{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T01:50:20Z","timestamp":1775181020635,"version":"3.50.1"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005788","name":"Medical University of Vienna","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005788","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>Vagus nerve stimulator (VNS) implantation is an established therapy for pharmacoresistant epilepsy that is not amenable to curative epilepsy surgery. Historically, VNS implantation has been performed by neurosurgeons, but otolaryngologist involvement is increasingly common. In this retrospective study, we aimed to evaluate the efficacy and safety of VNS implantation in children and adolescents from the otolaryngologists\u2019 perspective.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This study included children and adolescents who had undergone VNS implantation at the study center between 2014 and 2018. Patient files were analyzed with regards to the durations of device implantation and hospitalization, postoperative complications, and clinical outcome, including seizure frequency, clinical global impression of improvement (CGI-I) score, and quality of life (QoL).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 73 children underwent VNS surgery. The median age at implantation was 9.3\u2009\u00b1\u20094.6\u00a0years, and median epilepsy duration before VNS surgery was 6\u2009\u00b1\u20094\u00a0years. Lennox\u2013Gastaut syndrome was the most common syndrome diagnosis (62.3%), and structural abnormalities (49.3%) the most frequent etiology. Operation times ranged from 30 to 200\u00a0min, and median postoperative hospitalization length was 2\u2009\u00b1\u20090.9\u00a0days. No complications occurred, except for four revisions and two explantations due to local infections (2.7%). Among our patients, 76.7% were responders (\u2265\u200950% reduction in seizure frequency), 72.1% showed improved CGI-I scores, and 18.6\u201360.5% exhibited considerable improvements in the QoL categories energy, emotional health, and cognitive functions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our results indicate that VNS implantation is a highly effective and safe treatment option for children and adolescents with AED-refractory epilepsies who are not candidates for curative epilepsy surgery.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00405-021-06943-x","type":"journal-article","created":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T12:03:29Z","timestamp":1625141009000},"page":"3891-3899","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Management and outcome of vagus nerve stimulator implantation: experience of an otolaryngeal\/neuropediatric cooperation"],"prefix":"10.1007","volume":"278","author":[{"given":"S.","family":"Grasl","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Janik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Dressler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Diehm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Gr\u00f6ppel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Eichinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. C.","family":"Grasl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.","family":"Gstoettner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Feucht","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1458-9824","authenticated-orcid":false,"given":"E.","family":"Vyskocil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. D.","family":"Baumgartner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,1]]},"reference":[{"key":"6943_CR1","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1056\/NEJM200002033420503","volume":"342","author":"P Kwan","year":"2000","unstructured":"Kwan P, Brodie MJ (2000) Early identification of refractory epilepsy. N Engl J Med 342:314\u2013319","journal-title":"N Engl J Med"},{"key":"6943_CR2","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/S0140-6736(06)68182-8","volume":"367","author":"R Guerrini","year":"2006","unstructured":"Guerrini R (2006) Epilepsy in children. Lancet 367:499\u2013524","journal-title":"Lancet"},{"key":"6943_CR3","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1212\/WNL.0b013e31826c1b55","volume":"79","author":"AT Berg","year":"2012","unstructured":"Berg AT, Zelko FA, Levy SR et al (2012) Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes: a prospective cohort study. Neurology 79:1384\u20131391","journal-title":"Neurology"},{"key":"6943_CR4","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1111\/epi.12762","volume":"55","author":"I Orosz","year":"2014","unstructured":"Orosz I, McCormick D, Zamponi N et al (2014) Vagus nerve stimulation for drug-resistant epilepsy: a European long-term study up to 24 months in 347 children. Epilepsia 55:1576\u20131584","journal-title":"Epilepsia"},{"key":"6943_CR5","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3171\/jns.1993.78.1.0026","volume":"78","author":"HJ Landy","year":"1993","unstructured":"Landy