{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T07:57:48Z","timestamp":1792742268367,"version":"4.5.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003399","name":"Shanghai Science and Technology Commission","doi-asserted-by":"crossref","award":["21DZ2200700"],"award-info":[{"award-number":["21DZ2200700"]}],"id":[{"id":"10.13039\/501100003399","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Psychol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Congenital microtia significantly impacts children\u2019s psychological health, yet there has been limited focus on the effect of ear reconstruction surgery on psychological improvements, especially its pathway. This study aims to explore the role of ear appearance in improving psychological health in individuals with congenital unilateral microtia based on social identity theory, highlighting the limited understanding of the specific pathways involved in this relationship, and investigating how social function and benefit mediate the connection between ear appearance and psychological health in patients who underwent autologous cartilage ear reconstruction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A cross-sectional study was conducted, involving 96 patients with congenital unilateral microtia between January and June 2024 at the Eye &amp; ENT Hospital of Fudan University. Sociodemographic and clinical data were collected, along with responses to the EAR-Q and Glasgow Children\u2019s Benefit Inventory (GCBI) questionnaires. Data analysis was performed using multiple linear regression and the PROCESS macro in SPSS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Mediation analysis revealed that social function and emotion mediated the relationship between ear appearance and psychological function (total effect\u2009=\u20090.82; direct effect\u2009=\u20090.21; indirect effect\u2009=\u20090.61). Three mediation pathways were identified: ear appearance influenced psychological function through social function, emotional benefit, and a combined effect of both.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>These findings underscore the critical role of social interaction and emotional health in shaping psychological outcomes for individuals with congenital unilateral microtia following reconstruction. The results offer valuable insights for developing targeted interventions to enhance psychological well-being in this population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s40359-025-03073-5","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T14:53:35Z","timestamp":1753368815000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Relationship between ear appearance and psychological function among congenital unilateral microtia after autologous cartilage ear reconstruction: a chain mediation model"],"prefix":"10.1186","volume":"13","author":[{"given":"Xinyu","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenlong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaoyao","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"3073_CR1","doi-asserted-by":"publisher","unstructured":"Zhang Y, Jiang H, Yang Q, He L, Yu X, Huang X et al. Microtia in a chinese specialty clinic population: clinical heterogeneity and associated congenital anomalies. Plast Reconstr Surg. 2018 Dec;142(6):892e-903e. https:\/\/doi.org\/10.1097\/PRS.0000000000005066","DOI":"10.1097\/PRS.0000000000005066"},{"key":"3073_CR2","doi-asserted-by":"publisher","unstructured":"Zussino J, Zupan B, Preston R. Speech, language, and literacy outcomes for children with mild to moderate hearing loss: a systematic review. J Commun Disord. 2022 Sep-Oct;99:106248. https:\/\/doi.org\/10.1016\/j.jcomdis.2022.106248.","DOI":"10.1016\/j.jcomdis.2022.106248"},{"key":"3073_CR3","doi-asserted-by":"publisher","unstructured":"Lei L, Shichun Z, Zhenzhong L, Qiangwei W, Fangfang H, Zhensheng H et al. A survey of aesthetic standards of the ear. J Craniofac Surg. 2020 Mar\/Apr;31(2):527\u2013\u200929. https:\/\/doi.org\/10.1097\/SCS.0000000000006203","DOI":"10.1097\/SCS.0000000000006203"},{"key":"3073_CR4","doi-asserted-by":"publisher","unstructured":"Bolton MA, Lobben I, Stern TA. The impact of body image on patient care. Prim Care Companion J Clin Psychiatry. 