{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:21:37Z","timestamp":1787862097830,"version":"build-2784847793"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2024,4,6]],"date-time":"2024-04-06T00:00:00Z","timestamp":1712361600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,6]],"date-time":"2024-04-06T00:00:00Z","timestamp":1712361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Istanbul Atlas University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Dysphagia is a prevalent symptom observed in acute stroke. Several bedside screening tests are employed for the early detection of dysphagia. Pulse oximetry emerges as a practical and supportive method to augment the existing techniques utilized during bedside swallowing assessments. Desaturation levels, as measured by pulse oximetry, are acknowledged as indicative of aspiration by certain screening tests. However, the predictive capability of pulse oximetry in determining aspiration remains a subject of controversy. The objective of this study was to compare aspiration and oxygen desaturation levels by time and aspiration severity in dysphagic patients compared to healthy controls. It also aimed to evaluate the accuracy of pulse oximetry by comparing it with VFSS findings in detecting aspiration in both liquid (IDDSI-0) and semi-solid (IDDSI-4) consistencies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>Eighty subjects (40 healthy and 40 acute stroke patients) participated. Patients suspected of dysphagia underwent videofluoroscopy as part of the stroke unit\u2019s routine procedure. Baseline SpO<jats:sub>2<\/jats:sub> was measured before VFSS, and stabilized values were recorded. Sequential IDDSI-0 and IDDSI-4 barium tests were conducted with 5 ml boluses. Stabilized SPO<jats:sub>2<\/jats:sub> values were recorded during swallowing and 3-min post-feeding. Patients with non-dysphagia received equal bolus monitoring. Changes in SPO<jats:sub>2<\/jats:sub> during, before, and after swallowing were analyzed for each consistency in both groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The study revealed a statistically significant difference in SPO<jats:sub>2<\/jats:sub> between patients with dysphagia and controls for IDDSI-4 and IDSSI-0. In IDDSI-4, 20% of patients experienced SpO<jats:sub>2<\/jats:sub> decrease compared to 2.5% in control group (<jats:italic>p<\/jats:italic>\u2009=\u20090.013). For IDDSI-0, 35% of patients showed SpO<jats:sub>2<\/jats:sub> decrease, while none in the control group did (<jats:italic>p<\/jats:italic>\u2009=\u20090.0001). Aspiration rates were 2.5% in IDDSI-4 and 57.5% in IDDSI-0. In IDDSI-0, SpO<jats:sub>2<\/jats:sub> decrease significantly correlated with aspiration (<jats:italic>p<\/jats:italic>\u2009=\u20090.0001). In IDDSI-4, 20.5% had SpO<jats:sub>2<\/jats:sub> decrease without aspiration, and showing no significant difference (<jats:italic>p<\/jats:italic>\u2009=\u20090.613). Penetration-Aspiration Scale scores had no significant association with SpO<jats:sub>2<\/jats:sub> decrease (<jats:italic>p<\/jats:italic>\u2009=\u20090.602). Pulse oximetry in IDDSI-4 had limited sensitivity (0%) and positive predictive value, (0%) while in IDDSI-0, it demonstrated acceptable sensitivity (60.9%) and specificity (100%) with good discrimination capability (AUC\u2009=\u20090.83).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>A decrease in SPO<jats:sub>2<\/jats:sub> may indicate potential aspiration but is insufficient alone for detection. This study proposes pulse oximetry as a valuable complementary tool in assessing dysphagia but emphasizes that aspiration cannot be reliably predicted based solely on SpO<jats:sub>2<\/jats:sub> decrease.