Protect & Improve Your Hearing & Brain Health | Dr. Konstantina Stankovic

with Konstantina Stankovic

Published October 13, 2025
View Show Notes

About This Episode

Andrew Huberman and Dr. Konstantina Stankovic discuss how the auditory system works from the ear to the brain, emphasizing its extraordinary sensitivity and importance for communication, emotion, and cognition. They cover causes and types of hearing loss, tinnitus, noise exposure thresholds, and practical strategies to protect hearing, including sound level limits, earplugs, and possibly magnesium intake. The conversation also explores links between hearing loss and dementia, cochlear implants, genetic and environmental contributors to hearing loss, inner ear regeneration research, and broader issues such as environmental noise pollution and sensory-driven brain plasticity.

Topics Covered

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Quick Takeaways

  • Hearing loss is extremely common worldwide and often underappreciated, with one and a half billion people affected and strong evidence linking even subtle hearing deficits to cognitive decline and increased dementia risk.
  • The inner ear (cochlea) is extraordinarily small and sensitive, capable of detecting sub-angstrom displacements, which makes it both powerful and very vulnerable to damage from noise, drugs, infections, and other insults.
  • Temporary ringing or muffling after loud sound exposure can reflect permanent synaptic or cellular damage, even if standard hearing tests later look normal, contributing to so-called "hidden hearing loss."
  • Safe noise exposure is strongly time- and level-dependent: roughly 80 dB is safe for about 8 hours, and for every 3 dB increase above that, safe exposure time halves, making many concerts and loud environments inherently risky without protection.
  • Magnesium appears to protect against noise-induced hearing loss in some studies, and higher magnesium intake or serum levels are associated with better hearing, though optimal formulations and doses for hearing remain to be clarified.
  • Tinnitus is a phantom sound generated by the brain, often due to reduced input from the ear; attention and emotional circuits can amplify it, while amplification with hearing aids, cognitive behavioral therapy, and especially cochlear implants can significantly reduce it for many people.
  • Children and younger individuals are more vulnerable to noise-induced damage than adults, and what is comfortable for adults may be too loud for children, making early-life sound environments particularly important.
  • Many common medications and environmental exposures, including frequent use of non-steroidal anti-inflammatory drugs, certain antibiotics, chemotherapy agents, and micro- and nanoplastics, can injure auditory cells or neurons.
  • Women generally have better hearing than men before menopause, likely related to estrogen, but tend to "catch up" in hearing loss after menopause, and studies are now examining how hormone replacement might interact with hearing.
  • Birds can rapidly regenerate their inner ear hair cells, and dissecting the underlying pathways is informing efforts to reawaken similar regenerative processes in the mammalian ear while avoiding uncontrolled growth and cancer.

Podcast Notes

Introduction and global burden of hearing loss

Hearing loss prevalence and link to dementia

Hearing loss is widespread and growing[0:12]
Currently affects 1.5 billion people worldwide and disables 0.5 billion of them
World Health Organization estimates another 1 billion people will be affected by 2050
Association between hearing loss and dementia[0:00]
There is mounting evidence for a strong link between hearing loss and dementia
Not everyone with hearing loss will develop dementia, but researchers are trying to identify who is at risk

Podcast and guest introduction

Huberman Lab context and guest role

Podcast scope[0:29]
Huberman states the podcast discusses science and science-based tools for everyday life
Guest credentials[0:44]
Konstantina Stankovic is a medical doctor and researcher and chair of the Department of Otolaryngology - Head and Neck Surgery at Stanford School of Medicine

Episode goals and topics

Focus on hearing and related problems[0:58]
They will discuss how to protect hearing and deal with problems like tinnitus (ringing of the ears), which is described as very debilitating and common
Importance of hearing for cognition and engagement[1:07]
Most people don't think about hearing unless compromised, but clear hearing drives ability to think and engage with the world
Deaf people can have excellent cognition and engagement but compensate via sign language and lip reading
Subtle hearing deficits and cognitive issues[1:28]
Even subtle deficits can lead to focus issues and mild cognitive impairment
More serious hearing loss is directly related to dementia
Early onset of progressive hearing loss[1:40]
Partial hearing loss was traditionally associated with aging, but now progressive subtle hearing loss is occurring much earlier, even in childhood

