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We note that utilization of the care management services has been significantly higher than CTBS, and we found that CTBS are not typically billed for a patient in the same month as care management services

Possible contributing factors include: Reduced blood flow to the inner ear Increased oxidative stress Damage to delicate hearing structures Smoking combined with loud noise exposure may further increase the likelihood of hearing damage over time

Reviews, commentaries, conference abstracts, and studies not directly addressing tobacco-related microbial alterations were excluded