Comprehensive ABA-based interventions in the treatment of children with autism spectrum disorder - a meta-analysis.

BACKGROUND: Many studies display promising results for interventions that are based on Applied Behavior Analysis (ABA) in the treatment of autism spectrum disorder (ASD). METHODS: This meta-analysis assessed the effects of such treatments on developmental outcomes in children with ASD and on parental stress based on 11 studies with 632 participants. RESULTS: Compared to treatment as usual, minimal or no treatment, comprehensive ABA-based interventions showed medium effects for intellectual functioning (standardized mean difference SMD = 0.51, 95% CI [0.09; 0.92]) and adaptive behavior (SMD = 0.37, 95% CI [0.03; 0.70]). Language abilities, symptom severity or parental stress did not improve beyond the improvement in control groups. Moderator analyses indicate that language abilities at intake could influence the effect sizes and the influence of treatment intensity might decrease with older age. CONCLUSIONS: Practical implications and limitations are discussed.

Speech perception in noise and sound localization using different microphone modes in pediatric bilateral cochlear implant users.

OBJECTIVE: The aim of the study was to investigate if a directional microphone mode improves speech perception in noise and sound localization in experienced pediatric bilateral cochlear implant users. METHODS: 15 bilaterally implanted children were included in the analysis. Speech perception in 4 noise conditions (S0N0, S0N90, S0N-90, S0N180) and sound localization were measured when using the OPUS 2 audio processor (omnidirectional mode) and the SONNET audio processor (omnidirectional and natural mode). RESULTS: Speech perception in all 4 noise conditions was better with the SONNET natural mode than with the omnidirectional mode of either SONNET or OPUS 2. The root-mean-square error of the sound localization test was smaller with the natural mode of SONNET than with the omnidirectional mode of either SONNET or OPUS 2. The performance of the audio processors in the omnidirectional mode did not differ significantly except in the S0N0 condition of the speech perception test. CONCLUSION: The natural microphone mode of the SONNET audio processor improved speech perception in noise and sound localization in bilaterally implanted children.

The differences of the impact of a lipid and protein corona on the colloidal stability, toxicity, and degradation behavior of iron oxide nanoparticles.

AIM: In this study, the influence of a serum albumin (SA) and human plasma (HP) derived protein- and lipid molecule corona on the toxicity and biodegradability of different iron oxide nanoparticles (IONP) was investigated. METHODS: IONP were synthesized and physicochemically characterized regarding size, charge, and colloidal stability. The adsorbed proteins were quantified and separated by gel electrophoresis. Adsorbed lipids were profiled by ultraperformance liquid chromatography-ESI-tandem mass spectrometry. The biocompatibility was investigated using isolated erythrocytes and a shell-less hen's egg model. The biodegradability was assessed by iron release studies in artificial body fluids. RESULTS: The adsorption patterns of proteins and lipids varied depending on the surface characteristics of the IONP like charge and hydrophobicity. The biomolecule corona modified IONP displayed favorable colloidal stability and toxicological profile compared to IONP without biomolecule coronas, reducing erythrocyte aggregation and hemolysis in vitro as well as the corresponding effects ex ovo/in vivo. The coronas decreased the degradation speed of all tested IONP compared to bare particles, but, whereas all IONP degraded at the same rate for the SA corona, substantial differences were evident for IONP with HP-derived corona depending on the lipid adsorption profile. CONCLUSION: In this study the impact of the proteins and lipids in the biomolecule corona on the entire IONP application cycle from the injection process to the degradation was demonstrated.

Association of wound genesis on varying aspects of health-related quality of life in patients with different types of chronic wounds: Results of a cross-sectional multicentre study.