Episode roadmap

Lifespan perspective on hearing[2:10]
They will cover how the auditory system works from the womb, through adolescence, into old age
Protecting and improving hearing[2:10]
Listeners will learn specific things they can do to protect hearing and remedy partial hearing loss
Huberman notes that many current behaviors are subtly or not so subtly damaging hearing but can be remedied easily
Behavioral and supplement-based tools[2:24]
They will discuss behavioral protocols backed by science and mention the use of magnesium to protect against hearing loss

How hearing works: anatomy and physiology

Overview of sound transduction in the ear

Path of sound through the outer and middle ear[5:10]
Sound travels down the ear canal and vibrates the eardrum (tympanic membrane)
Vibration sets in motion the middle ear bones: malleus, incus, stapes (Latin: hammer, anvil, stirrup)
Inner ear fluids and sensory cells[5:39]
Middle ear bones drive fluid motion in the inner ear where delicate sensory cells (hair cells) reside
Hair cells have stereocilia on their surface; deflection leads to ionic current flow, neurotransmitter release, and excitation of the auditory nerve
Mechanical stimulus is converted into an electrical one (mechanoelectrical transduction)

Types of hearing loss

Conductive hearing loss[6:21]
Affects the ability of sound to be conducted to the inner ear
Causes include hole in the eardrum, fluid behind the eardrum, or middle ear bones that are fixed and do not vibrate
Treatment options include surgical procedures and non-surgical amplification with hearing aids
Sensorineural hearing loss[6:26]
More common type; originates from the inner ear
Difficult to study because the organ is tiny, encased in the densest bone in the body, and deep at the base of the skull

Scale and sensitivity of the cochlea

Size and fluid volume of the inner ear[7:51]
Human cochlea in cross-section is the size of Lincoln's upper face on a penny
Inner ear is filled with two types of fluid (perilymph and endolymph) totaling about 140 microliters, roughly three raindrops
Extreme mechanical sensitivity[8:59]
The ear can detect displacements on the order of the diameter of a hydrogen atom (sub-angstrom level)
Comparison: electronic chip traces are around 1 nanometer (about five silicon atoms); the ear detects motion one-tenth that scale
Outer hair cells and high-frequency motion[9:37]
Outer hair cells in the inner ear actually move at audio frequencies
Heart beating at 1 Hz; 2 Hz is arrhythmia and can be life-threatening, yet outer hair cells move up to 20,000 Hz in humans and 100,000 Hz in bats
Highlights how incredible and specialized the auditory system is for detecting sound

Evolutionary and survival role of hearing

Sound as a robust environmental signal[10:25]
Sound travels through various media and around obstacles, allowing detection day or night
Some species survive well with excellent hearing but no vision (e.g., bats, moles)

Frequency encoding and cochlear tuning

Place-frequency map in the cochlea

Uncoiling the cochlea[11:30]
Cochlea is a coiled organ ("cochlea" means snail in Greek); if uncoiled, it is a tube
Tonotopic organization[11:30]
High frequencies are encoded at the base (near the middle ear), low frequencies at the apex
High-frequency sounds primarily cause basal cochlear vibration; low frequencies travel to and vibrate the apex
Vulnerability of high-frequency region[13:10]
High-frequency end of the cochlea tends to be more vulnerable to noise, certain drugs, and aging

Historical perspectives on hearing and communication

Importance of hearing for communication and art[12:31]
Huberman notes podcasts highlight how important communication via hearing is, creating vivid, engaging experiences even without vision
Socrates is quoted: "Speak so that I can see you"
François Rabelais said hearing is the fittest sense for reception of arts, sciences, disciplines
Helen Keller said deafness is a worse misfortune than blindness because it separates you from people rather than things
Indirect impacts of hearing[14:32]
Hearing affects emotional, relational, and cognitive well-being beyond basic communication

Sound intensity, safe exposure, and noise-induced damage

Decibel scale and examples of everyday sound levels

Logarithmic nature of decibels[34:44]
Decibel (dB) is a logarithmic scale compressing a millionfold range of sound pressure into a manageable scale
Common sound level benchmarks[34:39]
Normal conversation in the studio is about 60 dB
Airplane cabin noise is typically around 80 dB
Motorcycle around 100 dB; many amplified music concerts 110-120 dB
Jet engine around 140 dB; loudest football stadium noise recorded at 142 dB in Kansas City

