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 C09 Otorhinolaryngologic Diseases D010038 +
  C09.218 Ear Diseases D004427 +
   C09.218.903 Tympanic Membrane Perforation D018058 
 C21 Disorders of Environmental Origin D007280 +
  C21.866 Wounds and Injuries D014947 +
   C21.866.930 Tympanic Membrane Perforation D018058