{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T02:30:10Z","timestamp":1791772210559,"version":"4.3.4"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005774","name":"Universitat de Barcelona","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005774","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":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Meni\u00e8re\u2019s disease is a chronic inner ear disorder marked by episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, and aural fullness, all of which significantly impair quality of life. Intratympanic corticosteroids (ITCs) have emerged as a potential therapy, but their clinical efficacy and safety remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted of randomized controlled trials (RCTs) comparing ITC to placebo in adult MD patients. Comprehensive searches were performed across multiple electronic databases. Six RCTs met the inclusion criteria, evaluating formulations such as dexamethasone and the sustained-release OTO-104. Outcomes were synthesized narratively, and the certainty of evidence was assessed using the GRADE framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence for the primary outcome\u2014vertigo control\u2014was rated as low certainty, due to methodological heterogeneity, inconsistent findings, and imprecision. Two trials demonstrated significant improvements with ITC compared to placebo, but results were not consistent across studies. Evidence for secondary outcomes, including tinnitus and aural pressure, was of very low to low certainty. Safety outcomes were supported by moderate-certainty evidence, with no serious adverse events reported across studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This review highlights the persistent uncertainty surrounding the clinical effectiveness of ITCs in MD. While some evidence supports modest benefit for vertigo control, inconsistencies and low certainty limit generalizability. Future RCTs should prioritize standardized outcome measures and robust methodological design to better define the therapeutic role of ITCs in Meni\u00e8re\u00b4s disease.MD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00405-025-09764-4","type":"journal-article","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T16:44:17Z","timestamp":1763225057000},"page":"1507-1515","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Intratympanic corticosteroid injection for M\u00e9ni\u00e8re\u2019s disease: systematic review of randomized controlled trials"],"prefix":"10.1007","volume":"283","author":[{"given":"Helena Guilera","family":"Mart\u00ednez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesc","family":"Larrosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Sandoval","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Remacha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8191-9833","authenticated-orcid":false,"given":"Manuel","family":"Bernal-Sprekelsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"issue":"Suppl 1","key":"9764_CR1","doi-asserted-by":"publisher","first-page":"S71","DOI":"10.1007\/s00415-015-7930-1","volume":"263","author":"R G\u00fcrkov","year":"2016","unstructured":"G\u00fcrkov R, Pyyk\u00f6 I, Zou J, Kentala E (2016) What is Meni\u00e8re\u2019s disease? A contemporary re-evaluation of endolymphatic hydrops. J Neurol 263(Suppl 1):S71\u201381. https:\/\/doi.org\/10.1007\/s00415-015-7930-1","journal-title":"J Neurol"},{"issue":"3","key":"9764_CR2","doi-asserted-by":"publisher","first-page":"e202","DOI":"10.1097\/AUD.0000000000000264","volume":"37","author":"J Tyrrell","year":"2016","unstructured":"Tyrrell J, Whinney DJ, Taylor T (2016) The cost of M\u00e9ni\u00e8re\u2019s disease: a novel multisource approach. Ear Hear 37(3):e202\u2013e209. https:\/\/doi.org\/10.1097\/AUD.0000000000000264","journal-title":"Ear Hear"},{"issue":"1","key":"9764_CR3","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1097\/WCO.0000000000001021","volume":"35","author":"JL Hoskin","year":"2022","unstructured":"Hoskin JL (2022) M\u00e9ni\u00e8re\u2019s disease: new guidelines, subtypes, imaging, and more. Curr Opin Neurol 35(1):90\u201397. https:\/\/doi.org\/10.1097\/WCO.0000000000001021","journal-title":"Curr Opin Neurol"},{"issue":"6","key":"9764_CR4","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1111\/coa.12844","volume":"42","author":"L Frejo","year":"2017","unstructured":"Frejo L, Martin-Sanz E, Teggi R et al (2017) Extended phenotype and clinical subgroups in unilateral Meniere disease: A cross\u2010sectional study with cluster