Safe exposure times and the 3 dB halving rule

80 dB as an 8-hour benchmark[36:23]
Rough guideline: 80 dB is safe for about 8 hours
Halving of safe time with each 3 dB increase[36:15]
83 dB safe for about 4 hours, 86 dB for 2 hours, 89 dB for 1 hour, 92 dB for 30 minutes
Most amplified music concerts exceed 92 dB, so safe exposure times are quite short

Temporary vs. hidden hearing loss

Reconceptualizing "temporary" threshold shift[38:01]
Previously, ringing/clogged feeling after loud concerts that resolved was considered temporary threshold shift
Now evidence shows some "temporary" shifts involve permanent synaptic damage even if audiograms later look normal
Hidden hearing loss concept[39:28]
Young people can have normal audiometric thresholds but complain of difficulty hearing in noise or new tinnitus after loud exposure
Anatomical correlates include damage to synapses between hair cells and neurons and possibly to hair cells and neurons themselves

Protecting hearing: earplugs, magnesium, and behavior

Earplug use and fitting

Choosing attenuation level[39:57]
For very loud events (e.g., 120 dB concerts), she recommends earplugs providing at least 30 dB attenuation
Musicians' earplugs often provide about 14 dB, which may be insufficient at very loud events
Proper insertion matters[40:11]
If earplugs are not inserted correctly, stated attenuation ratings are meaningless and protection is inadequate

Magnesium as potential protection against noise-induced hearing loss

Evidence from military studies[41:24]
In countries with mandatory military service, groups exposed to artillery and explosions were compared with and without magnesium supplementation beforehand
Those who took magnesium before noise exposure had less hearing loss
Magnesium changes in the cochlea after noise trauma[41:11]
After noise trauma, magnesium levels change more in the cochlea than any other studied ion
Population-level associations[41:14]
Large human studies show people with higher serum magnesium or higher magnesium intake tend to have better hearing
She emphasizes dose and formulation are not yet precisely known and need more study
Magnesium formulations and brain entry[42:55]
Different magnesium forms have different tissue targets (gut, musculoskeletal system, brain)
Current thinking is that magnesium threonate is most efficient at crossing the blood-brain barrier and is probably best for hearing protection, but this specific study has not yet been done

Sleep, tinnitus, and supplements

Supplements and tinnitus: current evidence

Lack of robust benefit from most supplements[58:09]
Systematic reviews and meta-analyses indicate that nutritional supplements, taken broadly, have not shown clear benefit for tinnitus when all subtypes are lumped together
Tinnitus as an umbrella term[58:20]
Tinnitus is an umbrella term covering many different conditions, analogous to sensorineural hearing loss being an umbrella term
She notes it is conceivable that some subtypes might respond to specific interventions, but current methods do not differentiate subtypes well

Evidence-based interventions for tinnitus

Guidelines from professional societies[59:18]
American Academy of Otolaryngology-Head and Neck Surgery endorses two main interventions: amplification with hearing aids (if needed) and cognitive behavioral therapy
These are the approaches shown to make a difference in controlled studies

Tinnitus, attention, and brain circuits

Tinnitus as a phantom sound[1:00:06]
Tinnitus is described as a phantom sound produced by the brain, often in response to reduced input from the ear
Role of attention and emotion[1:02:20]
Some people can ignore tinnitus once reassured it is not life-threatening; others are severely disabled or suicidal due to strong emotional circuit engagement
She explains that the more one thinks about tinnitus, the more the tinnitus circuit is reinforced, similar to other brain circuits
Background noise and being occupied with other tasks can lessen the impact of tinnitus
Brain hyperactivity evidence[1:01:11]
Imaging and electrophysiology show hyperactivity in auditory centers (e.g., inferior colliculus) in people with tinnitus, including those with normal audiometric thresholds
Loud noise that leads to tinnitus can cause loss of inhibition in auditory circuits, resulting in hyperactivity and/or increased synchrony

Cochlear implants as a treatment for tinnitus

Tinnitus improvement rates with cochlear implants[1:03:06]
Approximately 75% of people with tinnitus who receive cochlear implants (for severe or profound hearing loss) experience improvement
In about 10% of those cases, tinnitus goes away entirely
Implications for peripheral restoration[1:03:32]
Finding suggests that improving peripheral auditory function allows the brain to recalibrate and often suppress tinnitus

