang
Publication date
05-01-2024
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 5/2024
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-023-08427-6

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