2010;12(2). https:\/\/doi.org\/10.4088\/PCC.10r00947blu.","DOI":"10.4088\/PCC.10r00947blu"},{"key":"3073_CR5","unstructured":"Herdman TH. 3 the NANDA international classification of nursing diagnoses; 2024. 3 p."},{"key":"3073_CR6","doi-asserted-by":"publisher","unstructured":"Whicker JJ, Mu\u00f1oz K, Nelson LH. Parent challenges, perspectives and experiences caring for children who are deaf or hard-of-hearing with other disabilities: a comprehensive review. Int J Audiol. 2019;58(1):5\u201311. https:\/\/doi.org\/10.1080\/14992027.2018.1534011","DOI":"10.1080\/14992027.2018.1534011"},{"issue":"7","key":"3073_CR7","doi-asserted-by":"publisher","first-page":"2769","DOI":"10.1590\/1413-81232020257.274520188","volume":"25","author":"GX Carvalho","year":"2020","unstructured":"Carvalho GX, Nunes A, Moraes CL, Veiga G. Body image dissatisfaction and associated factors in adolescents. Cien Saude Colet. 2020;25(7):2769\u201382. https:\/\/doi.org\/10.1590\/1413-81232020257.274520188.","journal-title":"Cien Saude Colet"},{"issue":"3","key":"3073_CR8","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1055\/s-0029-1239448","volume":"25","author":"JF Reinisch","year":"2009","unstructured":"Reinisch JF, Lewin S. Ear reconstruction using a porous polyethylene framework and temporoparietal fascia flap. Facial Plast Surg. 2009;25(3):181\u201389. https:\/\/doi.org\/10.1055\/s-0029-1239448.","journal-title":"Facial Plast Surg"},{"issue":"9","key":"3073_CR9","doi-asserted-by":"publisher","first-page":"2358","DOI":"10.1016\/j.bjps.2020.12.087","volume":"74","author":"B Wang","year":"2021","unstructured":"Wang B, Guo R, Li Q, Ou Y, Hu J, Wang Y, et al. A novel two-stage strategy combing tissue expansion and nagata`s technique for total auricular reconstruction. J Plast Reconstr Aes. 2021;74(9):2358\u201363. https:\/\/doi.org\/10.1016\/j.bjps.2020.12.087. https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S174868152100019X. Available from: https:\/\/api.elsevier.com\/content\/article\/PII:S174868152100019X?httpAccept=text\/xml","journal-title":"J Plast Reconstr Aes"},{"key":"3073_CR10","doi-asserted-by":"publisher","unstructured":"Ronde EM, Esposito M, Lin Y, van Etten-Jamaludin FS, Bulstrode NW, Breugem CC. Long-term aesthetics, patient-reported outcomes, and auricular sensitivity after microtia reconstruction: a systematic review. J Plast Reconstr Aes. 2021;74(12):3213-34. https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S174868152100379X https:\/\/api.elsevier.com\/content\/article\/PII:S174868152100379X?httpAccept=text\/xmlhttps:\/\/doi.org\/10.1016\/j.bjps.2021.08.004","DOI":"10.1016\/j.bjps.2021.08.004"},{"key":"3073_CR11","doi-asserted-by":"publisher","unstructured":"Zhang T, Bulstrode N, Chang KW, Cho Y, Frenzel H, Jiang D, International consensus recommendations on microtia, aural atresia and functional ear reconstruction. J, Int Adv O et al. 2019 2019;15(2):204\u201308. https:\/\/doi.org\/10.5152\/iao.2019.7383","DOI":"10.5152\/iao.2019.7383"},{"key":"3073_CR12","doi-asserted-by":"publisher","unstructured":"Johns AL, Stock NM, Costa B, Billaud FK, Crerand CE. Psychosocial and health-related experiences of individuals with microtia and craniofacial microsomia and their families: narrative review over 2 decades. Cleft Palate Craniofac J. 2023;60(9):1090\u2013\u2009112. https:\/\/doi.org\/10.1177\/10556656221091699","DOI":"10.1177\/10556656221091699"},{"issue":"10","key":"3073_CR13","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1177\/1055665620931611","volume":"57","author":"C Hamlet","year":"2020","unstructured":"Hamlet C, Harcourt D. Exploring the experiences of adults with microtia: a qualitative study. Cleft Palate Craniofac J. 2020;57(10):1230\u201337. https:\/\/doi.org\/10.1177\/1055665620931611.","journal-title":"Cleft Palate Craniofac J"},{"issue":"3","key":"3073_CR14","first-page":"7","volume":"13","author":"H Tajfel","year":"1986","unstructured":"Tajfel H. The social identity theory of intergroup behavior. Psychol Intergroup Relations. 