Development, animals, and environmental noise

Fetal and early-life hearing

Onset of fetal hearing[1:14:23]
The fetus can hear in the second trimester
The organ of hearing is fully formed in utero and babies are born ready to hear
Fetal sound environment[1:13:49]
Experiments suggest fetuses can hear the mother's voice; detailed thresholds are hard to study due to safety limits

Animal hearing and environmental noise pollution

Pets and hearing[1:15:57]
She affirms all animals, including dogs and other pets, should be considered with respect to hearing damage from loud environments
Whales and dolphins affected by ship noise[1:16:19]
Large ships and motorized water vehicles generate noise that damages hearing and communication in sea animals like whales and dolphins
Whales rely on long-distance sound communication to navigate and stay with their group; noise pollution causes them to get lost
Light pollution and songbirds (analogy)[1:17:28]
Huberman mentions a study showing light pollution causes songbirds to sing longer throughout the year, disrupting mating and migration patterns
Lack of regulation on human environmental noise[1:19:09]
Stankovic notes amplified music is tightly controlled in some places (e.g., not allowed on certain European streets) but largely unregulated in the U.S.
She recounts being told that in a "free country" people can choose loud behavior if they know the consequences, highlighting a tension between regulation and autonomy

Hearing, social interaction, and dementia

Social isolation and stigma around hearing loss

Invisible nature and stigma[1:20:02]
Hearing loss is invisible; people often fear admitting it due to concerns about being perceived as losing cognitive capacity
Conversation difficulties and withdrawal[1:20:07]
In group settings, people with hearing loss may initially nod along, then misinterpret content, feel embarrassed, and eventually withdraw from social situations

Hearing loss and dementia risk

Strong indirect links[1:20:02]
Hearing loss leads to social isolation, depression, and cognitive decline, forming a strong indirect path to dementia
Direct mechanisms under investigation[1:25:25]
She says direct causal mechanisms linking hearing loss to dementia are actively being studied in humans and animal models, with some data supporting and some refuting a direct link

Economic and functional impact

Global cost of unaddressed hearing loss[1:21:19]
Annual cost of unaddressed hearing loss is nearly 1 trillion dollars globally
Costs include reduced employment opportunities, suboptimal job matches, and accommodations needed to support function

Limitations of standard hearing tests

Redundancy and threshold insensitivity[1:21:57]
Standard audiometric testing (tones in a sound booth) can appear normal even when up to 90% of auditory neurons are lost
The auditory system's extreme sensitivity and redundancy mean only one of about ten nerve fibers per hair cell is needed to detect sound in quiet
All ten fibers are needed for hearing in noisy environments, so deficits may only appear under noise
Speech-in-noise tests[1:22:48]
Testing speech understanding in noise, rather than in quiet, is emerging as a useful way to identify people at higher risk of cognitive decline related to hearing loss

Vestibular system, hyperacusis, and rare ear disorders

Hyperacusis and phonophobia

Reduced dynamic range in hearing loss[1:23:04]
Many people with hearing loss also experience hyperacusis: sounds must be loud to be heard but become painful or uncomfortable at higher levels
True phonophobia[1:23:53]
Severe fear of sound (phonophobia) is uncommon and often associated with underlying mental health conditions such as obsessive-compulsive disorder or certain personality traits

Vestibular organs and motion detection

Five balance organs in the inner ear[1:32:59]
Inner ear has one organ of hearing (cochlea) and five organs of balance
Two organs detect linear acceleration (one for horizontal, one for vertical)
Three semicircular canals detect angular acceleration (pitch, yaw, roll-like head movements)

Superior semicircular canal dehiscence syndrome

Symptoms and "superhuman" hearing[1:33:48]
In this condition, part of the bone over the superior semicircular canal is missing
Patients can hear bodily sounds intensely, including eyeball movements, footsteps, and water in the shower, which become unbearably loud
Loud sounds or straining (e.g., on the toilet) can induce spinning sensations and even cause them to pass out
Discovery and diagnosis[1:33:46]
The syndrome was discovered by Lloyd Minor, now dean of Stanford School of Medicine, who linked patients' reports of sound-induced eye movements to superior canal involvement
Minor applied loud sound to the ear and directly observed vertical eye movements, then used specialized CT imaging to visualize the dehiscence
Surgical treatment[1:34:11]
Surgery can plug or resurface the dehiscent canal, approached either via lifting the brain (middle cranial fossa) or drilling from behind the ear
Due to surgical risks, this operation is reserved mainly for patients with intractable vestibular symptoms rather than those only bothered by loud bodily sounds