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00405-024-08613-0","type":"journal-article","created":{"date-parts":[[2024,4,6]],"date-time":"2024-04-06T13:01:47Z","timestamp":1712408507000},"page":"3095-3105","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative analysis of videofluoroscopy and pulse oximetry for aspiration identification in patients with dysphagia after stroke and non-dysphagics"],"prefix":"10.1007","volume":"281","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6580-1189","authenticated-orcid":false,"given":"Serkan","family":"Bengisu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8954-0980","authenticated-orcid":false,"given":"\u00d6zlem","family":"\u00d6ge-Da\u015fd\u00f6\u011fen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2452-1874","authenticated-orcid":false,"given":"Hatice Yelda","family":"Y\u0131ld\u0131z","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,6]]},"reference":[{"key":"8613_CR1","doi-asserted-by":"publisher","first-page":"2756","DOI":"10.1161\/01.STR.0000190056.76543.eb","volume":"36","author":"R Martino","year":"2005","unstructured":"Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R (2005) Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke J Cereb Circ 36:2756\u20132763","journal-title":"Stroke J Cereb Circ"},{"issue":"2","key":"8613_CR2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.2165\/00002512-200522020-00006","volume":"22","author":"ML Berthier","year":"2005","unstructured":"Berthier ML (2005) Poststroke aphasia: epidemiology, pathophysiology and treatment. Drugs Aging 22(2):163\u2013182","journal-title":"Drugs Aging"},{"key":"8613_CR3","unstructured":"\u0130STAT\u0130ST\u0130KVER\u0130 Portali. Retrieved November 23, 2023 from https:\/\/data.tuik.gov.tr\/Bulten\/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri"},{"key":"8613_CR4","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/bs.afnr.2016.11.008","volume":"81","author":"C Gallegos","year":"2017","unstructured":"Gallegos C et al (2017) Nutritional aspects of dysphagia management. Adv Food Nutr Res 81:271\u2013318","journal-title":"Adv Food Nutr Res"},{"issue":"8","key":"8613_CR5","doi-asserted-by":"publisher","first-page":"7849","DOI":"10.1001\/archoto.2010.129","volume":"136","author":"KW Altman","year":"2010","unstructured":"Altman KW, Yu GP, Schaefer SD (2010) Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg 136(8):7849","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"9","key":"8613_CR6","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1161\/01.STR.0000177529.86868.8d","volume":"36","author":"JA Hinchey","year":"2005","unstructured":"Hinchey JA et al (2005) Formal dysphagia screening protocols prevent pneumonia. Stroke 36(9):1972\u20131976","journal-title":"Stroke"},{"key":"8613_CR7","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s004559910006","volume":"15","author":"R Martino","year":"2000","unstructured":"Martino R, Pron G, Diamant NE (2000) Screening for oropharyngeal dysphagia in stroke: in sufficient evidence for guidelines. Dysphagia 15:19\u201330","journal-title":"Dysphagia"},{"key":"8613_CR8","volume-title":"National clinical guideline for stroke","author":"Intercollegiate Stroke Working Party","year":"2012","unstructured":"Intercollegiate Stroke Working Party (2012) National clinical guideline for stroke, 4th edn. Royal College of Physicians, London","edition":"4"},{"key":"8613_CR9","volume-title":"Concise clinical guidelines for stroke management","author":"National Stroke Foundation","year":"2010","unstructured":"National Stroke Foundation (2010) Concise clinical guidelines for stroke management. National Stroke Foundation, Melbourne"},{"key":"8613_CR10","volume-title":"VA\/DoD clinical practice guideline for the management of stroke rehabilitation","author":"The Management of Stroke Working Group","year":"2010","unstructured":"The Management of Stroke Working Group (2010) VA\/DoD clinical practice guideline for the management of stroke rehabilitation. Office of Quality and Performance, Washington"},{"key":"8613_CR11","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1177\/1747493015622461","volume":"11","author":"LK Casaubon","year":"2016","unstructured":"Casaubon LK, Boulanger JM, Glasser E, Blacquiere D, Boucher S, Brown K, Goddard T, Gordon J, Horton M, Lalonde J et al (2016) Canadian stroke best practice recommendations: acute inpatient stroke care guidelines, update 2015. Int J Stroke 11:239\u2013252","journal-title":"Int J