Patients with chronic wounds are significantly impaired in their health-related quality of life (HRQoL). The validated Wound-QoL questionnaire allows assessing the impact of chronic wounds on different aspects of HRQoL including physical, psychological, and everyday life-related impairments. The aim of our study was to investigate associations of these HRQoL dimensions with age, sex, and particularly wound genesis. In this retrospective, cross-sectional, multicentre study, Wound-QoL questionnaires from clinical routine of patients with venous leg ulcers, arterial leg ulcers, mixed leg ulcers, and diabetic foot ulcers (DFU) were evaluated. Effects of wound genesis, sex, and age were assessed with analysis of variance as well as correlation and multiple linear regression analyses. The completed questionnaires of 381 patients (f = 152/m = 229; mean age 68.9) were included. The wound genesis groups showed significantly different distributions of age and sex. We also found significant differences between those groups in everyday life-related QoL, with the greatest impairments in patients with DFU. Physical QoL scores showed significant differences between men and women depending on diagnosis group: in patients with venous leg ulcers, women had greater impairment of physical QoL than men. Independent of the underlying diagnosis, women had significantly higher scores in the psychological subscale as well as in the Wound-QoL sum scale. Within the subgroup of arterial leg ulcer patients, overall HRQoL sum score was significantly worse in older patients. Regression analyses supported negative effects of DFU diagnosis and female sex on HRQoL. Our data offer evidence that HRQoL shows clinically relevant differences between patients with chronic wounds of different genesis. Moreover, our data revealed that HRQoL is associated with age and sex, which should be considered when treating the patient groups. In order to be able to capture these important aspects and to offer individualised and patient-oriented treatments, the Wound-QoL should be implemented as a quick and uncomplicated standard instrument in daily routine. Patients with chronic wounds are significantly impaired in their health-related quality of life. Validated Wound-QoL questionnaire is a quick and easy-to-use instrument for daily practice. Wound-related quality of life shows clinically relevant differences between patients with chronic wounds of different genesis. Wound-related quality of life is associated with age and sex, which should be considered when treating these patient groups. Health-related quality of life should be regularly objectified in all patients with chronic wounds with a validated measuring instrument.

Site-specific interrogation of an ionic chiral fragment during photolysis using an X-ray free-electron laser.

Short-wavelength free-electron lasers with their ultrashort pulses at high intensities have originated new approaches for tracking molecular dynamics from the vista of specific sites. X-ray pump X-ray probe schemes even allow to address individual atomic constituents with a 'trigger'-event that preludes the subsequent molecular dynamics while being able to selectively probe the evolving structure with a time-delayed second X-ray pulse. Here, we use a linearly polarized X-ray photon to trigger the photolysis of a prototypical chiral molecule, namely trifluoromethyloxirane (C3H3F3O), at the fluorine K-edge at around 700 eV. The created fluorine-containing fragments are then probed by a second, circularly polarized X-ray pulse of higher photon energy in order to investigate the chemically shifted inner-shell electrons of the ionic mother-fragment for their stereochemical sensitivity. We experimentally demonstrate and theoretically support how two-color X-ray pump X-ray probe experiments with polarization control enable XFELs as tools for chiral recognition.

Impact of the Vestibular System on the Formation and Progression to Idiopathic Scoliosis: A Review of Literature.

The physiopathogenesis of adolescent idiopathic scoliosis remains unknown. However, a multifactorial pathogenesis is being assumed. Besides biomechanical, biochemical, and genetic factors, some studies have focused on congenital or acquired abnormalities in the vestibular organ with consecutive development of scoliosis. This study aims to analyze a possible correlation between any vestibular organ congenital or acquired pathologies and scoliosis based on the current literature. Therefore, we conducted a literature search in three databases, with search terms such as "scoliosis," "organ of balance," "idiopathic scoliosis," "vestibular organ," "spine," and "balance." Fifteen studies were selected and used for research. The relationship between scoliosis and vestibular organ abnormalities was recorded from all included works. Seven studies demonstrated a direct correlation between vestibular organ anatomical abnormalities and the form of the scoliotic spine. Another study confirmed the influence of the pathology of the vestibular organ on scoliosis but questioned whether it had an impact on the formation or the progression of the curvature. Others demonstrated a temporal overlap of the embryonic development of the vestibular organ and the beginning of pre-scoliotic characteristics, but their relationship remained questionable. In three studies, the correlation remained unclear, and any context has been denied. It seems unlikely that an isolated vestibular disorder can trigger structural scoliosis. However, the vestibular system pathologies may certainly occur in the multifactorial genesis of idiopathic scoliosis. Whether the correlation refers to the expression or the progression of scoliosis or may even have an influence on both remains unclear. New treatment options could be derived from these findings with a positive influence on the course of the deformity.