Drugs, toxins, and lifestyle factors impacting hearing

Non-steroidal anti-inflammatory drugs (NSAIDs) and hearing

Regular NSAID use and risk[1:59:20]
Regular intake of NSAIDs like ibuprofen (defined as at least twice a week) increases the likelihood of developing hearing loss
This has been shown in studies of both men and women; younger people may be more vulnerable, but much of the loss is reversible when the drug is stopped

Other ototoxic medications

Antibiotics and diuretics[2:00:58]
Certain antibiotics such as gentamicin can be toxic to hearing
Some diuretics like furosemide can cause hearing loss
Drugs for erectile dysfunction[2:01:10]
Medications used to treat erectile dysfunction can cause sudden hearing loss; in most cases this is reversible if the medication is stopped
Chemotherapy agents[2:02:03]
Platinum-containing compounds used for cancer treatment are toxic to the ear and auditory neurons, in addition to other neurons in the body

Heavy metals and microplastics

Heavy metal toxicity[2:02:03]
Lead and mercury are noted as heavy metals that are toxic to neurons in the ear and elsewhere
Micro- and nanoplastics[2:03:39]
Plastic is ubiquitous, and micro- and nanoplastics are increasingly recognized as environmental pollutants
Her group exposed entire inner ears to micro- and nanoplastics and found they were preferentially taken up by hair cells
Functional consequences are not yet known, but the preferential uptake is described as striking and concerning
She warns against heating food in plastic containers (e.g., microwaving) because extremes of temperature increase plastic release

Inner ear regeneration, birds, and future therapies

Lack of natural regeneration in mammals

Non-regenerating hair cells[2:08:59]
In mammals, when inner ear hair cells are gone, they do not spontaneously regenerate

Bird hair cell regeneration

Rapid regeneration in birds[2:08:45]
Birds regenerate their hair cells quickly after damage, completing regeneration within days to about a month
Pathways identified[2:09:04]
Stanford investigator Stefan Heller published work describing specific pathways essential for hair cell regeneration in birds

Reawakening regenerative pathways in humans

Concept of controlled regeneration[2:09:46]
Understanding bird regeneration suggests the possibility of reawakening similar pathways in mammals and humans
Any approach must tightly control activation and deactivation of regenerative pathways, because unchecked cell division can lead to cancer
Notable absence of inner ear cancer[2:09:46]
She notes there is no primary cancer of the inner ear, which is highlighted as an intriguing fact
This uniqueness of the inner ear may eventually inform new cancer therapies, since it represents an organ that does not develop primary cancer

Distinctive healing in the head and neck and AI reflections

Head and neck microenvironment and healing

Rich blood supply and lymphatics[2:11:10]
Head and neck region features remarkable blood supply and a dense lymphatic system (including adenoid, tonsils, and lymph nodes), known as Waldeyer's ring
Reconstructive surgery outcomes[2:12:43]
In head and neck reconstruction after cancer (e.g., jaw or tongue removal), surgeons transplant tissue from other body sites (such as fibula or radial forearm), sewing artery to artery, vein to vein, nerve to nerve
Despite bringing sterile tissue into a microbe-rich environment, these reconstructions generally heal well with only standard short perioperative antibiotics
This robustness is cited as evidence of a unique and inspiring healing environment in the head and neck region

AI and acceleration of human progress

Doubling times across eras[2:21:12]
She references an essay (winner of a New York Times essay award) describing how long it takes different advances to double the economy
Hunting-based economies took about a quarter of a millennium to double; scientific discoveries take about 60 years; technological advances about 15 years
Potential inflection point with AI[2:21:58]
She suggests AI and superintelligence may represent an inflection point where growth of human progress, previously steady, could dramatically accelerate
She characterizes this prospect as super exciting and difficult to fully imagine

