본문 바로가기
KERD
논문KCI 등재

Surgical Algorithm for Obstructive Sleep Apnea: An Update

유명상|Robert Wayne Riley|Stanley Yung Chuan Liu
대한이비인후과학회 (Korean Society of Otorhinolaryngology-Head and Neck Surgery)|2020.08|Clinical and Experimental Otorhinolaryngology|제13권 제3호|pp. 215-224|DOI https://doi.org/10.21053/ceo.2020.01053

2

조회

0

다운로드

3

인용

0

참고문헌

키워드

AlgorithmObstructive Sleep ApneaSleep SurgeryMaxillomandibular AdvancementHypoglossal Nerve StimulationUpper Airway StimulationPalatopharyngoplasty

초록

Sleep surgery is part of a continuum of care for obstructive sleep apnea (OSA) that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as positive airway pressure or oral appliance therapy. The updated surgical algorithm in this review adds precision in three areas: patient selection, identification of previously unaddressed anatomic phenotypes with associated treatment modality, and improved techniques of previously established procedures. While the original Riley and Powell phase 1 and 2 approach to sleep surgery has focused on individual surgical success rate, this algorithm strives for an overall treatment success with multi-modal and patient-centric treatments.

Abstract

Sleep surgery is part of a continuum of care for obstructive sleep apnea (OSA) that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as positive airway pressure or oral appliance therapy. The updated surgical algorithm in this review adds precision in three areas: patient selection, identification of previously unaddressed anatomic phenotypes with associated treatment modality, and improved techniques of previously established procedures. While the original Riley and Powell phase 1 and 2 approach to sleep surgery has focused on individual surgical success rate, this algorithm strives for an overall treatment success with multi-modal and patient-centric treatments.

참고문헌 (114)