Stroke"},{"issue":"4","key":"8613_CR12","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1016\/j.pmr.2008.06.004","volume":"19","author":"B Martin-Harris","year":"2008","unstructured":"Martin-Harris B, Jones B (2008) The videofluorographic swallowing study. Phys Med Rehabil Clin N Am 19(4):769\u201385,viii. https:\/\/doi.org\/10.1016\/j.pmr.2008.06.004","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"8613_CR13","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.radi.2019.10.011","volume":"26","author":"E Boaden","year":"2020","unstructured":"Boaden E, Nightingale J, Bradbury C, Hives L, Georgiou R (2020) Clinical practice guidelines for videofluoroscopic swallowing studies: a systematic review. Radiography 26:154\u2013162","journal-title":"Radiography"},{"issue":"2","key":"8613_CR14","first-page":"231","volume":"14","author":"MCAF Cardoso","year":"2010","unstructured":"Cardoso MCAF, Silva AMT (2010) Pulse oximetry: instrumental alternative in the clinical evaluation by the bed for the dysphagia. Int Arch Otorhinolayngol 14(2):231\u2013238","journal-title":"Int Arch Otorhinolayngol"},{"issue":"1","key":"8613_CR15","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/00000542-198901000-00019","volume":"70","author":"KK Tremper","year":"1989","unstructured":"Tremper KK, Barker SJ (1989) Pulse oximetry. Anesthesiology 70(1):98\u2013108","journal-title":"Anesthesiology"},{"issue":"6","key":"8613_CR16","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1016\/j.rmed.2013.02.004","volume":"107","author":"ED Chan","year":"2013","unstructured":"Chan ED, Chan MM, Chan MM (2013) Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations. Respir Med 107(6):789\u2013799","journal-title":"Respir Med"},{"issue":"9","key":"8613_CR17","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1161\/01.STR.28.9.1773","volume":"28","author":"MJ Collins","year":"1997","unstructured":"Collins MJ, Bakheit AM (1997) Does pulse oximetry reliably detect aspiration in dysphagic stroke patients? Stroke 28(9):1773\u20131775","journal-title":"Stroke"},{"issue":"4","key":"8613_CR18","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1093\/ageing\/24.4.267","volume":"24","author":"NH Zaidi","year":"1995","unstructured":"Zaidi NH et al (1995) Oxygen desaturation on swallowing as a potential marker of aspiration in acute stroke. Age Ageing 24(4):267\u2013270","journal-title":"Age Ageing"},{"issue":"3","key":"8613_CR19","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1007\/PL00009597","volume":"14","author":"B Sherman","year":"1999","unstructured":"Sherman B et al (1999) Assessment of dysphagia with the use of pulse oximetry. Dysphagia 14(3):152\u2013156","journal-title":"Dysphagia"},{"issue":"2","key":"8613_CR20","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1007\/PL00009560","volume":"13","author":"C Sellars","year":"1998","unstructured":"Sellars C, Dunnet C, Carter R (1998) A preliminary comparison of videofluoroscopy of swallow and pulse oximetry in the identification of aspiration in dysphagic patients. Dysphagia 13(2):82\u201386","journal-title":"Dysphagia"},{"key":"8613_CR21","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/BF01351478","volume":"8","author":"B Rogers","year":"1993","unstructured":"Rogers B, Msall M, Shucard D (1993) Hypoxemia during oral feedings in adults with dysphagia and severe neurological disabilities. Dysphagia 8:43\u201348","journal-title":"Dysphagia"},{"issue":"2","key":"8613_CR22","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/s004550010003","volume":"15","author":"N Colodny","year":"2000","unstructured":"Colodny N (2000) Comparison of dysphagics and nondysphagics on pulse oximetry during oral feeding. Dysphagia 15(2):68\u201373. https:\/\/doi.org\/10.1007\/s004550010003. (PMID: 10758188)","journal-title":"Dysphagia"},{"issue":"1","key":"8613_CR23","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1159\/000453083","volume":"7","author":"T Marian","year":"2017","unstructured":"Marian T, Schr\u00f6der J, Muhle P, Claus I, Oelenberg S, Hamacher C, Warnecke T, Suntrup-Kr\u00fcger S, Dziewas R (2017) Measurement of oxygen desaturation is not useful for the detection of aspiration in