Journal of International Advanced Otology最新文献

{"title":"Acute Bacterial Meningitis and Petrous Apicitis in a Child with Aplasia Cutis Congenita: A Case Report.","authors":"Marina Saldanha,&nbsp;Vhaishakh Nayar,&nbsp;Benita Anna Augustine,&nbsp;Rathika D Shenoy","doi":"10.5152/iao.2023.22888","DOIUrl":"10.5152/iao.2023.22888","url":null,"abstract":"<p><p>Petrous apicitis and acute bacterial meningitis are uncommon in the present antibiotic era. The diagnosis of petrous apicitis is seldom considered unless there is cranial nerve palsy. A young child with aplasia cutis congenita presented with acute bacterial meningitis and an incidental opacified left mastoid in brain imaging. During the course, fever persisted, and high-resolution temporal bone imaging showed rapid progression to coalescent mastoiditis, petrous apicitis with erosions of tegmen tympani, and petrous apex. Other findings included bony dehiscences and thinning of left calvaria. Tympanomastoid exploration showed herniated brain and cerebrospinal fluid leak through tegmen tympani, which was closed with temporalis fascia graft. Herein, we report a rare presentation of petrous and tegmen erosion along with aplasia cutis congenita and discuss the challenges in diagnosis and management.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"355-359"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/74/jiao-19-4-355.PMC10544651.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barotrauma-Induced Perilymph Fistula: Video Head Impulse Test and High-Resolution Temporal Bones Computed Tomography Role in Evaluation and FollowUp.","authors":"Yoni E Gutkovich,&nbsp;Lev Shlizerman,&nbsp;Miki Paker,&nbsp;Salim Mazzawi,&nbsp;Kfir Siag,&nbsp;Avi Shupak","doi":"10.5152/iao.2023.22771","DOIUrl":"10.5152/iao.2023.22771","url":null,"abstract":"<p><p>We report a case of a woman presenting with unilateral right profound hearing loss accompanied by vertigo secondary to barotrauma-induced perilymph fistula during recreational skydiving. Video head impulse test demonstrated a reduced gain in both the right horizontal and right anterior semicircular canals accompanied by frequently gathered overt corrective saccades. High-resolution computed tomography revealed an enlarged vestibular aqueduct on the affected side, a predisposing factor for the development of perilymph fistula. An exploratory tympanotomy was performed during which a perilymph leak was visualized at the round window niche. Temporal fascia patches enforced by absorbable gelatin sponges were applied to both round and oval windows. During post-surgery follow-up, the patient remained free of vestibular symptoms. An audiogram displayed mild improvement in the right ear speech reception threshold, although her hearing remained non-serviceable. The video head impulse test showed a favorable dynamic with a stepwise return to normal gain values in all semicircular canals and the disappearance of overt corrective saccades. This is the first case in which video head impulse test was employed as a valuable diagnostic tool for the evaluation and post-surgery follow-up of vestibular function in a barotrauma-induced perilymph fistula. The demonstration of an enlarged vestibular aqueduct on high-resolution computed tomography and the risk of perilymph fistula recurrence are discussed.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"350-354"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e2/da/jiao-19-4-350.PMC10544128.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Delay in Pediatric Vestibular Disorders.","authors":"Anita Bhandari, Rajneesh Bhandari, Payal Kumbhat","doi":"10.5152/iao.2023.231052","DOIUrl":"10.5152/iao.2023.231052","url":null,"abstract":"<p><strong>Background: </strong>Vertigo and dizziness in children can be multi-factorial. Vestibular function tests allow an improved differential diagnosis and treatment. Delay in diagnosis of the diverse etiologies causing dizziness can adversely affect the health of children and is a matter of concern for their families. This study analyzes the delay in diagnosis and the importance of establishing a diagnosis with detailed history and neuro-otological evaluation.</p><p><strong>Methods: </strong>A total of 241 children presenting with vertigo to a tertiary otoneurology clinic between January 2019 and April 2022 were analyzed for the duration between the onset of symptoms and diagnosis, presenting complaints, and characteristic findings.