1986;13(3):7\u201324.","journal-title":"Psychol Intergroup Relations"},{"issue":"1","key":"3073_CR15","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1146\/annurev-psych-070620-111818","volume":"72","author":"R Spears","year":"2021","unstructured":"Spears R, Fiske ST, Schacter DL. Social influence and group identity. Annu Rev Psychol. 2021;72(1):367\u201390. https:\/\/doi.org\/10.1146\/annurev-psych-070620-111818. https:\/\/go.exlibris.link\/XRTRjwHb.","journal-title":"Annu Rev Psychol"},{"issue":"4","key":"3073_CR16","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1353\/aad.2016.0036","volume":"161","author":"TS Hartshorne","year":"2016","unstructured":"Hartshorne TS, Schmittel MC. Social-emotional development in children and youth who are deafblind. Am Ann Deaf. 2016;161(4):444\u201353. https:\/\/doi.org\/10.1353\/aad.2016.0036.","journal-title":"Am Ann Deaf"},{"key":"3073_CR17","doi-asserted-by":"publisher","unstructured":"Egbert J. Adverse childhood experiences among deaf and hard-of-hearing adults. Disabil Health J. 2024 Oct;2:101711. https:\/\/doi.org\/10.1016\/j.dhjo.2024.101711.","DOI":"10.1016\/j.dhjo.2024.101711"},{"key":"3073_CR18","doi-asserted-by":"publisher","unstructured":"Baartmans J, van Steensel F, Mobach L, Lansu T, Bijsterbosch G, Verpaalen I et al. Social anxiety and perceptions of likeability by peers in children. Br J Dev Psychol. 2020 Jun;38(2):319\u2013\u200936. https:\/\/doi.org\/10.1111\/bjdp.12324","DOI":"10.1111\/bjdp.12324"},{"key":"3073_CR19","doi-asserted-by":"publisher","unstructured":"Wong CL, Ching TY, Leigh G, Cupples L, Button L, Marnane V et al. Psychosocial development of 5-year-old children with hearing loss: risks and protective factors. Int J Audiol. 2018;57(sup2):S81\u201392. https:\/\/doi.org\/10.1080\/14992027.2016.1211764","DOI":"10.1080\/14992027.2016.1211764"},{"issue":"4","key":"3073_CR20","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1177\/1948550617715068","volume":"8","author":"AM Schoemann","year":"2017","unstructured":"Schoemann AM, Boulton AJ, Short SD. Determining power and sample size for simple and complex mediation models. Soc Psychol Personal Sci 2017. 2017;8(4):379\u201386.","journal-title":"Soc Psychol Personal Sci 2017"},{"issue":"2","key":"3073_CR21","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/00006534-199308000-00001","volume":"92","author":"S Nagata","year":"1993","unstructured":"Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg. 1993;92(2):187\u2013201. https:\/\/doi.org\/10.1097\/00006534-199308000-00001.","journal-title":"Plast Reconstr Surg"},{"key":"3073_CR22","doi-asserted-by":"publisher","unstructured":"Klassen AF, Longmire NM, Bulstrode NW, Fisher DM, Kasrai L, O\u2019Hara J et al. Development of a new patient-reported outcome measure for ear conditions: the EAR-q. Plast Reconstr Surg Glob Open. 2018;6(8):e1842. https:\/\/doi.org\/10.1097\/GOX.0000000000001842","DOI":"10.1097\/GOX.0000000000001842"},{"key":"3073_CR23","unstructured":"McMaster U. Ear-q - measuring what matters to patients. Available from: https:\/\/qportfolio.org\/ear-q\/ (2018). Accessed 4 Jul 2024."},{"issue":"9","key":"3073_CR24","doi-asserted-by":"publisher","first-page":"2341","DOI":"10.1016\/j.bjps.2021.01.014","volume":"74","author":"AF Klassen","year":"2021","unstructured":"Klassen AF, Rae C, Bulstrode NW, Berenguer B, Cui C, Fisher DM, et al. An international study to develop the EAR-q patient-reported outcome measure for children and young adults with ear conditions. J Plast Reconstr Aes. 2021;74(9):2341\u201348. https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1748681521000577.","journal-title":"J Plast Reconstr Aes"},{"key":"3073_CR25","doi-asserted-by":"publisher","unstructured":"Kubba H, Swan IR, Gatehouse S. The glasgow children\u2019s benefit inventory: a new instrument for assessing health-related benefit after an intervention. Ann Otol Rhinol Laryngol. 