  1. Riley RW, "Obstructive sleep apnea syndrome : a surgical protocol for dynamic upper airway reconstruction", J Oral Maxillofac Surg, 51(7), pp.742~749 (1993)
  2. Powell N, "A reversible uvulopalatal flap for snoring and sleep apnea syndrome", Sleep, 19(7), pp.593~599 (1996)
  3. Riley RW, "Maxillary, mandibular, and hyoid advancement : an alternative to tracheostomy in obstructive sleep apnea syndrome", Otolaryngol Head Neck Surg, 94(5), pp.584~588 (1986)
  4. Riley RW, "Maxillofacial surgery and nasal CPAP : a comparison of treatment for obstructive sleep apnea syndrome", Chest, 98(6), pp.1421~1425 (1990)
  5. Decker M, "Keep the airway open and let the brain sleep", Am J Respir Crit Care Med, 190(11), pp.1207~1209 (2014)
  6. Liu SY, "The role of the revised Stanford protocol in today’s precision medicine", Sleep Med Clin, 14(1), pp.99~107 (2019)
  7. Liu SY, "Sleep apnea and snoring: surgical and non-surgical therapy", pp.104~109 (2020), Elsevier
  8. Zozula R, "Compliance with continuous positive airway pressure therapy : assessing and improving treatment outcomes", Curr Opin Pulm Med, 7(6), pp.391~398 (2001)
  9. Chervin RD, "Compliance with nasal CPAP can be improved by simple interventions", Sleep, 20(4), pp.284~289 (1997)
  10. Torre C, "High incidence of posterior nasal cavity obstruction in obstructive sleep apnea patients", Sleep Sci Pract, 1(1), pp.8~ (2017)
  11. Camacho M, "Inferior turbinate classification system, grades 1 to 4 : development and validation study", Laryngoscope, 125(2), pp.296~302 (2015)
  12. Terris DJ, "Reliability of the Muller maneuver and its association with sleep-disordered breathing", Laryngoscope, 110(11), pp.1819~1823 (2000)
  13. Huynh NT, "Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations", Am J Orthod Dentofacial Orthop, 140(6), pp.762~770 (2011)
  14. Kim JH, "The nasomaxillary complex, the mandible, and sleep-disordered breathing", Sleep Breath, 15(2), pp.185~193 (2011)
  15. Williams R, "The upper airway nasal complex : structural contribution to persistent nasal obstruction", Otolaryngol Head Neck Surg, 161(1), pp.171~177 (2019)
  16. Goldberg AN, "Sleep apnea and snoring E-Book: surgical and non-surgical therapy", pp.45~ (2008), Elsevier
  17. Punjabi NM, "Sleep-disordered breathing and cardiovascular disease : an outcome-based definition of hypopneas", Am J Respir Crit Care Med, 177(10), pp.1150~1155 (2008)
  18. Kendzerska T, "Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality : a decade-long historical cohort study", PLoS Med, 11(2), pp.e1001599~ (2014)
  19. Aurora RN, "Misclassification of OSA severity with automated scoring of home sleep recordings", Chest, 147(3), pp.719~727 (2015)
  20. Kapoor M, "Home sleep tests for Obstructive Sleep Apnea(OSA)", J Am Board Fam Med, 28(4), pp.504~509 (2015)
  21. Nerfeldt P, "Polygraphy vs. polysomnography: missing OSAs in symptomatic snorers: a reminder for clinicians", Sleep Breath, 18(2), pp.297~303 (2014)
  22. Watson NF, "Health care savings : the economic value of diagnostic and therapeutic care for obstructive sleep apnea", J Clin Sleep Med, 12(8), pp.1075~1077 (2016)
  23. Scannone A, "Cephalometric and dental measures as diagnostic tools for the obstructive sleep apnea", J Sleep Disor Treat Care, 6(4) (2017)
  24. Torre C, "Hypopharyngeal evaluation in obstructive sleep apnea with awake flexible laryngoscopy : validation and updates to Cormack-Lehane and modified Cormack-Lehane scoring systems", Clin Otolaryngol, 43(3), pp.823~827 (2018)
  25. Kim JW, "Extraction of acoustic biomarkers from PSG to detect OSA", Sleep Med, 40, pp.e160~ (2017)
  26. Kim WY, "The effect of body position on airway patency in obstructive sleep apnea : CT imaging analysis", Sleep Breath, 23(3), pp.911~916 (2019)
  27. Huon LK, "Dynamic upper airway collapse observed from sleep MRI : BMI-matched severe and mild OSA patients", Eur Arch Otorhinolaryngol, 273(11), pp.4021~4026 (2016)
  28. Soose RJ, "Novel surgical approaches for the treatment of obstructive sleep apnea", Sleep Med Clin, 11(2), pp.189~202 (2016)
  29. Kent DT, "Drug-induced sedation endoscopy in the evaluation of OSA patients with incomplete oral appliance therapy response", Otolaryngol Head Neck Surg, 153(2), pp.302~307 (2015)
  30. Vroegop AV, "Drug-induced sleep endoscopy : evaluation of a selection tool for treatment modalities for obstructive sleep apnea", Respiration, 99(5), pp.451~457 (2020)