Impact of the Vestibular System on the Formation and Progression to Idiopathic Scoliosis: A Review of Literature

The physiopathogenesis of adolescent idiopathic scoliosis remains unknown. However, a multifactorial pathogenesis is being assumed. Besides biomechanical, biochemical, and genetic factors, some studies have focused on congenital or acquired abnormalities in the vestibular organ with consecutive development of scoliosis. This study aims to analyze a possible correlation between any vestibular organ congenital or acquired pathologies and scoliosis based on the current literature. Therefore, we conducted a literature search in three databases, with search terms such as “scoliosis,” “organ of balance,” “idiopathic scoliosis,” “vestibular organ,” “spine,” and “balance.” Fifteen studies were selected and used for research. The relationship between scoliosis and vestibular organ abnormalities was recorded from all included works. Seven studies demonstrated a direct correlation between vestibular organ anatomical abnormalities and the form of the scoliotic spine. Another study confirmed the influence of the pathology of the vestibular organ on scoliosis but questioned whether it had an impact on the formation or the progression of the curvature. Others demonstrated a temporal overlap of the embryonic development of the vestibular organ and the beginning of pre-scoliotic characteristics, but their relationship remained questionable. In three studies, the correlation remained unclear, and any context has been denied. It seems unlikely that an isolated vestibular disorder can trigger structural scoliosis. However, the vestibular system pathologies may certainly occur in the multifactorial genesis of idiopathic scoliosis. Whether the correlation refers to the expression or the progression of scoliosis or may even have an influence on both remains unclear. New treatment options could be derived from these findings with a positive influence on the course of the deformity.

Comparison of the Effects of Two Cochlear Implant Fine Structure Coding Strategies on Speech Perception.

Purpose This study aims to investigate the effect of upgrading from the fine structure processing (FSP) coding strategy to the novel fine structure strategy "FS4" in adults in adults with cochlear implants manufactured by MED-EL GmbH (Innsbruck, Austria). Method A crossover, double-blinded study was conducted for 12 weeks. Twelve adult participants were randomly assigned to two groups. During the first 6-week test interval, one group continued to use their everyday FSP strategy, whereas the other group was upgraded to the FS4 strategy. In the second 6-week interval, the two groups switched coding strategies. Speech perception was measured at the end of each test interval with the Oldenburg Sentence Test and the Göttingen Sentence Test. Participants completed the Speech, Spatial and Qualities of Hearing Scale at the end of each test interval and a simple preference test at the end of the study. Results There was no significant difference in speech perception test results obtained with the Oldenburg Sentence Test and the Göttingen Sentence Test, neither in quiet nor in noise. Participants' Speech, Spatial and Qualities of Hearing Scale self-evaluation and preference test results showed that the two coding strategies had similar effects on their hearing perception. No clear preference for either of the strategies was found. Conclusions Speech perception test results and the participants' level of satisfaction were similar for the two FS coding strategies. Despite differences in the presentation of temporal fine structure between FSP and FS4, a clear benefit of the newer FS4 strategy could not be shown.

Platelet-rich fibrin suppresses in vitro osteoclastogenesis.