2004 Dec;113(12):980\u2013\u200986. https:\/\/doi.org\/10.1177\/000348940411301208","DOI":"10.1177\/000348940411301208"},{"key":"3073_CR26","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.1017\/SJP.2021.46","volume":"24","author":"JJ Igartua","year":"2021","unstructured":"Igartua JJ, Hayes AF. Mediation, moderation, and conditional process analysis: concepts, computations, and some common confusions. Span J Psychol. 2021;24:e49. https:\/\/doi.org\/10.1017\/SJP.2021.46","journal-title":"Span J Psychol"},{"key":"3073_CR27","doi-asserted-by":"publisher","unstructured":"Jovic TH, Gibson J, Jovic M, Dobbs TD, Griffiths R, Akbari A et al. The psychosocial impact of microtia and ear reconstruction: a national data-linkage study. Front Pediatr. 2023;11:1148975. https:\/\/doi.org\/10.3389\/fped.2023.1148975","DOI":"10.3389\/fped.2023.1148975"},{"key":"3073_CR28","unstructured":"Carpendale J, Lewis C. How children develop social Understanding. Blackwell Publishing; 2006."},{"issue":"1","key":"3073_CR29","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1146\/annurev.psych.56.091103.070137","volume":"56","author":"B Major","year":"2005","unstructured":"Major B, O\u2019Brien LT. The social psychology of stigma. Annu Rev Psychol. 2005;56(1):393\u2013421. https:\/\/doi.org\/10.1146\/annurev.psych.56.091103.070137. https:\/\/www.annualreviews.org\/doi\/10.1146\/annurev.psych.56.091103.070137https:\/\/www.annualreviews.org\/doi\/pdf\/","journal-title":"Annu Rev Psychol"},{"key":"3073_CR30","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.copsyc.2017.10.003","volume":"23","author":"MA Hogg","year":"2018","unstructured":"Hogg MA, Rinella MJ. Social identities and shared realities. Curr Opin Psychol. 2018;23:6\u201310. https:\/\/doi.org\/10.1016\/j.copsyc.2017.10.003.","journal-title":"Curr Opin Psychol"},{"key":"3073_CR31","doi-asserted-by":"publisher","unstructured":"Sorter M, Chua J, Lamy M, Barzman D, Ryes L, Shekhtman JA. Management of emotion dysregulation and outbursts in children and adolescents. Curr Psychiatry Rep. 2022 Mar;24(3):213\u201326. https:\/\/doi.org\/10.1007\/s11920-022-01325-4.","DOI":"10.1007\/s11920-022-01325-4"},{"issue":"9","key":"3073_CR32","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1016\/j.bjps.2009.09.005","volume":"63","author":"A Steffen","year":"2010","unstructured":"Steffen A, Wollenberg B, K\u00f6nig IR, Frenzel H. A prospective evaluation of psychosocial outcomes following ear reconstruction with rib cartilage in microtia. J Plast Reconstr Aes. 2010;63(9):1466\u201373. https:\/\/doi.org\/10.1016\/j.bjps.2009.09.005. https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1748681509006263https:\/\/api.elsevier.com\/content\/article\/PII:S1748681509006263?httpAccept=text\/xml.","journal-title":"J Plast Reconstr Aes"},{"issue":"1","key":"3073_CR33","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/bjso.12349","volume":"59","author":"R Brown","year":"2020","unstructured":"Brown R. The social identity approach: appraising the Tajfellian legacy. Br J Soc Psychol. 2020;59(1):5\u201325. https:\/\/doi.org\/10.1111\/bjso.12349.","journal-title":"Br J Soc Psychol"},{"issue":"4","key":"3073_CR34","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.bjps.2014.12.019","volume":"68","author":"AL Johns","year":"2015","unstructured":"Johns AL, Lucash RE, Im DD, Lewin SL. Pre and post-operative psychological functioning in younger and older children with microtia. J Plast Reconstr Aes. 2015;68(4):492\u201397. https:\/\/doi.org\/10.1016\/j.bjps.2014.12.019. https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1748681514007219https:\/\/api.elsevier.com\/content\/article\/PII:S1748681514007219?httpAccept=text\/xml.","journal-title":"J Plast Reconstr Aes"},{"key":"3073_CR35","doi-asserted-by":"publisher","first-page":"101768","DOI":"10.1016\/j.bodyim.2024.101768","volume":"51","author":"M Thornton","year":"2024","unstructured":"Thornton M, Harcourt D, Deave T, Kiff J, White P, Williamson H. Cross-condition risk and protective factors for psychosocial distress in parents and carers of children and young people with appearance-affecting conditions and injuries. Body Image. 