analysis. Clin Otolaryngol 42(6):1172\u20131180. https:\/\/doi.org\/10.1111\/coa.12844","journal-title":"Clin Otolaryngol"},{"issue":"1","key":"9764_CR5","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1055\/s-0039-3402065","volume":"40","author":"P Perez-Carpena","year":"2020","unstructured":"Perez-Carpena P, Lopez-Escamez JA (2020) Current Understanding and clinical management of Meni\u00e8re\u2019s disease: a systematic review. Semin Neurol 40(1):138\u2013150. https:\/\/doi.org\/10.1055\/s-0039-3402065","journal-title":"Semin Neurol"},{"issue":"2","key":"9764_CR6","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD015171.pub2","volume":"2023","author":"KE Webster","year":"2023","unstructured":"Webster KE, Galbraith K, Harrington-Benton NA (2023) Systemic pharmacological interventions for M\u00e9ni\u00e8re\u2019s disease. Cochrane Database Syst Rev (2):CD015171. https:\/\/doi.org\/10.1002\/14651858.CD015171.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"9764_CR7","doi-asserted-by":"publisher","unstructured":"Pullens B, van Benthem PP (2011) Intratympanic gentamicin for M\u00e9ni\u00e8re\u2019s disease or syndrome. Cochrane Database Syst Rev 3CD008234. https:\/\/doi.org\/10.1002\/14651858.CD008234.pub2","DOI":"10.1002\/14651858.CD008234.pub2"},{"issue":"4","key":"9764_CR8","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1177\/0194599820909439","volume":"162","author":"GJ Basura","year":"2020","unstructured":"Basura GJ, Adams ME, Monfared A et al (2020) Clinical practice guideline: M\u00e9ni\u00e8re\u2019s disease executive summary. Otolaryngol Head Neck Surg 162(4):415\u2013434. https:\/\/doi.org\/10.1177\/0194599820909439","journal-title":"Otolaryngol Head Neck Surg"},{"key":"9764_CR9","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.heares.2018.03.002","volume":"368","author":"AN Salt","year":"2018","unstructured":"Salt AN, Plontke SK (2018) Pharmacokinetic principles in the inner ear: influence of drug properties on intratympanic applications. Hear Res 368:28\u201340. https:\/\/doi.org\/10.1016\/j.heares.2018.03.002","journal-title":"Hear Res"},{"issue":"7","key":"9764_CR10","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1017\/S0022215111000028","volume":"125","author":"FL Chi","year":"2011","unstructured":"Chi FL, Yang MQ, Zhou YD, Wang B (2011) Therapeutic efficacy of topical application of dexamethasone to the round window niche after acoustic trauma caused by intensive impulse noise in Guinea pigs. J Laryngol Otol 125(7):673\u2013685. https:\/\/doi.org\/10.1017\/S0022215111000028","journal-title":"J Laryngol Otol"},{"issue":"2","key":"9764_CR11","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1055\/s-0036-1583524","volume":"21","author":"EA Bogaz","year":"2017","unstructured":"Bogaz EA, Maranh\u00e3o AS, Inoue DP et al (2017) M\u00e9ni\u00e8re\u2019s disease treatment. Int Arch Otorhinolaryngol 21(2):184\u2013191. https:\/\/doi.org\/10.1055\/s-0036-1583524","journal-title":"Int Arch Otorhinolaryngol"},{"key":"9764_CR12","doi-asserted-by":"publisher","DOI":"10.3389\/fncel.2019.00347","volume":"13","author":"AN Salt","year":"2019","unstructured":"Salt AN, Hartsock JJ, Hou J, Piu F (2019) Comparison of the pharmacokinetic properties of triamcinolone and dexamethasone for local therapy of the inner ear. Front Cell Neurosci 13:347. https:\/\/doi.org\/10.3389\/fncel.2019.00347","journal-title":"Front Cell Neurosci"},{"issue":"10","key":"9764_CR13","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1097\/MAO.0000000000001227","volume":"37","author":"PR Lambert","year":"2016","unstructured":"Lambert PR, Carey J, Mikulec AA et al (2016) Intratympanic sustained-exposure dexamethasone thermosensitive gel: randomized phase 2b trial. Otol Neurotol 37(10):1669\u20131676. https:\/\/doi.org\/10.1097\/MAO.0000000000001227","journal-title":"Otol Neurotol"},{"issue":"8","key":"9764_CR14","doi-asserted-by":"publisher","first-page":"3795","DOI":"10.1007\/s00405-022-07374-y","volume":"279","author":"S Li","year":"2022","unstructured":"Li S, Pyykk\u00f6 I, Zhang Q et al (2022) Consensus on intratympanic drug delivery for Meni\u00e8re\u2019s disease. Eur Arch Otorhinolaryngol 279(8):3795\u20133799. https:\/\/doi.org\/10.1007\/s00405-022-07374-y","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"2","key":"9764_CR15","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD015245.pub2","volume":"2023","author":"KE Webster","year":"2023","unstructured":"Webster KE, Lee A, Galbraith K et al (2023) Intratympanic corticosteroids for M\u00e9ni\u00e8re\u2019s