The journal of international advanced otology最新文献

{"title":"Clinical Significance of Neuro-Otological Examinations in Persistent Postural-Perceptual Dizziness: A Retrospective Study.","authors":"Fumiyuki Goto, Shoji Kaneda, Koichiro Wasano","doi":"10.65717/iao.2026.252185","DOIUrl":"https://doi.org/10.65717/iao.2026.252185","url":null,"abstract":"<p><strong>Background: </strong>Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder characterized by non-spinning dizziness, postural instability, and hypersensitivity to visual and motion stimuli. While Bárány Society criteria enable diagnosis, the prognostic value of neuro-otological examinations remains unclear. To assess the relationship between neuro-otological test results and short-term clinical improvement in PPPD, clarifying their clinical significance.</p><p><strong>Methods: </strong>A retrospective review was conducted of 24 patients with PPPD identified from 103 patients with intractable dizziness treated between 2022 and 2024. All underwent video head impulse testing (vHIT), cervical vestibular-evoked myogenic potential (cVEMP), and ocular VEMP (oVEMP). Semicircular canal dysfunction was defined as reduced gain with corrective saccades; otolith dysfunction as absent responses or abnormal asymmetry ratios. Dizziness Handicap Inventory (DHI) and Hospital Anxiety and Depression Scale (HADS) were administered. All received selective serotonin reuptake inhibitors plus structured vestibular rehabilitation. Clinical improvement was evaluated with the Clinical Global Impression-Improvement (CGI-I) scale at 3 months.</p><p><strong>Results: </strong>Among the 23 patients analyzed, the mean CGI-I score was 2.7 ± 0.9. Ten patients had a good prognosis (mean CGI-I score,1.8 ± 0.4), whereas 13 had a poor prognosis (mean CGI-I score, 3.4 ± 0.5). No significant differences in DHI or HADS scores were observed between the prognosis groups. Otolithic vertigo was the most common precipitating condition. Otolith dysfunction was identified in 9 patients (38%): cVEMP only (n=5), oVEMP only (n=1), and both (n=3). No horizontal semicircular canal dysfunction was detected on vHIT. Prognosis did not differ significantly between patients with (3.1 ± 0.8) and without (2.5 ± 0.9) vestibular dysfunction (P > .05). A history of psychiatric consultation was also not associated with prognosis (P > .05). Patients who initiated treatment within 3 months of symptom onset tended to have better outcomes, although the difference was not statistically significant.</p><p><strong>Conclusion: </strong>Over one-third of PPPD patients demonstrated otolith dysfunction, suggesting peripheral vestibular involvement in pathogenesis. While vestibular test abnormalities were not linked to short-term prognosis under standardized therapy, cVEMP and oVEMP provided patho-physiological insights and identified isolated otolith deficits undetected by vHIT. Larger prospective studies are warranted to evaluate their prognostic utility and guide personalized rehabilitation.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-5"},"PeriodicalIF":1.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Study to Test the Effectiveness of Intratympanic Dexamethasone Injections as a Treatment for Severe Disabling Tinnitus.","authors":"Asma Mohd Shoukat, Jyothi A Chavadaki, Ayesha Nazneen, Mohammed Soharwardi","doi":"10.65717/iao.2026.262088","DOIUrl":"10.65717/iao.2026.262088","url":null,"abstract":"<p><strong>Background: </strong>Tinnitus is the perception of sound without an external source and is frequently linked with hearing impairment. Subjective tin-nitus affects approximately 10% of the population, and in many cases, no cause is identified, classified as idiopathic. Intratympanic corticosteroids have gained attention for their targeted therapeutic effects. This study explores intratympanic dexamethasone in managing idiopathic cochlear tinnitus. Objective of this study is to evaluate the effectiveness of intratympanic dexamethasone injections in patients with severe disabling tin-nitus associated with or without sensorineural hearing loss.</p><p><strong>Methods: </strong>A descriptive observational study was conducted in the Department of Otorhinolaryngology at Navodaya Medical College and Hospital from October 2019 to September 2021. Sixty-five patients aged 18-60 years with tinnitus of at least 1-month duration and associated sensorineural hearing loss were included. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI). Patients received intratympanic dexamethasone (4 mg/mL, 0.4-0.6 mL) weekly for 4 weeks, with outcomes evaluated at completion.</p><p><strong>Results: </strong>The majority of patients were male (60%) and below 30 years of age. Significant improvement in THI scores was observed post-treatment, with mild cases increasing from 21.5% to 67.7%, moderate cases decreasing from 63.1% to 32.3%, and severe cases reducing from 15.4% to 0% (P < .05). Minimal complications were noted.