  31. Glen JB, "The development of ‘Diprifusor’ : a TCI system for propofol", Anaesthesia, 53(Suppl 1), pp.13~21 (1998)
  32. Hillman DR, "Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol", Anesthesiology, 111(1), pp.63~71 (2009)
  33. Eastwood PR, "Collapsibility of the upper airway at different concentrations of propofol anesthesia", Anesthesiology, 103(3), pp.470~477 (2005)
  34. Chattopadhyay U, "Comparison between propofol and dexmedetomidine on depth of anesthesia : a prospective randomized trial", J Anaesthesiol Clin Pharmacol, 30(4), pp.550~554 (2014)
  35. Charakorn N, "Drug-induced sleep endoscopy", Otolaryngol Clin North Am, 49(6), pp.1359~1372 (2016)
  36. Croft CB, "Sleep nasendoscopy : a technique of assessment in snoring and obstructive sleep apnoea", Clin Otolaryngol Allied Sci, 16(5), pp.504~509 (1991)
  37. Kezirian EJ, "Drug-induced sleep endoscopy : the VOTE classification", Eur Arch Otorhinolaryngol, 268(8), pp.1233~1236 (2011)
  38. Friedman M, "Clinical staging for sleep-disordered breathing", Otolaryngol Head Neck Surg, 127(1), pp.13~21 (2002)
  39. Iwanaga K, "Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep", Acta Otolaryngol Suppl, (550), pp.36~40 (2003)
  40. Vicini C, "The nose oropharynx hypopharynx and larynx(NOHL)classification : a new system of diagnostic standardized examination for OSAHS patients", Eur Arch Otorhinolaryngol, 269(4), pp.1297~1300 (2012)
  41. Vroegop AV, "Drug-induced sleep endoscopy in sleep-disordered breathing : report on 1, 249 cases", Laryngoscope, 124(3), pp.797~802 (2014)
  42. Ravesloot MJ, "One hundred consecutive patients undergoing drug-induced sleep endoscopy : results and evaluation", Laryngoscope, 121(12), pp.2710~2716 (2011)
  43. Vanderveken OM, "Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea", J Clin Sleep Med, 9(5), pp.433~438 (2013)
  44. Zhang P, "The role of obstruction length and height in predicting outcome of velopharyngeal surgery", Otolaryngol Head Neck Surg, 153(1), pp.144~149 (2015)
  45. Liu SY, "Efficacy of maxillomandibular advancement examined with drug-induced sleep endoscopy and computational fluid dynamics airflow modeling", Otolaryngol Head Neck Surg, 154(1), pp.189~195 (2016)
  46. Lavie P, "Rediscovering the importance of nasal breathing in sleep or, shut your mouth and save your sleep", J Laryngol Otol, 101(6), pp.558~563 (1987)
  47. Busaba NY, "The nose in snoring and obstructive sleep apnea", Curr Opin Otolaryngol Head Neck Surg, 7(1), pp.11~ (1999)
  48. Olsen KD, "Sleep and breathing disturbance secondary to nasal obstruction", Otolaryngol Head Neck Surg, 89(5), pp.804~810 (1981)
  49. Cole P, "Mechanisms of nasal obstruction in sleep", Laryngoscope, 94(12 Pt 1), pp.1557~1559 (1984)
  50. Verse T, "Effect of nasal surgery on sleep-related breathing disorders", Laryngoscope, 112(1), pp.64~68 (2002)
  51. Camacho M, "The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures : a systematic review and meta-analysis", Sleep, 38(2), pp.279~286 (2015)
  52. Trindade SH, "Nasal septoplasty in patients with obstructive sleep apnea syndrome : effects on polysomnographic parameters", J Sleep Med Disord, 4(2), pp.1077~ (2017)
  53. Elhabashy M, "Effectiveness of septoplasty with or without inferior turbinate reduction in patients with obstructive sleep apnea", Eur Respir J, 54(Suppl 63), pp.PA4163~ (2019)
  54. Friedman M, "Sleep apnea and snoring: surgical and non-surgical therapy", pp.120~126 (2020), Elsevier
  55. Abdelwahab M, "Impact of distraction osteogenesis maxillary expansion on the internal nasal valve in obstructive sleep apnea", Otolaryngol Head Neck Surg, 161(2), pp.362~367 (2019)
  56. Iwasaki T, "How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea?", Sleep Breath, 24(1), pp.287~296 (2020)
  57. Liu SY, "Distraction Osteogenesis Maxillary Expansion(DOME)for adult obstructive sleep apnea patients with high arched palate", Otolaryngol Head Neck Surg, 157(2), pp.345~348 (2017)
  58. Yoon A, "Distraction Osteogenesis Maxillary Expansion(DOME)for adult obstructive sleep apnea patients with narrow maxilla and nasal floor", Sleep Med, 65, pp.172~176 (2020)
  59. Camacho M, "Rapid maxillary expansion for pediatric obstructive sleep apnea : a systematic review and meta-analysis", Laryngoscope, 127(7), pp.1712~1719 (2017)