disease. Cochrane Database Syst Rev (2):CD015245. https:\/\/doi.org\/10.1002\/14651858.CD015245.pub2","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"9764_CR16","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.otohns.2005.05.010","volume":"133","author":"MA Gardu\u00f1o-Anaya","year":"2005","unstructured":"Gardu\u00f1o-Anaya MA, De Couthino H et al (2005) Dexamethasone inner ear perfusion by intratympanic injection in unilateral M\u00e9ni\u00e8re\u2019s disease: a two-year prospective trial. Otolaryngol Head Neck Surg 133(2):285\u2013294. https:\/\/doi.org\/10.1016\/j.otohns.2005.05.010","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"1","key":"9764_CR17","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/mao.0b013e31815dbafc","volume":"29","author":"MS Boleas-Aguirre","year":"2008","unstructured":"Boleas-Aguirre MS, Lin FR, Della Santina CC, Minor LB, Carey JP (2008) Longitudinal results with intratympanic dexamethasone in the treatment of M\u00e9ni\u00e8re\u2019s disease. Otol Neurotol 29(1):33\u201338. https:\/\/doi.org\/10.1097\/mao.0b013e31815dbafc","journal-title":"Otol Neurotol"},{"issue":"1","key":"9764_CR18","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1097\/MAO.0b013e3181c34e53","volume":"31","author":"C Herraiz","year":"2010","unstructured":"Herraiz C, Plaza G, Aparicio JM, Gallego I, Marcos S, Ruiz C (2010) Transtympanic steroids for M\u00e9ni\u00e8re\u2019s disease. Otol Neurotol. 31(1):162\u2013167. https:\/\/doi.org\/10.1097\/MAO.0b013e3181c34e53","journal-title":"Otol Neurotol."},{"key":"9764_CR19","doi-asserted-by":"crossref","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136\/bmj.n71","DOI":"10.1136\/bmj.n71"},{"key":"9764_CR20","doi-asserted-by":"crossref","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi: 10.1136\/bmj.l4898","DOI":"10.1136\/bmj.l4898"},{"key":"9764_CR21","doi-asserted-by":"crossref","unstructured":"Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Sch\u00fcnemann HJ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924\u2013926. doi: 10.1136\/bmj.39489.470347.","DOI":"10.1136\/bmj.39489.470347.AD"},{"issue":"6","key":"9764_CR22","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1097\/MAO.0000000000003886","volume":"44","author":"J Phillips","year":"2023","unstructured":"Phillips J, Mikulec AA, Robinson JM, Skarinsky D, Anderson JJ (2023) Efficacy of intratympanic OTO-104 for the treatment of M\u00e9ni\u00e8re\u2019s disease: outcome of three randomized, double-blind, placebo-controlled studies. Otol Neurotol 44(6):584\u2013592. https:\/\/doi.org\/10.1097\/MAO.0000000000003886","journal-title":"Otol Neurotol"},{"issue":"9","key":"9764_CR23","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1097\/MAO.0000000000004289","volume":"45","author":"A Scarpa","year":"2024","unstructured":"Scarpa A, Carucci M, Ralli M, De Luca P, Salzano G, Viola P, Chiarella G, Salzano FA (2024) Efficacy of intratympanic OTO-104 for the treatment of M\u00e9ni\u00e8re\u2019s disease: outcome of three randomized, double-blind, placebo-controlled studies. Otol Neurotol 45(9):1087\u20131088. https:\/\/doi.org\/10.1097\/MAO.0000000000004289","journal-title":"Otol Neurotol"},{"key":"9764_CR24","unstructured":"AVERTS-1 Study of OTO-104 in subjects with unilateral Meni\u00e8re\u2019s disease (2023) ClinicalTrials Gov NCT02612337"},{"key":"9764_CR25","unstructured":"AVERTS-2 Study of OTO-104 in subjects with unilateral Meni\u00e8re\u2019s disease (2023) ClinicalTrials Gov NCT02717442"},{"key":"9764_CR26","unstructured":"Clinical Study 811 Phase 3 Study of OTO-104 in Subjects With Unilateral Meni\u00e8re\u2019s Disease (2022) ClinicalTrials Gov NCT03664674"},{"issue":"7","key":"9764_CR27","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1097\/MAO.0b013e318263d35d","volume":"33","author":"PR Lambert","year":"2012","unstructured":"Lambert PR, Nguyen S, Maxwell KS et al (2012) A randomized, double-blind, placebo-controlled clinical study to assess safety and clinical activity of OTO-104 given as a single intratympanic injection. Otol Neurotol 33(7):1257\u20131265. https:\/\/doi.org\/10.1097\/MAO.0b013e318263d35d","journal-title":"Otol Neurotol"},{"issue":"6","key":"9764_CR28","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1097\/MAO.0000000000002255","volume":"40","author":"L Devantier","year":"2019","unstructured":"Devantier L, Djurhuus BD, Hougaard DD, H\u00e4ndel MN, Guldfred FL, Schmidt JH, Edemann-Callesen H (2019) Intratympanic steroid for M\u00e9ni\u00e8re\u2019s disease: a systematic review. Otol Neurotol 