</p><p><strong>Conclusion: </strong>Intratympanic dexamethasone was associated with reduced tinnitus severity in patients with idiopathic tinnitus, with or without sensorineural hearing loss. As this was a single-arm study without a control group, these findings warrant cautious interpretation pending validation in randomized controlled trials.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-9"},"PeriodicalIF":1.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tympanic Membrane Adhesion Model by Transcanal Endoscopic Ear Surgery in Rat.","authors":"Kazuhisa Yamamoto, Tsunetaro Morino, Yuki Takizawa, Shun Kikuchi, Masayuki Yamato, Hiromi Kojima","doi":"10.65717/iao.2026.252317","DOIUrl":"https://doi.org/10.65717/iao.2026.252317","url":null,"abstract":"<p><strong>Background: </strong>Tympanic membrane adhesion is a clinically significant and challenging complication of otologic surgery. However, a simple and reproducible animal model suitable for studying the pathogenesis of this disease and evaluating treatment strategies has not yet been established. This study aimed to develop a reproducible rat model of tympanic membrane adhesion using transcanal endoscopic ear surgery (TEES).</p><p><strong>Methods: </strong>Twenty-eight Sprague-Dawley rats underwent TEES. In each rat, 1 ear underwent a complete adhesion-inducing procedure involving tympanic membrane perforation and removal of the middle ear mucosa (model group), whereas the contralateral ear underwent tympanic membrane perforation only (sham group). Adhesion formation and bone hyperplasia were evaluated using micro-computed tomography, macroscopic observation, and histological analysis up to 56 days postoperatively.</p><p><strong>Results: </strong>Tympanic membrane adhesion occurred in 81.8% of ears 14 days after the procedure. No adhesions were observed in the sham group. All adhesion-positive ears showed middle ear bone hyperplasia at the mucosa-ablated sites, and histological analysis confirmed fusion between the tympanic membrane epithelium and the newly formed bone. In cases where adhesion was not achieved after the initial procedure, reoperation led to successful adhesion in all ears. No tympanic membrane retraction or middle ear effusion was observed during the postoperative period.</p><p><strong>Conclusion: </strong>A simple and highly reproducible rat tympanic membrane adhesion model was established using TEES. This model consistently reproduces postoperative tympanic membrane adhesion accompanied by middle ear bone hyperplasia and provides a useful platform for elucidating the mechanisms of adhesion and evaluating regenerative or antiadhesion therapies in the middle ear.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-8"},"PeriodicalIF":1.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cochlear Implant Electrode Impedances: A 5-Year Study.","authors":"Rania Sharaf, Shaza Saleh, Yassin Abdelsamad, Salman F Alhabib, Ahmed Ghormallah Alghamdi, Abdulrahman Hagr","doi":"10.65717/iao.2026.262371","DOIUrl":"https://doi.org/10.65717/iao.2026.262371","url":null,"abstract":"<p><strong>Background: </strong>Electrode impedance (EI) monitoring is vital for understanding electrode-tissue interface dynamics and ensuring consistent neural stimulation in cochlear implant (CI) recipients.</p><p><strong>Methods: </strong>This retrospective cohort study examined long-term EI patterns in 79 CI recipients (136 implanted ears) over a 5-year period. Impedance measurements were obtained intraoperatively and at 1 and 5 years post-implantation across 12 electrodes, categorized into apical (electrodes 1-4), middle (5-8), and basal (9-12) regions.</p><p><strong>Results: </strong>The apical region showed stable impedance throughout the 5-year analysis, with no significant changes. Middle and basal electrodes exhibited significant increases in impedance at both the 1- and 5-year assessments compared with intraoperative values. But no significant progression occurred between the 1- and 5-year assessments, indicating that impedance stabilized for long-term duration after its initial stabilization within the 1-year period.</p><p><strong>Conclusion: </strong>The biological response surrounding the electrode array occurs predominantly as an early postoperative event that subsequently stabilizes rather than progresses. The dynamic impedance patterns underscore the importance of regular monitoring during the initial postoperative year. They also suggest that individualized mapping strategies may be required.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-7"},"PeriodicalIF":1.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Candidates for Revision Tympanoplasty and Implantable Hearing Devices in Cases of Postoperative Hearing Failure in Cholesteatoma.","authors":"Yuko Kondo, Yutaka Yamamoto, Takara Nakazawa, Sho Kurihara, Masahiro Takahashi, Masaomi Motegi, Kazuhisa Yamamoto, Yuika Sakurai, Hiromi Kojima","doi":"10.65717/iao.2026.262348","DOIUrl":"https://doi.org/10.65717/iao.2026.262348","url":null,"abstract":"<p><strong>Background: </strong>To evaluate postoperative hearing outcomes in patients undergoing tympanoplasty for acquired cholesteatoma and to identify candidates suitable for revision surgery or implantable hearing devices.