  60. Iwasaki T, "Improvement of nasal airway ventilation after rapid maxillary expansion evaluated with computational fluid dynamics", Am J Orthod Dentofacial Orthop, 141(3), pp.269~278 (2012)
  61. Iwasaki T, "The effect of rapid maxillary expansion on pharyngeal airway pressure during inspiration evaluated using computational fluid dynamics", Int J Pediatr Otorhinolaryngol, 78(8), pp.1258~1264 (2014)
  62. Villa MP, "Rapid maxillary expansion in children with obstructive sleep apnea syndrome : 12-month follow-up", Sleep Med, 8(2), pp.128~134 (2007)
  63. Ishman SL, "Temporal trends in sleep apnea surgery : 1993-2010", Laryngoscope, 124(5), pp.1251~1258 (2014)
  64. Camacho M, "Laser-assisted uvulopalatoplasty for obstructive sleep apnea: a systematic review and meta-analysis", Sleep, 40(3) (2017)
  65. Thaler ER, "Outcomes for multilevel surgery for sleep apnea : obstructive sleep apnea, transoral robotic surgery, and uvulopalatopharyngoplasty", Laryngoscope, 126(1), pp.266~269 (2016)
  66. Lin HC, "The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea", hypopnea syndrome, 2008, pp.118(5), 902~908
  67. Li HY, "Palatal surgery for obstructive sleep apnea : from ablation to reconstruction", Sleep Med Clin, 14(1), pp.51~58 (2019)
  68. Awad M, "Tonsillectomy and pharyngoplasty : tissue-preserving techniques", Atlas Oral Maxillofac Surg Clin North Am, 27(1), pp.17~22 (2019)
  69. Camacho M, "Expansion sphincter pharyngoplasty for obstructive sleep apnea : an update to the recent meta-analysis", Eur Arch Otorhinolaryngol, 273(9), pp.2857~2858 (2016)
  70. Vicini C, "Barbed reposition pharyngoplasty(BRP)for OSAHS : a feasibility, safety, efficacy and teachability pilot study : "we are on the giant’s shoulders"", Eur Arch Otorhinolaryngol, 272(10), pp.3065~3070 (2015)
  71. Pang KP, "Palate surgery for obstructive sleep apnea : a 17-year meta-analysis", Eur Arch Otorhinolaryngol, 275(7), pp.1697~1707 (2018)
  72. Hsu YS, "Does sleep endoscopy staging pattern correlate with outcome of advanced palatopharyngoplasty for moderate to severe obstructive sleep apnea?", J Clin Sleep Med, 13(10), pp.1137~1144 (2017)
  73. Pang KP, "Expansion sphincter pharyngoplasty : a new technique for the treatment of obstructive sleep apnea", Otolaryngol Head Neck Surg, 137(1), pp.110~114 (2007)
  74. Cahali MB, "Lateral pharyngoplasty versus uvulopalatopharyngoplasty : a clinical, polysomnographic and computed tomography measurement comparison", Sleep, 27(5), pp.942~950 (2004)
  75. Woodson BT, "Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharygoplasty", Otolaryngol Head Neck Surg, 133(2), pp.211~217 (2005)
  76. Jacobowitz O, "Sleep apnea and snoring: surgical and non-surgical therapy", pp.99~103 (2020), Elsevier
  77. Stanley Yung‐Chuan Liu, "Palatopharyngoplasty Resolves Concentric Collapse in Patients Ineligible for Upper Airway Stimulation", The Laryngoscope, 130(12) (2020), Wiley[DOI]
  78. Campanini A, "Awake versus sleep endoscopy : personal experience in 250 OSAHS patients", Acta Otorhinolaryngol Ital, 30(2), pp.73~77 (2010)
  79. Friedman M, "Evaluation of submucosal minimally invasive lingual excision technique for treatment of obstructive sleep apnea", hypopnea syndrome, 2008, pp.139(3), 378~385
  80. Li HY, "Coblation endoscopic lingual lightening(CELL)for obstructive sleep apnea", Eur Arch Otorhinolaryngol, 273(1), pp.231~236 (2016)
  81. Montevecchi F, "Transoral robotic surgery(TORS) : a new tool for high risk tracheostomy decannulation", Acta Otorhinolaryngol Ital, 37(1), pp.46~50 (2017)
  82. Cammaroto G, "Trans-oral robotic tongue reduction for OSA: does lingual anatomy influence the surgical outcome?", J Clin Sleep Med, 14(8), pp.1347~1351 (2018)
  83. Camacho M, "Comprehensive review of surgeries for obstructive sleep apnea syndrome", Braz J Otorhinolaryngol, 79(6), pp.780~788 (2013)
  84. Justin GA, "Transoral robotic surgery for obstructive sleep apnea : a systematic review and meta-analysis", Otolaryngol Head Neck Surg, 154(5), pp.835~846 (2016)
  85. Vicini C, "Modern management of obstructive sleep apnea", pp.59~68 (2019), Springer
  86. Chan JY, "Early results of a safety and feasibility clinical trial of a novel single-port flexible robot for transoral robotic surgery", Eur Arch Otorhinolaryngol, 274(11), pp.3993~3996 (2017)
  87. Chan JY, "Augmented reality for image guidance in transoral robotic surgery", J Robot Surg, 14, pp.579~583 (2020)