</p><p><strong>Results: </strong>Two hundred and forty-one patients with a mean age of 12.5 ± 3.02 years (range, 5-16 years) were evaluated. About 39.4% of patients were diagnosed after over a year (with some over 5 years) of suffering from vertigo and only 18.7% of patients were diagnosed correctly within 1 month of symptom onset. The presenting features were variable with 174 (72.2%) complaining of spinning, unsteadiness, and falls seen in 36+10+37 (34.4%). Vestibular migraine was the most common diagnosis (63.39%), followed by benign paroxysmal positional vertigo (24.48%), of which the posterior canal was most affected (50.85%) followed by horizontal (40.68%) and anterior canal (8.47%). Other etiologies noted were central (14.10%) and peripheral vestibulopathy (17.42%) and variable other causes (6.19%).</p><p><strong>Conclusion: </strong>Many pediatric vertigo and dizziness patients do not reach the correct diagnosis for long durations and are treated as \"unspecified dizziness.\" A detailed examination with a multidisciplinary approach including vestibular evaluation is advocated to give definitive treatment to these children.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"318-322"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/96/jiao-19-4-318.PMC10544334.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Among Medical Therapy, SelfAdministered Exercise, and Characteristics of Ménière's Disease.","authors":"Ilmari Pyykkö,&nbsp;Nora Pyykkö,&nbsp;Vinaya Manchaiah","doi":"10.5152/iao.2023.21559","DOIUrl":"10.5152/iao.2023.21559","url":null,"abstract":"<p><strong>Background: </strong>The aim of the current study was to explore the associations among different therapeutic procedures, self-administered exercise, and characteristics of Ménière's disease.</p><p><strong>Methods: </strong>The study used a retrospective design and included 539 people with Ménière's disease who were focusing on self-administered exercise. The mean age and history of Ménière's disease among these participants were 61.9 years and 15.6 years, respectively. Of the participants, 79.5% were female. The data were collected by an electronic questionnaire that focused on symptoms of Ménière's disease, exercise and training habits, balance problems, impacts of the complaints, quality of life, medical treatment, physiotherapy, and psychotherapy.</p><p><strong>Results: </strong>Of the participants, 79.3% used medical treatment. Betahistine (56.8%) was the most popular followed by periodical anti-emetic use (41.0%) and diuretics (22.4%). Of the participants 70% were doing some self-administered training. The frequency of training depended on age, severity of balance problems, vestibular drop attacks, and gait problems. The type of training depended on age, quality of life, vestibular drop attacks, and gait problems. No association was found between vertigo and frequency/type of balance training.</p><p><strong>Conclusion: </strong>The use or effect of therapeutic procedures for Ménière's disease patients was not related to symptoms experienced. Most participants with Ménière's disease used training programs that aimed to alleviate their condition, especially balance-, gait-, and vestibular drop attack-associated problems. Patient support organizations should be working to help characterize the types of balance disorders people are dealing with in order to individually tailor a rehabilitation program to the patient's needs.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"323-332"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/d8/jiao-19-4-323.PMC10544177.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Conduction Threshold Measurements in Patients with Bone Conduction Devices: A Comparison of Available Methods.","authors":"Maciej Juliusz Wróbel,&nbsp;Renata Gibasiewicz,&nbsp;Marta Pietraszek,&nbsp;Łukasz Kluczyński,&nbsp;Wojciech Gawęcki","doi":"10.5152/iao.2023.22734","DOIUrl":"10.5152/iao.2023.22734","url":null,"abstract":"<p><strong>Background: </strong>The semi-implantable bone conduction devices connect the skull to the hearing device by means of an implant. This implant affords us 3 possible methods for conducting bone conduction evaluation, which may produce a different result for the same patient, and comparisons of results from different centers may therefore be interpreted incorrectly. Thus, the authors attempt to quantify the audiometric differences between the obtained auditory results and to check whether the results of standard pure tone audiometry could be replaced with the results obtained by alternative measurement methods.</p><p><strong>Methods: </strong>Measurements were conducted in a group of 53 adult patients implanted with bone conduction devices in 3 modes: bone conduction-direct, when the bone conduction device itself is used to assess the audiometric threshold; bone conduction-pure tone audiometry with audiometric oscillator placed over mastoid aside of an implant; and bone conduction-indirect with oscillator placed on an implant.