HJ, Ramsay RE, Slater J et al (1993) Vagus nerve stimulation for complex partial seizures: surgical technique, safety, and efficacy. J Neurosurg 78:26\u201331","journal-title":"J Neurosurg"},{"key":"6943_CR6","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1111\/j.1528-1157.1994.tb02483.x","volume":"35","author":"RE Ramsay","year":"1994","unstructured":"Ramsay RE, Uthman BM, Augustinsson LE et al (1994) Vagus nerve stimulation for treatment of partial seizures: 2. Safety, side effects, and tolerability. First International Vagus Nerve Stimulation Study Group. Epilepsia 35:627\u2013636","journal-title":"Epilepsia"},{"key":"6943_CR7","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.yebeh.2010.10.017","volume":"20","author":"RE Elliott","year":"2011","unstructured":"Elliott RE, Morsi A, Kalhorn SP et al (2011) Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response. Epilepsy Behav 20:57\u201363","journal-title":"Epilepsy Behav"},{"key":"6943_CR8","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1212\/WNL.53.8.1731","volume":"53","author":"GL Morris 3rd","year":"1999","unstructured":"Morris GL 3rd, Mueller WM (1999) Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group E01\u2013E05. Neurology 53:1731\u20131735","journal-title":"Neurology"},{"key":"6943_CR9","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1111\/j.1525-1403.2012.00522.x","volume":"16","author":"ACC Cukiert","year":"2012","unstructured":"Cukiert ACC, Burattini JA, Lima AM et al (2012) A prospective long-term study on the outcome after vagus nerve stimulation at maximally tolerated current intensity in a cohort of children with refractory secondary generalized epilepsy. Neuromodulation 16:551\u2013556","journal-title":"Neuromodulation"},{"key":"6943_CR10","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1212\/WNL.0b013e3182a393d1","volume":"81","author":"GL Morris 3rd","year":"2013","unstructured":"Morris GL 3rd, Gloss D, Buchhalter J et al (2013) Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 81:1453\u20131459","journal-title":"Neurology"},{"issue":"Suppl 4","key":"6943_CR11","first-page":"S269","volume":"3","author":"JS Hauptman","year":"2012","unstructured":"Hauptman JS, Mathern GW (2012) Vagal nerve stimulation for pharmacoresistant epilepsy in children. Surg Neurol Int 3(Suppl 4):S269\u2013S274","journal-title":"Surg Neurol Int"},{"key":"6943_CR12","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.seizure.2013.01.008","volume":"22","author":"R Arya","year":"2013","unstructured":"Arya R, Greiner HM, Lewis A et al (2013) Vagus nerve stimulation for medically refractory absence epilepsy. Seizure 22:267\u2013270","journal-title":"Seizure"},{"key":"6943_CR13","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3171\/2012.5.PEDS11489","volume":"10","author":"EM Thompson","year":"2012","unstructured":"Thompson EM, Wozniak SE, Roberts CM et al (2012) Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence. J Neurosurg Pediatr 10:200\u2013205","journal-title":"J Neurosurg Pediatr"},{"key":"6943_CR14","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.ejpn.2012.01.001","volume":"16","author":"SL Helmers","year":"2012","unstructured":"Helmers SL, Duh MS, Guerin A et al (2012) Clinical outcomes, quality of life, and costs associated with implantation of vagus nerve stimulation therapy in pediatric patients with drug-resistant epilepsy. Eur J Paediatr Neurol 16:449\u2013458","journal-title":"Eur J Paediatr Neurol"},{"key":"6943_CR15","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.seizure.2006.06.002","volume":"15","author":"AV Alexopoulos","year":"2006","unstructured":"Alexopoulos AV, Kotagal P, Loddenkemper T et al (2006) Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy. Seizure 15:491\u2013503","journal-title":"Seizure"},{"key":"6943_CR16","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1097\/00006123-200012000-00016","volume":"47","author":"RV Patwardhan","year":"2000","unstructured":"Patwardhan RV, Stong B, Bebin EM et al (2000) Efficacy of vagal nerve stimulation in children with medically refractory epilepsy. Neurosurgery 47:1353\u20131357","journal-title":"Neurosurgery"},{"key":"6943_CR17","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1097\/00005537-200302000-00005","volume":"113","author":"C Zalvan","year":"2003","unstructured":"Zalvan C, Sulica L, Wolf S et al (2003) Laryngopharyngeal dysfunction from the implant vagal nerve stimulator. Laryngoscope 113:221\u2013225","journal-title":"Laryngoscope"},{"key":"6943_CR18","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.jclinane.2009.10.002","volume":"22","author":"BG Fahy","year":"2010","unstructured":"Fahy BG (2010) Intraoperative and perioperative complications with a vagus nerve stimulation device. J Clin Anesth 22:213\u2013222","journal-title":"J Clin Anesth"},{"key":"6943_CR19","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s10143-005-0005-5","volume":"29","author":"F Rychlicki","year":"2006","unstructured":"Rychlicki