2024;51:101768. https:\/\/doi.org\/10.1016\/j.bodyim.2024.101768.","journal-title":"Body Image"},{"key":"3073_CR36","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1016\/j.neubiorev.2021.05.028","volume":"128","author":"PJ Eslinger","year":"2021","unstructured":"Eslinger PJ, Anders S, Ballarini T, Boutros S, Krach S, Mayer AV, et al. The neuroscience of social feelings: mechanisms of adaptive social functioning. Neurosci Biobehav Rev. 2021;128:592\u2013620. https:\/\/doi.org\/10.1016\/j.neubiorev.2021.05.028.","journal-title":"Neurosci Biobehav Rev"},{"key":"3073_CR37","doi-asserted-by":"publisher","unstructured":"Cubitt JJ, Chang LY, Liang D, Vandervord J, Marucci DD. Auricular reconstruction. J Paediatr Child Health. 2019 May;55(5):512\u201317. https:\/\/doi.org\/10.1111\/jpc.14444.","DOI":"10.1111\/jpc.14444"},{"key":"3073_CR38","doi-asserted-by":"publisher","unstructured":"Gordon K, Henkin Y, Kral A. Asymmetric hearing during development: the aural preference syndrome and treatment options. Pediatrics. 2015 Jul;136(1):141\u2013\u200953. Available from: https:\/\/doi.org\/10.1542\/peds.2014-3520","DOI":"10.1542\/peds.2014-3520"},{"key":"3073_CR39","doi-asserted-by":"publisher","unstructured":"Hubka P, Schmidt L, Tillein J, Baumhoff P, Konerding W, Land R et al. Dissociated representation of binaural cues in single-sided deafness: implications for cochlear implantation. J Neurosci. 2024;44(28). https:\/\/doi.org\/10.1523\/JNEUROSCI.1653-23.2024","DOI":"10.1523\/JNEUROSCI.1653-23.2024"},{"issue":"1","key":"3073_CR40","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.bodyim.2007.08.003","volume":"5","author":"DB Sarwer","year":"2008","unstructured":"Sarwer DB, Crerand CE. Body dysmorphic disorder and appearance enhancing medical treatments. Body Image. 2008;5(1):50\u20138. https:\/\/doi.org\/10.1016\/j.bodyim.2007.08.003.","journal-title":"Body Image"},{"key":"3073_CR41","doi-asserted-by":"publisher","unstructured":"McPherson KE, Kerr S, McGee E, Morgan A, Cheater FM, McLean J et al. The association between social capital and mental health and behavioural problems in children and adolescents: an integrative systematic review. BMC Psychol. 2014;2(1):7. https:\/\/doi.org\/10.1186\/2050-7283-2-7","DOI":"10.1186\/2050-7283-2-7"},{"key":"3073_CR42","doi-asserted-by":"publisher","unstructured":"Hay DF, Paine AL, Perra O, Cook KV, Hashmi S, Robinson C et al. Prosocial and aggressive behavior: a longitudinal study. Monogr Soc Res Child Dev. 2021;86(2):7\u2013103. https:\/\/doi.org\/10.1111\/mono.12427","DOI":"10.1111\/mono.12427"}],"container-title":["BMC Psychology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40359-025-03073-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40359-025-03073-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40359-025-03073-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T21:32:59Z","timestamp":1757280779000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpsychology.biomedcentral.com\/articles\/10.1186\/s40359-025-03073-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,24]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3073"],"URL":"https:\/\/doi.org\/10.1186\/s40359-025-03073-5","relation":{},"ISSN":["2050-7283"],"issn-type":[{"value":"2050-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,24]]},"assertion":[{"value":"29 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 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":"The study was conducted according to the principles in the declaration of Helsinki-version 2008. All procedures were approved by the Ethics Committee and the Ethics Review Board of Eye & ENT Hospital of Fudan University (No. 2023191). Informed consent was obtained from all participants prior to the initiation of data collection, consent was also provided by a parent\/legal guardian for individuals under 16 years of age. Additionally, participants were provided with a detailed explanation of the study\u2019s objectives.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"826"}}