  88. Song SA, "Genial tubercle advancement and genioplasty for obstructive sleep apnea : a systematic review and meta-analysis", Laryngoscope, 127(4), pp.984~992 (2017)
  89. Riley RW, "Obstructive sleep apnea syndrome : a review of 306 consecutively treated surgical patients", Otolaryngol Head Neck Surg, 108(2), pp.117~125 (1993)
  90. Liu SY, "An accurate method of designing and performing individual-specific genioglossus advancement", Otolaryngol Head Neck Surg, 156(1), pp.194~197 (2017)
  91. Cheng A, "Genioglossus and genioplasty advancement", Atlas Oral Maxillofac Surg Clin North Am, 27(1), pp.23~28 (2019)
  92. Oliven A, "Effect of coactivation of tongue protrusor and retractor muscles on pharyngeal lumen and airflow in sleep apnea patients", J Appl Physiol(1985), 103(5), pp.1662~1668 (2007)
  93. Dedhia RC, "Upper airway stimulation for obstructive sleep apnea : past, present, and future", Sleep, 38(6), pp.899~906 (2015)
  94. Strollo PJ Jr, "Upper-airway stimulation for obstructive sleep apnea", N Engl J Med, 370(2), pp.139~149 (2014)
  95. Costantino A, "Hypoglossal nerve stimulation long-term clinical outcomes : a systematic review and meta-analysis", Sleep Breath, 24(2), pp.399~411 (2020)
  96. Hofauer B, "Adherence to upper-airway stimulation in the treatment of OSA", Chest, 153(2), pp.574~575 (2018)
  97. Bohorquez D, "Upper airway stimulation therapy and sleep architecture in patients with obstructive sleep apnea", Laryngoscope, 130(4), pp.1085~1089 (2020)
  98. Powell N, "A surgical protocol for sleep disordered breathing", Oral Maxillofac Surg Clin North Am, 7(3), pp.345~356 (1995)
  99. Riley RW, "Maxillofacial surgery and obstructive sleep apnea syndrome", Otolaryngol Clin North Am, 23(4), pp.809~826 (1990)
  100. Riley RW, "Maxillary, mandibular, and hyoid advancement for treatment of obstructive sleep apnea : a review of 40 patients", J Oral Maxillofac Surg, 48(1), pp.20~26 (1990)
  101. Vicini C, "Surgery vs ventilation in adult severe obstructive sleep apnea syndrome", Am J Otolaryngol, 31(1), pp.14~20 (2010)
  102. Camacho M, "Large maxillomandibular advancements for obstructive sleep apnea : an operative technique evolved over 30 years", J Craniomaxillofac Surg, 43(7), pp.1113~1118 (2015)
  103. Liu SY, "Maxillomandibular advancement : contemporary approach at Stanford", Atlas Oral Maxillofac Surg Clin North Am, 27(1), pp.29~36 (2019)
  104. Boyd SB, "Management of obstructive sleep apnea by maxillomandibular advancement", Oral Maxillofac Surg Clin North Am, 21(4), pp.447~457 (2009)
  105. Liu SY, "Lateral pharyngeal wall tension after maxillomandibular advancement for obstructive sleep apnea is a marker for surgical success : observations from drug-induced sleep endoscopy", J Oral Maxillofac Surg, 73(8), pp.1575~1582 (2015)
  106. Chen YF, "Optimizing mandibular sagittal split of large maxillomandibular advancements for obstructive sleep apnea : patient and surgical factors", Clin Oral Investig, 24(3), pp.1359~1367 (2020)
  107. Holty JE, "Maxillomandibular advancement for the treatment of obstructive sleep apnea : a systematic review and meta-analysis", Sleep Med Rev, 14(5), pp.287~297 (2010)
  108. Zaghi S, "Maxillomandibular advancement for treatment of obstructive sleep apnea : a meta-analysis", JAMA Otolaryngol Head Neck Surg, 142(1), pp.58~66 (2016)
  109. Riley RW, "Surgery and obstructive sleep apnea : long-term clinical outcomes", Otolaryngol Head Neck Surg, 122(3), pp.415~421 (2000)
  110. Vigneron A, "Maxillomandibular advancement for obstructive sleep apnea syndrome treatment : long-term results", J Craniomaxillofac Surg, 45(2), pp.183~191 (2017)
  111. Boyd SB, "Maxillomandibular advancement improves multiple health-related and functional outcomes in patients with obstructive sleep apnea : a multicenter study", J Oral Maxillofac Surg, 77(2), pp.352~370 (2019)
  112. Green KK, "Drug-induced sleep endoscopy and surgical outcomes : a multicenter cohort study", Laryngoscope, 129(3), pp.761~770 (2019)
  113. Soares D, "Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery", Laryngoscope, 122(2), pp.473~479 (2012)
  114. Liu SY, "Continuing the original Stanford Sleep Surgery Protocol from upper airway reconstruction to upper airway stimulation : our first successful case", J Oral Maxillofac Surg, 75(7), pp.1514~1518 (2017)