F, Zamponi N, Cesaroni E et al (2006) Complications of vagal nerve stimulation for epilepsy in children. Neurosurg Rev 29:103\u2013107","journal-title":"Neurosurg Rev"},{"key":"6943_CR20","first-page":"489","volume":"67","author":"S Spuck","year":"2010","unstructured":"Spuck S, Tronnier V, Orosz I et al (2010) Operative and technical complications of vagus nerve stimulator implantation. Neurosurgery 67:489\u2013494","journal-title":"Neurosurgery"},{"key":"6943_CR21","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1016\/j.seizure.2013.06.011","volume":"22","author":"H Kahlow","year":"2013","unstructured":"Kahlow H, Olivecrona M (2013) Complications of vagal nerve stimulation for drug-resistant epilepsy: a single center longitudinal study of 143 patients. Seizure 22:827\u2013833","journal-title":"Seizure"},{"key":"6943_CR22","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1227\/NEU.0000000000000985","volume":"78","author":"JD Couch","year":"2016","unstructured":"Couch JD, Gilman AM, Doyle WK (2016) Long-term expectations of vagus nerve stimulation: a look at battery replacement and revision surgery. Neurosurgery 78:42\u201346","journal-title":"Neurosurgery"},{"key":"6943_CR23","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3171\/2016.1.PEDS15534","volume":"18","author":"D Revesz","year":"2016","unstructured":"Revesz D, Rydenhag B, Ben-Menachem E (2016) Complications and safety of vagus nerve stimulation: 25 years of experience at a single center. J Neurosurg Pediatr 18:97\u2013104","journal-title":"J Neurosurg Pediatr"},{"key":"6943_CR24","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.jns.2011.02.022","volume":"304","author":"Y Tran","year":"2011","unstructured":"Tran Y, Shah AK, Mittal S (2011) Lead breakage and vocal cord paralysis following blunt neck trauma in a patient with vagal nerve stimulator. J Neurol Sci 304:132\u2013135","journal-title":"J Neurol Sci"},{"key":"6943_CR25","first-page":"949","volume":"96","author":"JG Kalkanis","year":"2002","unstructured":"Kalkanis JG, Krishna P, Espinosa JA et al (2002) Self-inflicted vocal cord paralysis in patients with vagus nerve stimulators. Report of two cases J Neurosurg 96:949\u2013951","journal-title":"Report of two cases J Neurosurg"},{"key":"6943_CR26","doi-asserted-by":"publisher","first-page":"389","DOI":"10.3171\/2011.12.PEDS11124","volume":"9","author":"A Clark","year":"2012","unstructured":"Clark A, Kupermann RA, Auguste KI et al (2012) Intractable episodic bradycardia resulting from progressive lead traction in an epileptic child with a vagus nerve stimulator: a delayed complication. J Neurosurg Pediatr 9:389\u2013393","journal-title":"J Neurosurg Pediatr"},{"key":"6943_CR27","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.otohns.2006.02.037","volume":"135","author":"T Ghanem","year":"2006","unstructured":"Ghanem T, Early SV (2006) Vagal nerve stimulator implantation: an otolaryngologist\u2019s perspective. Otolaryngol Head Neck Surg 135:46\u201351","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"Suppl 2","key":"6943_CR28","doi-asserted-by":"publisher","first-page":"S38","DOI":"10.1111\/j.1528-1157.1990.tb05847.x","volume":"31","author":"SA Reid","year":"1990","unstructured":"Reid SA (1990) Surgical technique for implantation of the neurocybernetic prosthesis. Epilepsia 31(Suppl 2):S38\u2013S39","journal-title":"Epilepsia"},{"key":"6943_CR29","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1001\/archotol.128.11.1263","volume":"128","author":"DJ Kirse","year":"2002","unstructured":"Kirse DJ, Werle AH, Murphy JV et al (2002) Vagus nerve stimulator implantation in children. Arch Otolaryngol Head Neck Surg 128:1263\u20131268","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"6943_CR30","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1016\/j.amjoto.2017.03.011","volume":"38","author":"AI Al Omari","year":"2017","unstructured":"Al Omari AI, Alzoubi FQ, Alsalem MM et al (2017) The vagal nerve stimulation outcome, and laryngeal effect: Otolaryngologists roles and perspective. Am J Otolaryngol 38:408\u2013413","journal-title":"Am J Otolaryngol"},{"issue":"Suppl 1","key":"6943_CR31","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1111\/epi.13678","volume":"58","author":"F Giordano","year":"2017","unstructured":"Giordano F, Zicca A, Barba C et al (2017) Vagus nerve stimulation: surgical technique of implantation and revision and related morbidity. Epilepsia 58(Suppl 1):85\u201390","journal-title":"Epilepsia"},{"key":"6943_CR32","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1007\/s00405-012-2118-0","volume":"270","author":"G Horowitz","year":"2013","unstructured":"Horowitz G, Amit M, Fried I et al (2013) Vagal nerve stimulation for refractory epilepsy: the surgical procedure and complications in 100 implantations by a single medical center. Eur Arch Otorhinolaryngol 270:355\u2013358","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"6943_CR33","doi-asserted-by":"publisher","first-page":"73","DOI":"10.3171\/2008.10.PEDS08294","volume":"3","author":"EL