40(6):806\u2013812. https:\/\/doi.org\/10.1097\/MAO.0000000000002255","journal-title":"Otol Neurotol"},{"issue":"8","key":"9764_CR29","doi-asserted-by":"publisher","first-page":"3897","DOI":"10.1007\/s00405-025-09329-5","volume":"282","author":"H Osc\u00e9","year":"2025","unstructured":"Osc\u00e9 H, Loos E, Huygen A, Desloovere C (2025) Treatment of M\u00e9ni\u00e8re\u2019s disease: a scoping review of the current evidence. Eur Arch Otorhinolaryngol 282(8):3897\u20133923. https:\/\/doi.org\/10.1007\/s00405-025-09329-5","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"9764_CR30","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1469276","volume":"15","author":"FR Gerritsen","year":"2024","unstructured":"Gerritsen FR, Schenck AA, Locher H, van de Berg R, van Benthem PP, Blom HM (2024) The evolution of intractable M\u00e9ni\u00e8re\u2019s disease: attacks resolve over time. Front Neurol 15:1469276. https:\/\/doi.org\/10.3389\/fneur.2024.1469276","journal-title":"Front Neurol"},{"key":"9764_CR31","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1496384","volume":"15","author":"I Pyykko","year":"2024","unstructured":"Pyykko I, Zou J, Vetkas N (2024) Changes in symptom pattern in Meniere\u2019s disease by duration: the need for comprehensive management. Front Neurol 15:1496384. https:\/\/doi.org\/10.3389\/fneur.2024.1496384","journal-title":"Front Neurol"},{"key":"9764_CR32","doi-asserted-by":"crossref","unstructured":"Sumi T, Watanabe I, Tsunoda A, Nishio A, Komatsuzaki A, Kitamura K. Longitudinal study of 29 patients with M\u00e9ni\u00e8re\u2019s disease with follow-up of 10 years or more. Acta Otolaryngol. ;132:10\u201315. doi:10.3109\/00016489.2011.627570","DOI":"10.3109\/00016489.2011.627570"},{"key":"9764_CR33","doi-asserted-by":"crossref","unstructured":"Boreel EM, van Esch B, Schermer TR, Mol BM, van Benthem P, Bruintjes TD. The effectiveness of intratympanic injections with methylprednisolone versus placebo in the treatment of vertigo attacks in M\u00e9ni\u00e8re\u2019s disease (PREDMEN trial): a study protocol for a phase-3 multicentre, double-blinded, randomised, placebo-controlled trial. BMJ Open. 2024;14(8):e076872. doi: 10.1136\/bmjopen-2023-076872","DOI":"10.1136\/bmjopen-2023-076872"},{"key":"9764_CR34","doi-asserted-by":"publisher","DOI":"10.1186\/s43163-020-00018-0","volume":"36","author":"RR El Shafei","year":"2020","unstructured":"El Shafei RR, Qotb M (2020) Comparison of the effect of three treatment interventions for the control of Meni\u00e8re\u2019s disease: a randomized control trial. Egypt J Otolaryngol 36:22","journal-title":"Egypt J Otolaryngol"},{"key":"9764_CR35","unstructured":"Borghei P, Sadeghian E, Hasanzadeh F, Emami H. Intratympanic dexamethasone delivery versus placebo in intractable Meni\u00e8re disease. AJS. ;3(3\u20134):58\u201362."},{"issue":"1","key":"9764_CR36","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1097\/MAO.0b013e318200a0e0","volume":"32","author":"S Yoda","year":"2011","unstructured":"Yoda S, Cureoglu S, Shimizu S, Morita N, Fukushima H, Sato T, Harada T, Paparella MM (2011) Round window membrane in M\u00e9ni\u00e8re\u2019s disease: a human temporal bone study. Otol Neurotol. 32(1):147\u2013151. https:\/\/doi.org\/10.1097\/MAO.0b013e318200a0e0","journal-title":"Otol Neurotol."},{"key":"9764_CR37","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-025-09297-w","author":"BSY Yeo","year":"2025","unstructured":"Yeo BSY, Toh EMS, Lim NE, Lee RS, Ho RCM, Tam WWS, Ngo RYS (2025) Association of Meni\u00e8re\u2019s disease with depression and anxiety: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. https:\/\/doi.org\/10.1007\/s00405-025-09297-w","journal-title":"Eur Arch Otorhinolaryngol"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-025-09764-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-025-09764-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-025-09764-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T01:51:41Z","timestamp":1773971501000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-025-09764-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,15]]},"references-count":37,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["9764"],"URL":"https:\/\/doi.org\/10.1007\/s00405-025-09764-4","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,15]]},"assertion":[{"value":"13 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"As Editor-in-Chief of the journal, the corresponding author of this manuscript was not involved in the review nor decision process.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}