dysphagic stroke patients. Cerebrovasc Dis Extra 7(1):44\u201350. https:\/\/doi.org\/10.1159\/000453083","journal-title":"Cerebrovasc Dis Extra"},{"issue":"12","key":"8613_CR24","doi-asserted-by":"publisher","first-page":"2984","DOI":"10.1161\/01.STR.0000248758.32627.3b","volume":"37","author":"DJ Ramsey","year":"2006","unstructured":"Ramsey DJ, Smithard DG, Kalra L (2006) Can pulse oximetry or a bedside swallowing assessment be used to detect aspiration after stroke? Stroke 37(12):2984\u20132988. https:\/\/doi.org\/10.1161\/01.STR.0000248758.32627.3b. (Epub 2006 Nov 9. PMID: 17095740)","journal-title":"Stroke"},{"issue":"3","key":"8613_CR25","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1007\/s00455-017-9868-1","volume":"33","author":"D Britton","year":"2018","unstructured":"Britton D, Roeske A, Ennis SK, Benditt JO, Quinn C, Graville D (2018) Utility of pulse oximetry to detect aspiration: an evidence-based systematic review. Dysphagia 33(3):282\u2013292","journal-title":"Dysphagia"},{"issue":"2","key":"8613_CR26","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/BF00417897","volume":"11","author":"JC Rosenbek","year":"1996","unstructured":"Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11(2):93\u201398","journal-title":"Dysphagia"},{"issue":"4","key":"8613_CR27","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s004550000028","volume":"15","author":"SB Leder","year":"2000","unstructured":"Leder SB (2000) Use of arterial oxygen saturation, heart rate, and blood pressure as indirect objective physiologic markers to predict aspiration. Dysphagia 15(4):201\u2013205","journal-title":"Dysphagia"},{"issue":"4","key":"8613_CR28","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1016\/j.apmr.2004.10.021","volume":"86","author":"TG Wang","year":"2005","unstructured":"Wang TG et al (2005) Pulse oximetry does not reliably detect aspiration on videofluoroscopic swallowing study. Arch Phys Med Rehabil 86(4):730\u2013734","journal-title":"Arch Phys Med Rehabil"},{"issue":"6","key":"8613_CR29","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1016\/j.clnu.2008.06.011","volume":"27","author":"P Clav\u00e9","year":"2008","unstructured":"Clav\u00e9 P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M (2008) Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr 27(6):806\u2013815. https:\/\/doi.org\/10.1016\/j.clnu.2008.06.011. (Epub 2008 Sep 11. PMID: 18789561)","journal-title":"Clin Nutr"},{"issue":"5","key":"8613_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00455-017-9809-z","volume":"32","author":"CM Steele","year":"2017","unstructured":"Steele CM, Grace-Martin K (2017) Reflections on clinical and statistical use of the penetration-aspiration scale. Dysphagia 32(5):1\u201316","journal-title":"Dysphagia"},{"key":"8613_CR31","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1159\/000339979","volume":"72","author":"L Rofes","year":"2012","unstructured":"Rofes L, Arreola V, Clav\u00e9 P (2012) The volume-viscosity swallow test for clinical screening of dysphagia and aspiration. Nestle Nutr Inst Workshop Ser 72:33\u201342. https:\/\/doi.org\/10.1159\/000339979. (Epub 2012 Sep 24. PMID: 23051998)","journal-title":"Nestle Nutr Inst Workshop Ser"},{"issue":"5","key":"8613_CR32","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1152\/jappl.1962.17.5.787","volume":"17","author":"HJH Colebatch","year":"1962","unstructured":"Colebatch HJH, Halmagyi DFJ (1962) Reflex airway reaction to fluid aspiration. J Appl Physiol 17(5):787\u2013794","journal-title":"J Appl Physiol"},{"issue":"4","key":"8613_CR33","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/S0030-6665(20)31488-2","volume":"21","author":"JA Logemann","year":"1988","unstructured":"Logemann JA (1988) Swallowing physiology and pathophysiology. Otolaryngol Clin North Am 21(4):613\u2013623 (PMID: 3054716)","journal-title":"Otolaryngol Clin North Am"},{"issue":"9","key":"8613_CR34","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1111\/j.1365-2036.2006.03118.x","volume":"24","author":"P Clav\u00e9","year":"2006","unstructured":"Clav\u00e9 P, de Kraa M, Arreola V, Girvent M, Farr\u00e9 