Air","year":"2009","unstructured":"Air EL, Ghomri YM, Tyagi R et al (2009) Management of vagal nerve stimulator infections: do they need to be removed? J Neurosurg Pediatr 3:73\u201378","journal-title":"J Neurosurg Pediatr"},{"key":"6943_CR34","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.clineuro.2015.06.023","volume":"137","author":"L Galbarriatu","year":"2015","unstructured":"Galbarriatu L, Pomposo I, Aurrecoechea J et al (2015) Vagus nerve stimulation therapy for treatment-resistant epilepsy: a 15-year experience at a single institution. Clin Neurol Neurosurg 137:89\u201393","journal-title":"Clin Neurol Neurosurg"},{"key":"6943_CR35","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.yebeh.2017.12.009","volume":"83","author":"HC Fan","year":"2018","unstructured":"Fan HC, Hsu TR, Chang KP et al (2018) Vagus nerve stimulation for 6- to 12-year-old children with refractory epilepsy: Impact on seizure frequency and parenting stress index. Epilepsy Behav 83:119\u2013123","journal-title":"Epilepsy Behav"},{"key":"6943_CR36","first-page":"9709056","volume":"2016","author":"S Gurbani","year":"2016","unstructured":"Gurbani S, Chayasirisobhon S, Cahan L et al (2016) Neuromodulation therapy with vagus nerve stimulation for intractable epilepsy: a 2-year efficacy analysis study in patients under 12 years of age. Epilepsy Res Treat 2016:9709056","journal-title":"Epilepsy Res Treat"},{"key":"6943_CR37","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1177\/0883073808315417","volume":"23","author":"EM Sherman","year":"2008","unstructured":"Sherman EM, Connolly MB, Slick DJ et al (2008) Quality of life and seizure outcome after vagus nerve stimulation in children with intractable epilepsy. J Child Neurol 23:991\u2013998","journal-title":"J Child Neurol"},{"key":"6943_CR38","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1111\/j.1471-4159.2011.07214.x","volume":"117","author":"R Raedt","year":"2011","unstructured":"Raedt R, Clinckers R, Mollet L et al (2011) Increased hippocampal noradrenaline is a biomarker for efficacy of vagus nerve stimulation in a limbic seizure model. J Neurochem 117:461\u2013469","journal-title":"J Neurochem"},{"key":"6943_CR39","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1017\/S1461145712000387","volume":"16","author":"S Manta","year":"2013","unstructured":"Manta S, El Mansari M, Debonnel G et al (2013) Electrophysiological and neurochemical effects of long-term vagus nerve stimulation on the rat monoaminergic systems. Int J Neuropsychopharmacol 16:459\u2013470","journal-title":"Int J Neuropsychopharmacol"},{"key":"6943_CR40","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.brs.2011.03.001","volume":"5","author":"CR Conway","year":"2012","unstructured":"Conway CR, Sheline YI, Chibnall JT et al (2012) Brain blood-flow change with acute vagus nerve stimulation in treatment-refractory major depressive disorder. Brain Stimul 5:163\u2013171","journal-title":"Brain Stimul"},{"key":"6943_CR41","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.pscychresns.2010.11.004","volume":"191","author":"M Kosel","year":"2011","unstructured":"Kosel M, Brockmann H, Frick C et al (2011) Chronic vagus nerve stimulation for treatment-resistant depression increases regional cerebral blood flow in the dorsolateral prefrontal cortex. Psychiatry Res 191:153\u2013159","journal-title":"Psychiatry Res"},{"key":"6943_CR42","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/S0165-0173(03)00143-7","volume":"42","author":"CW Berridge","year":"2003","unstructured":"Berridge CW, Waterhouse BD (2003) The locus coeruleus-noradrenergic system: modulation of behavioral state and state-dependent cognitive processes. Brain Res Brain Res Rev 42:33\u201384","journal-title":"Brain Res Brain Res Rev"},{"key":"6943_CR43","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.neubiorev.2014.05.005","volume":"45","author":"K Vonck","year":"2014","unstructured":"Vonck K, Raedt R, Naulaerts J et al (2014) Vagus nerve stimulation\u202625 years later! What do we know about the effects on cognition? Neurosci Biobehav Rev 45:63\u201371","journal-title":"Neurosci Biobehav Rev"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-021-06943-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-021-06943-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-021-06943-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T19:05:27Z","timestamp":1629745527000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-021-06943-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":43,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["6943"],"URL":"https:\/\/doi.org\/10.1007\/s00405-021-06943-x","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,1]]},"assertion":[{"value":"16 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was obtained from the Ethics Committee of the Medical University of Vienna (EK 1530\/2019, with annual extensions to date).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}