</p><p><strong>Results: </strong>The analysis revealed differences between obtained results, which can reach up to 21.48 dB with a mean of 10 dB across all frequencies. The lowest values, regardless of the type of implant connection (\"magnetic\"; \"snap\"), were recorded for bone conduction-indirect mode whereas the highest mean all-frequency thresholds were recorded in the mode defined as bone conduction-direct.</p><p><strong>Conclusion: </strong>The method that provides the most comparable thresholds is when the oscillator is positioned on the mastoid, aside from an implant. It should be the method of choice for any hearing evaluation in patients fitted with bone conduction devices, because of standardized equipment and the availability of preoperative data obtained with the same method.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"288-294"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/0b/jiao-19-4-288.PMC10544138.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous Fat Injection for the Treatment of Patulous Eustachian Tube.","authors":"Juan Chen,&nbsp;Hao Xiong,&nbsp;Yuebo Chen,&nbsp;Haidi Yang","doi":"10.5152/iao.2023.221009","DOIUrl":"10.5152/iao.2023.221009","url":null,"abstract":"<p><strong>Background: </strong>Patulous eustachian tube is a disorder that leads to disturbing symptoms such as autophony, respiratory noise, and aural fullness. There has not been an established treatment found for this disorder. This study aims to assess the efficacy of autologous fat injection for a novel treatment of patients with patulous eustachian tube.</p><p><strong>Methods: </strong>Twenty-eight patients with refractory patulous eustachian tube were recruited for the study. Endoscopic autologous fat injection was performed submucosally into the anterior and posterior portion of the pharyngeal orifice of the eustachian tube. The outcomes were quantitatively assessed by comparing the difference between pre- and postoperative scores with the visual analog scale on 4 criteria: aural fullness, respiratory noise, tinnitus, and autophony.</p><p><strong>Results: </strong>Autologous fat injection was performed successfully in all patients without major complications. According to the combined visual analog scale scores, after the treatments, 20 patients showed significant improvement and 6 showed moderate improvement. The overall success rate of the treatment was 92.9%.</p><p><strong>Conclusion: </strong>Autologous fat injection is an effective and safe procedure for the treatment of patulous eustachian tube.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"311-317"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/06/jiao-19-4-311.PMC10544000.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facial Nerve Tumors in Children: Two Clinical Cases and a Review of the Literature.","authors":"Mariapaola Guidi,&nbsp;Flavio Giordano,&nbsp;Simone Peraio,&nbsp;Greta Conti,&nbsp;Renzo Guerrini,&nbsp;Franco Trabalzini","doi":"10.5152/iao.2023.22940","DOIUrl":"10.5152/iao.2023.22940","url":null,"abstract":"<p><p>We provide an extensive review of clinical features, diagnosis, and treatment of primitive facial nerve tumors in children, and report 2 recent personal observations. We conducted a comprehensive literature search through PubMed, Medline, and ScienceDirect and collected information on patients' age, symptoms, tumor types and sites, diagnostic procedures, surgical approaches, and outcomes. Overall, we reviewed 26 pediatric cases from 20 papers. About 69.2% of children presented with some degree of facial palsy. Other symptoms included hearing loss, dizziness, and tinnitus. 84.6% of tumors were schwannomas, followed by meningiomas, epithelioid hemangioendothelioma, and germ cell tumors. The geniculate ganglion was the most commonly affected segment of the facial nerve. A total of 92.3% of children received surgery as complete or partial tumor resection. Facial nerve function improved in 26.9% of children. No tumor recurrence was reported. Facial nerve tumors are extremely rare in children but should be considered in the differential diagnosis of facial palsy, even in newborns. Audiometric and radiologic examinations are necessary; radiologic imaging allows to determine tumor localization, and the correct surgical approach surgery is suggested in almost all cases.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"303-310"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/4b/jiao-19-4-303.PMC10543928.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffusion Tensor Imaging of Auditory Pathway: A Comparison of Pediatric Cochlear Implant Candidates and Healthy Cases.","authors":"Direnç Özlem Aksoy,&nbsp;Yeşim Karagöz,&nbsp;Kemal Furkan Kaldırımoğlu,&nbsp;Melis Baykara Ulusan,&nbsp;Abdullah Soydan Mahmutoğlu","doi":"10.5152/iao.2023.22998","DOIUrl":"10.5152/iao.2023.22998","url":null,"abstract":"<p><strong>Background: </strong>We aimed to investigate the changes that may occur in the auditory neural network in pediatric congenital hearing loss cases.