</p><p><strong>Methods: </strong>This retrospective study analyzed 177 patients who underwent primary tympanoplasty for acquired cholesteatoma between 2009 and 2015. Postoperative hearing outcomes were classified based on the air-bone gap (ABG), with ≤15 dB defined as successful. Candidates for revision tympanoplasty were identified according to the presence of an intact stapes, aerated mesotympanum on CT, and absence of tympanic membrane adhesion. Eligibility for cochlear implants (CIs), bone-anchored hearing aids (Baha®), and Vibrant Soundbridge (VSB) was assessed following Japan Otological Society (JOS) guidelines.</p><p><strong>Results: </strong>Of 177 patients, 98 (55.3%) had unsuccessful hearing outcomes. Among these, 46 (46.9%) were candidates for revision tympanoplasty and 37 (37.7%) for implantable hearing devices (3 for CI, 13 for Baha®, and 27 for VSB), with partial overlap. Overall, 71 of the 98 patients (72.4%) were eligible for either revision surgery or hearing device implantation.</p><p><strong>Conclusion: </strong>More than half of the patients undergoing tympanoplasty for acquired cholesteatoma had suboptimal postoperative hearing; however, many patients remained candidates for additional interventions, highlighting the importance of structured postoperative reassessment, individualized auditory rehabilitation, and collaborative care between physicians and institutions.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-6"},"PeriodicalIF":1.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Auditory and Language Development in Children with White Matter Diffused Lesions Using Cochlear Implants.","authors":"Banumathi, Jawahar Antony Periannan, Manjula Puttabasappa, Saravanan Palani, Megha, Geetha Chinnaraj","doi":"10.65717/iao.2026.252241","DOIUrl":"https://doi.org/10.65717/iao.2026.252241","url":null,"abstract":"<p><strong>Background: </strong>The objective was to study the auditory and speech and language development in children with white matter diffused lesions using cochlear implants (CIs). A total of 12 pediatric CI recipients with diffused white matter lesions (WMLs) were compared with 12 implant age-matched children without WMLs.</p><p><strong>Methods: </strong>The measures included for comparison of performance were sound field aided thresholds, speech identification, and language development at 2 years post cochlear implantation.</p><p><strong>Results: </strong>Analysis revealed auditory detection was within the soft conversational level and no statistically significant difference was noticed in speech perception scores between the 2 groups. However, children with WMLs demonstrated significantly lower receptive and expressive language ages compared to the control group.</p><p><strong>Conclusion: </strong>Despite preserved auditory detection, white matter diffuse lesions appear to significantly impact language comprehension and expression. This may result from lesions interfering with cognitive processes crucial for speech and language development. The finding highlights the need for comprehensive pre-implant evaluations, counseling on guarded prognosis and tailored rehabilitation strategies for children with white matter diffuse lesions.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-8"},"PeriodicalIF":1.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Treatment with Platelet-Rich Concentrate on Temporalis Fascia Myringoplasty for Managing Tympanic Membrane Perforation Due to Chronic Otitis Media: A Systemic Review and Meta-analysis.","authors":"Do Hyun Kim, David W Jang, Se Hwan Hwang","doi":"10.65717/iao.2026.252203","DOIUrl":"10.65717/iao.2026.252203","url":null,"abstract":"<p><strong>Unlabelled: </strong>This meta-analysis assessed the efficacy of temporalis fascia myringoplasty (TFM) combined with platelet-rich concentrate (PRC) on tympanic membrane (TM) healing in TM perforation due to chronic otitis media (COM), compared to TFM alone. A comprehensive search was conducted across PubMed, SCOPUS, EMBASE, Web of Science, and the Cochrane Library. The intervention group underwent TFM with the addition of PRC, while the control group received TFM alone. Key outcomes measured included the success rate (complete TM healing), postoperative infection incidence, changes in air-bone gap (ABG) and air conduction (AC), and the proportion of patients experiencing postoperative auditory improvement of at least 10 decibels, as recorded in audiograms. Pooled effects were determined using standardized mean differences or odds ratios, with 95% CIs. Twenty-four studies (n=1669) were included. TFM combined with PRC led to greater improvements in ABG and AC. The intervention group showed a significant increase in postoperative auditory improvement, exceeding 10 decibels in audiograms, as well as a higher success rate. Subgroup analysis by perforation size revealed that the intervention group achieved superior outcomes in medium and large perforations. Additionally, PRC application significantly reduced the incidence of postoperative infection. Autologous PRC application during TFM enhances surgical success and hearing improvement, especially in medium and large perforations, while also lowering postoperative infection rates.