Closing reflections and practical takeaways

Huberman's behavioral changes and summary

Commitment to safer listening practices[2:22:13]
Huberman states he will be more thoughtful about headphone volume and general noise exposure to preserve hearing
Communication strategies with people who have hearing loss[2:22:49]
He reiterates that when talking to someone with hearing loss, it is more effective to face them, reduce background noise, and slow speech than to simply speak louder or yell

Gratitude and importance of ongoing research

Appreciation of auditory system richness[2:24:13]
Huberman expresses a much greater appreciation for the richness of the auditory system and its pervasive role in emotional, social, and cognitive life
Call for continued updates[2:24:40]
He invites Stankovic to return to share updates on discoveries related to hearing, tinnitus, cancer links, nutrition, and other intersecting domains

Lessons Learned

Actionable insights and wisdom you can apply to your business, career, and personal life.

1

Protecting your hearing requires actively managing sound exposure, because the auditory system is extraordinarily sensitive and damage from loud noise can accumulate even when standard hearing tests still look normal.

Reflection Questions:

  • What are the loudest environments I regularly expose myself (and my family) to, and how long do we typically stay in them?
  • How could I start tracking and limiting my noise exposure time above roughly 80 dB, for example by using earplugs or leaving earlier?
  • What specific change could I make this week-such as reducing headphone volume or wearing protection at events-to better safeguard my hearing over the long term?
2

Indirect effects of hearing loss-like social withdrawal, depression, and difficulty following conversations in noise-can quietly undermine cognitive health and increase dementia risk, so early recognition and support are strategic for long-term brain function.

Reflection Questions:

  • Where have I or someone close to me started avoiding social situations or group conversations because it's hard to hear clearly?
  • How might getting a proper hearing evaluation or using simple communication strategies (facing the person, reducing background noise) improve our daily interactions and mental well-being?
  • What concrete step could I take in the next month to check on and, if needed, support my own or a loved one's hearing and social engagement?
3

Attention and emotion strongly shape how we experience symptoms like tinnitus, which means that managing what you focus on and how you interpret sensations can change how disabling those sensations become.

Reflection Questions:

  • When I notice a bothersome sensation (like ringing, pain, or tension), do I tend to fixate on it or redirect my attention to something else?
  • How could I build small habits-such as using background sound, engaging in absorbing activities, or practicing cognitive strategies-that reduce the mental "spotlight" on uncomfortable sensations?
  • What is one situation this week where I could deliberately shift my focus away from a distressing bodily sensation and observe how that changes my experience?
4

Seemingly routine habits with medications, supplements, and plastics can have long-term effects on sensory systems, so it's worth periodically reassessing whether you truly need what you're taking and how you handle food and packaging.

Reflection Questions:

  • Which medications or over-the-counter drugs do I take regularly out of habit rather than clear ongoing need?
  • How might reducing unnecessary NSAID use, avoiding heating food in plastic, or improving my diet for magnesium and other nutrients impact my long-term health, including hearing?
  • What single change-such as switching storage containers, reviewing meds with a clinician, or adding magnesium-rich foods-could I implement this month to lower avoidable risks?
5

The brain remains remarkably plastic throughout life, and providing it with high-quality, appropriately challenging sensory input (such as music training or richer auditory environments at safe levels) can enhance resilience and function.

Reflection Questions:

  • In what ways am I currently challenging my brain with complex but enjoyable sensory experiences, like learning music, a language, or a new skill?
  • How could I incorporate more deliberate auditory practice-such as focused listening, musical training, or speech-in-noise exercises-into my routine without overexposing my ears to loudness?
  • What is one small, sustainable practice I could start this week that would give my brain richer input while still respecting safe hearing levels?
6

Because diagnostic labels like "sensorineural hearing loss" or "tinnitus" each hide many different subtypes, pushing for more precise assessment and personalized treatment is often more effective than accepting one-size-fits-all solutions.

Reflection Questions:

  • Where in my own health or work life have I accepted a broad label (e.g., "stress," "back pain," "fatigue") without seeking deeper understanding of the specific drivers?
  • How might asking more detailed questions or pursuing more nuanced testing change the options available to me or someone I support?
  • What is one area of my health or performance where I could move beyond a generic diagnosis and explore more tailored, evidence-based approaches?

Episode Summary - Notes by Avery

Protect & Improve Your Hearing & Brain Health | Dr. Konstantina Stankovic
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