BACKGROUND: Platelet-rich fibrin (PRF) membranes can preserve alveolar ridge dimension after tooth extraction. Thus, it can be presumed that PRF suppresses the catabolic events that are caused by osteoclastic bone resorption. METHODS: To address this possibility, we investigated the impact of soluble extracts of PRF membranes on in vitro osteoclastogenesis in murine bone marrow cultures. Osteoclastogenesis was induced by exposing murine bone marrow cultures to receptor activator of nuclear factor kappa B ligand (RANKL), macrophage colony-stimulating factor (M-CSF) and transforming growth factor-beta 1 (TGF-ß1) in the presence or absence of PRF. Osteoclastogenesis was evaluated based on histochemical, gene expression, and resorption analysis. Viability was confirmed by formation of formazan crystals, live-dead staining and caspase-3 activity assay. RESULTS: We report here that in vitro osteoclastogenesis is greatly suppressed by soluble extracts of PRF membranes as indicated by tartrate-resistant acid phosphatase (TRAP) staining and pit formation. In support of the histochemical observations, soluble extracts of PRF membranes decreased expression levels of the osteoclast marker genes TRAP, Cathepsin K, dendritic cell-specific transmembrane protein (DCSTAMP), nuclear factor of activated T-cells (NFATc1), and osteoclast-associated receptor (OSCAR). PRF membranes, however, cannot reverse the process once osteoclastogenesis has evolved. CONCLUSION: These in vitro findings indicate that PRF membranes can inhibit the formation of osteoclasts from hematopoietic progenitors in bone marrow cultures. Overall, our results imply that the favorable effects of PRF membranes in alveolar ridge preservation may be attributed, at least in part, by the inhibition of osteoclastogenesis.

Reliability and Correlation Between Indoor Allergen Concentrations from Vacuumed Surface Samples and Electrostatic Dust Collectors.

OBJECTIVES: Most studies on indoor allergen exposure used vacuumed surface samples for quantification. One alternative is electrostatic dust collectors (EDCs), which sample previously airborne settled dust. The aim of this study was to compare allergen quantification using two different sampling methods, with respect to repeatability, and to determine how well the results agree with one another. METHODS: Four times a year, measurements were made from samples that were either collected from the vacuuming of surfaces, or from EDCs, from 20 German day-care centers totaling 167 rooms. Overall, 504 vacuumed samples collected from smooth floors, 435 samples from carpets, 291 samples from upholstered furniture and beds, and 605 EDC samples were analyzed using six fluorescence enzyme immunoassays recognizing Fel d 1, Can f 1, Mus m 1, domestic mite (DM), Dermatophagoides pteronyssinus (Dp), and Tyrophagus putrescentiae (Tp) antigens. Variances and correlations among the repeat measurements over the course of the year within each sample type, and the correlations between surface samples and the corresponding EDC samples were calculated. RESULTS: Repeat measurements over the year correlated significantly with one another. However, only Fel d 1, Can f 1, and DM in the EDC samples; DM, Dp, Tp, and Fel d 1 in the upholstered furniture samples; and DM in the carpet samples show representative results of single measurements according to their variance ratios (within-room/between-room variance <1). The highest correlation between surface and EDC samples was found for Fel d 1 on the upholstered furniture (r 0.52), followed by Can f 1 on the upholstered furniture and Can f 1 on carpets (r 0.47 and 0.45, respectively). The maximum correlation for mite antigens was between carpet samples and EDC (DM r 0.27, Dp r 0.33). Mus m 1 and Tp antigens for the most part did not correlate to the EDC results. CONCLUSIONS: Both vacuumed dust from upholstered furniture and EDC samples were suitable for repeatable quantification of several allergens in day-care centers within a year. However, there was little agreement among the different collection methods, especially for Mus m 1 and certain mite antigens. Therefore, the method and location used for collection may greatly influence allergen exposure assessment and study results.

Simulation of the long-term fate of superparamagnetic iron oxide-based nanoparticles using simulated biological fluids.

Aim: To simulate the stability and degradation of superparamagnetic iron oxide nanoparticles (MNP) in vitro as part of their life cycle using complex simulated biological fluids. Materials & methods: A set of 13 MNP with different polymeric or inorganic shell materials was synthesized and characterized regarding stability and degradation of core and shell in simulated biological fluids. Results: All MNP formulations showed excellent stability during storage and in simulated body fluid. In endosomal/lysosomal media the degradation behavior depended on shell characteristics (e.g., charge, acid-base character) and temperature enabling the development of an accelerated stress test protocol. Conclusion: Kinetics of transformations depending on the MNP type could be established to define structure-activity relationships as prediction model for rational particle design.