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-11"},"PeriodicalIF":1.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author response: Health-Related Quality of Life Evaluation in Children with Cochlear Implants.","authors":"Tugba Tulaci, Banu Tijen Ceylan, Murad Mutlu, Kamil Gokce Tulaci, İstemihan Akin, Ali Ozdek","doi":"10.65717/iao.2026.2623301","DOIUrl":"https://doi.org/10.65717/iao.2026.2623301","url":null,"abstract":"","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Suppression Head Impulse Paradigm in Clinical Vestibular Testing: An Interpretation-Focused Narrative Review.","authors":"Leonardo Manzari","doi":"10.65717/iao.2026.262416","DOIUrl":"https://doi.org/10.65717/iao.2026.262416","url":null,"abstract":"<p><strong>Unlabelled: </strong>Suppression head impulse test (SHIMP) is a video head impulse test paradigm in which the visual target is head-fixed. Because the head impulse stimulus is identical to the conventional head impulse paradigm (HIMP; earth-fixed target), the 2 paradigms provide complementary information: HIMP primarily reveals vestibular hypofunction through compensatory catch-up saccades, whereas SHIMP elicits post-impulse anti-compensatory \"recapture\" saccades in healthy individuals and can therefore highlight residual vestibular drive and the integrity of the vestibulo-saccadic interaction. Since its first clinical description, SHIMP has been applied across unilateral and bilateral vestibular disorders and, more recently, in selected central nervous system conditions. However, interpretation remains variable between laboratories and devices and can be confounded by predictable stimulation, early saccades, covert substitution strategies, and phase-dependent changes after acute vestibular loss. This narrative review focuses on an interpretation framework that explicitly separates (i) vestibular drive (slow-phase vestibulo-ocular reflex and gain) from (ii) the saccadic strategy required to re-foveate the task-defined target. The review synthesizes the physiological rationale for the reversed saccadic signature of SHIMP versus HIMP, proposes a terminology set, and provides practical interpretation rules with key sub-cases (acute versus follow-up unilateral vestibular loss; bilateral vestibulopathy with \"inappropriate\" covert saccades; SHIMP-negative patterns with functional gain in central disorders). Emphasis is placed on trace-level waveform inspection and longitudinal, context-aware reading of gain and saccade metrics.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-10"},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between 226-Hz Single Frequency Static Admittance and Wideband Absorbance in Adults with Normal Hearing.","authors":"Apoorva Shivaprakash, Animesh Barman","doi":"10.65717/iao.2026.262455","DOIUrl":"https://doi.org/10.65717/iao.2026.262455","url":null,"abstract":"<p><strong>Background: </strong>Single-frequency tympanometry using a 226-Hz probe tone is routinely employed to evaluate middle-ear function. However, individuals with normal hearing may exhibit different tympanometric subtypes (types A, As, and Ad), reflecting variations in middle-ear mechanics. Whether these differences correspond to systematic changes in wideband absorbance (WBA) remains unclear.</p><p><strong>Methods: </strong>Sixty ears from adults aged 18-35 years with normal hearing sensitivity were included. Based on conventional tympanometry, ears were categorized into types A, As, and Ad groups (20 ears each). Wideband absorbance was measured from 250 to 8000 Hz under ambient and peak pressure conditions. Mixed repeated-measures analysis of variance assessed the effects of pressure, frequency, and tympanometric subtype on absorbance. Post-hoc comparisons identified intergroup differences, and correlation analysis examined the relationship between 226-Hz static admittance and WBA.</p><p><strong>Results: </strong>Absorbance was higher at peak than ambient pressure across groups, with the greatest differences at lower frequencies. Distinct absorbance patterns emerged among tympanometric subtypes, particularly in the low- to mid-frequency range. Under peak pressure, significant differences extended to 1250 Hz between types A and As ears and to 3000 Hz in comparisons involving type Ad. Static admittance showed a strong positive correlation with WBA up to approximately 3 kHz, weakening at higher frequencies.</p><p><strong>Conclusion: </strong>Tympanometric subtypes in normal-hearing adults are associated with measurable differences in wideband energy transmission. Integrating WBA with conventional tympanometry may enhance clinical interpretation by providing a more comprehensive view of middle-ear function.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":"22 4","pages":"1-7"},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}