∗Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth

†Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA

‡Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua

§Centre for Nephrology, University College London, London, UK

∥Department of Public Health at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua

¶Mayflower Medical Outreach, Managua Nicaragua

#Vivian Pellas Hospital, Managua, Nicaragua

∗∗Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth

††Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA

Address correspondence and reprint requests to James E. Saunders, M.D., Dartmouth-Hitchcock Medical Center, Otolaryngology Clinic, 4F, One Medical Center Drive, Lebanon, NH 03756; E-mail: [email protected]

Sources of support and disclosure of funding: This research is supported by NIH Grant R21 DC015133.

The authors disclose no conflicts of interest.