R, Palomera E, Serra-Prat M (2006) The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther 24(9):1385\u20131394. https:\/\/doi.org\/10.1111\/j.1365-2036.2006.03118.x. (PMID: 17059520)","journal-title":"Aliment Pharmacol Ther"},{"issue":"5","key":"8613_CR35","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1177\/000348941112000502","volume":"120","author":"SG Butler","year":"2011","unstructured":"Butler SG et al (2011) Effects of liquid type, delivery method, and bolus volume on penetration-aspiration scores in healthy older adults during flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol 120(5):288\u2013295","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"8613_CR36","doi-asserted-by":"publisher","first-page":"489","DOI":"10.3389\/fphys.2012.00489","volume":"3","author":"T Nishino","year":"2012","unstructured":"Nishino T (2012) The swallowing reflex and its significance as an airway defensive reflex. Front Physiol 3:489. https:\/\/doi.org\/10.3389\/fphys.2012.00489","journal-title":"Front Physiol"},{"key":"8613_CR37","doi-asserted-by":"publisher","first-page":"676","DOI":"10.3389\/fphys.2017.00676","volume":"8","author":"N Yagi","year":"2017","unstructured":"Yagi N, Oku Y, Nagami S, Yamagata Y, Kayashita J, Ishikawa A, Domen K, Takahashi R (2017) Inappropriate timing of swallow in the respiratory cycle causes breathing-swallowing discoordination. Front Physiol 8:676. https:\/\/doi.org\/10.3389\/fphys.2017.00676","journal-title":"Front Physiol"},{"key":"8613_CR38","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s00455-009-9237-9","volume":"25","author":"T Park","year":"2010","unstructured":"Park T, Kim Y, Ko DH, McCullough G (2010) Initiation and duration of laryngeal closure during the pharyngeal swallow in post-stroke patients. Dysphagia 25:177\u2013182. https:\/\/doi.org\/10.1007\/s00455-009-9237-9","journal-title":"Dysphagia"},{"key":"8613_CR39","doi-asserted-by":"publisher","first-page":"2547","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.05.031","volume":"23","author":"KL Huang","year":"2014","unstructured":"Huang KL, Liu TY, Huang YC, Leong CP, Lin WC, Pong YP (2014) Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy. J Stroke Cerebrovasc Dis 23:2547\u20132553. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2014.05.031","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"2","key":"8613_CR40","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1007\/s004550011001","volume":"16","author":"SG Hiss","year":"2001","unstructured":"Hiss SG, Treole K, Stuart A (2001) Effects of age, gender, bolus volume, and trial on swallowing apnea duration and swallow\/respiratory phase relationships of normal adults. Dysphagia 16(2):128\u2013135. https:\/\/doi.org\/10.1007\/s004550011001","journal-title":"Dysphagia"},{"key":"8613_CR41","doi-asserted-by":"publisher","DOI":"10.1044\/2019_JSLHR-19-00163","author":"TJ Valenzo","year":"2019","unstructured":"Valenzo TJ, Guida BT, Peladeau-Pigeon M, Steele CM (2019) Respiratory-swallow coordination in healthy adults during drinking of thin to extremely thick liquids: a research note. J Speech Lang Hear Res. https:\/\/doi.org\/10.1044\/2019_JSLHR-19-00163","journal-title":"J Speech Lang Hear Res"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-024-08613-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-024-08613-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-024-08613-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T11:10:25Z","timestamp":1714648225000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-024-08613-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,6]]},"references-count":41,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["8613"],"URL":"https:\/\/doi.org\/10.1007\/s00405-024-08613-0","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,6]]},"assertion":[{"value":"23 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest concerning this research.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants met the ethical standards of the institutional research committee (IRC:99102440\/2020-04) and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}