관련 논문AI추천

Contemporary Surgery for Obstructive Sleep Apnea SyndromeNelson B. Powell대한이비인후과학회 · Clinical and Experimental Otorhinolaryngology2009 · 제2권 제3호폐쇄성 수면 무호흡증의 외과적 접근이의룡대한치과의사협회 · 대한치과의사협회지2021 · 제59권 제12호Maxillomandibular Advancement and Upper Airway Stimulation: Extrapharyngeal Surgery for Obstructive Sleep Apnea유명상, Badr Ibrahim, Robert Wayne Riley, Stanley Yung Chuan Liu대한이비인후과학회 · Clinical and Experimental Otorhinolaryngology2020 · 제13권 제3호A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel ObstructionCaiyun Zhang, Hongliang Zheng, Minhui Zhu, Shicai Chen, Siwen Xia, Song Shi, Yanghui Xia대한이비인후과학회 · Clinical and Experimental Otorhinolaryngology2015 · 제8권 제2호Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study구수권, 김성완, 김유석, 김정훈, 김효열, 원태빈, 이승훈, 이재서, 정유삼, 조규섭, 조재훈, 최지호대한이비인후과학회 · Clinical and Experimental Otorhinolaryngology2015 · 제8권 제4호폐쇄성 수면무호흡증(Obstructive Sleep Apnea)의 외과적 처치김태경, 이덕원대한치과의사협회 · 대한치과의사협회지2015 · 제53권 제12호

이 간행물의 다른 논문 (15건)

Exploring the Neurodynamic Signals of the Deafened Brain: Factors Influencing Cochlear Implant OutcomesAnu Sharma, 경정숙pp. 211-212Subperiosteal Tunneling in Lateral Osteotomy: Truth Versus Mere Facts진홍률pp. 213-214Maxillomandibular Advancement and Upper Airway Stimulation: Extrapharyngeal Surgery for Obstructive Sleep ApneaRobert Wayne Riley, 유명상, Badr Ibrahim, Stanley Yung Chuan Liupp. 225-233Psychiatric Distress as a Common Risk Factor for Tinnitus and Joint Pain: A National Population-Based Survey김현정, 한혜민, 한경도, 박의현, 정학현, 임기정, 최인학pp. 234-240Noise-Induced Change of Cortical Temporal Processing in Cochlear Implant Users한지혜, 이지현, 이효정pp. 241-248
원문 보기