</p><p><strong>Methods: </strong>Fifty-four cochlear implant candidates and 47 normal-hearing controls were included in this retrospective study. Fractional anisotropy, radial diffusivity, and apparent diffusion coefficient maps were generated. We placed region of interest on the cochlear nucleus, superior olivary nucleus, lateral lemniscus, medial geniculate body, auditory radiation, Heschl's gyrus, inferior fronto-occipital fasciculus, superior longitudinal fascicle, and corpus callosum splenium. The area of the cochlear nerve was measured. Diffusion tensor imaging metrics, children's ages, and cochlear nerve area were compared.</p><p><strong>Results: </strong>Apparent diffusion coefficient and radial diffusivity values of patients were higher than the control group in all places except the radial diffusivity values of medial geniculate body. The fractional anisotropy values of the patients in lateral lemniscus, auditory radiation, Heschl's gyrus, inferior fronto-occipital fasciculus, superior longitudinal fascicle, and corpus callosum splenium were lower than the control group. There is a positive correlation between fractional anisotropy and age in both patient and control groups for all locations. The cochlear nerve area is lower in patients (0.88 ± 0.29) than in the control group (1.18 ± 0.14) (P = .000). The cochlear nerve area has a positive correlation with age in the patient group (P = .000) but has not in the control group. The cochlear nerve area positively correlates with fractional anisotropy values of all locations except fractional anisotropy values of medial geniculate body.</p><p><strong>Conclusion: </strong>The alterations of diffusion tensor imaging metrics on the auditory pathway reflect the microstructural changes of white matter tracts.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"333-341"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/bb/jiao-19-4-333.PMC10544541.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Computed Tomography-Based Artificial Intelligence Modeling and Magnetic Resonance Imaging in Diagnosis of Cholesteatoma.","authors":"Orkun Eroğlu,&nbsp;Yeşim Eroğlu,&nbsp;Muhammed Yıldırım,&nbsp;Turgut Karlıdag,&nbsp;Ahmet Çınar,&nbsp;Abdulvahap Akyiğit,&nbsp;İrfan Kaygusuz,&nbsp;Hanefi Yıldırım,&nbsp;Erol Keleş,&nbsp;Şinasi Yalçın","doi":"10.5152/iao.2023.221004","DOIUrl":"10.5152/iao.2023.221004","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to compare the success rates of computed tomography image-based artificial intelligence models and magnetic resonance imaging in the diagnosis of preoperative cholesteatoma.</p><p><strong>Methods: </strong>The files of 75 patients who underwent tympanomastoid surgery with the diagnosis of chronic otitis media between January 2010 and January 2021 in our clinic were reviewed retrospectively. The patients were classified into the chronic otitis group without cholesteatoma (n=34) and the chronic otitis group with cholesteatoma (n=41) according to the presence of cholesteatoma at surgery. A dataset was created from the preoperative computed tomography images of the patients. In this dataset, the success rates of artificial intelligence in the diagnosis of cholesteatoma were determined by using the most frequently used artificial intelligence models in the literature. In addition, preoperative MRI were evaluated and the success rates were compared.</p><p><strong>Results: </strong>Among the artificial intelligence architectures used in the paper, the lowest result was obtained in MobileNetV2 with an accuracy of 83.30%, while the highest result was obtained in DenseNet201 with an accuracy of 90.99%. In our paper, the specificity of preoperative magnetic resonance imaging in the diagnosis of cholesteatoma was 88.23% and the sensitivity was 87.80%.</p><p><strong>Conclusion: </strong>In this study, we showed that artificial intelligence can be used with similar reliability to magnetic resonance imaging in the diagnosis of cholesteatoma. This is the first study that, to our knowledge, compares magnetic resonance imaging with artificial intelligence models for the purpose of identifying preoperative cholesteatomas.</p>","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"342-349"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/23/jiao-19-4-342.PMC10544284.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence (AI) in Otology: What Will the Future Be?","authors":"O Nuri Özgirgin","doi":"10.5152/iao.2023.170723","DOIUrl":"10.5152/iao.2023.170723","url":null,"abstract":"Artificial","PeriodicalId":54793,"journal":{"name":"Journal of International Advanced Otology","volume":"19 4","pages":"269-270"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/b6/jiao-19-4-269.PMC10544571.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}