How flexible is the disulfide linker? A combined rotational-computational investigation of diallyl disulfide.

The symmetrically substituted diallyl disulfide adopts a non-symmetric conformation in the gas-phase, as observed with supersonic-jet rotational spectroscopy. The determination of the equilibrium structure with a predicate mixed regression illustrates both the benefits of the mass-dependent method for moderately large molecules and the structural peculiarities of the disulfide bridge.

Preservation of Vestibular Function and Residual Hearing After Round Window Cochlear Implantation.

OBJECTIVE: To examine the possible correlation between the loss of short-term residual hearing and vestibular function after cochlear implantation (CI). STUDY DESIGN: Retrospective patient review. SETTING: Academic tertiary referral center. PATIENTS: One hundred twenty patients with normal vestibular function (VF) in the caloric testing and residual hearing (RH) at the frequencies 250, 500, and 1000 Hz on the surgery side between 2008 and 2016 were included in the study. INTERVENTION: Primary CI on the first side via round window with a conventional full-length electrode. MAIN OUTCOME MEASURES: Changes of RH and VF 7 weeks after surgery were analyzed. Preservation of RH was defined as measurable postoperative thresholds at the frequencies 250, 500, and 1000 Hz in the pure-tone audiogram. Preservation of the VF after CI was assessed both by an absolute and relative threshold in the caloric testing. RESULTS: Seven weeks after implantation, the preservation of RH was achieved in 52 (43.3 %) patients and the preservation of VF in 95 (79.2 %) patients on the operated side. There was no significant statistical correlation between these two parameters. CONCLUSION: The loss of RH was more than twice as frequent as the loss of VF. However, no statistical correlation between the failure of the two inner ear functions was found. The exact causes are still unknown, but our data could give an indication that there may be different underlying pathomechanisms.

The S-S Bridge: A Mixed Experimental-Computational Estimation of the Equilibrium Structure of Diphenyl Disulfide.

The disulfide bridge (-S-S-) is an important structural motif in organic and protein chemistry, but only a few accurate equilibrium structures are documented. We report the results of supersonic-jet microwave spectroscopy experiments on the rotational spectra of diphenyl disulfide, C6 H5 -S-S-C6 H5 (including all 13 C and 34 S monosubstituted isotopologues), and the determination of the equilibrium structure by the mixed estimation (ME) method. A single conformation of C2 symmetry was observed in the gas phase. This disulfide is a challenging target since its structure is determined by 34 independent parameters. Additionally, ab initio calculations revealed the presence of three low-frequency vibrations (<50 cm-1 ) associated to phenyl torsions which would prevent the calculation of an accurate force field. For this reason, instead of the semiexperimental method, we used the mass-dependent (rm ) method to fit the structural parameters concurrently to moments of inertia and predicate parameters, affected with appropriate uncertainties. The predicates were obtained by high-level quantum-chemical computations. A careful analysis of the results of different fits and a comparison with the ab initio optimizations confirms the validity of the used methods, providing detailed structural information on the title compound and the disulfide bridge.

Influence of ambient air pressure changes on vestibular symptoms after stapes surgery.

OBJECTIVE: To examine if vestibular irritation after stapes surgery may be provoked by pressure changes across the tympanic membrane, which consecutively results in displacements of the ossicular chain and the piston prosthesis suspended to it. METHODS: In this prospective study 15 patients (13 female, 2 male) received unilateral stapes surgery (4 left, 11 right ear) with stapedotomy (n=14) or stapedectomy (n=1) at an academic tertiary referral center. Surgery was performed under local anesthesia via a transmeatal approach with a piston prosthesis 0.4×4.5mm. The fixation of the stapes, the exclusion of a malleus head fixation, and the gliding capacity of the malleus-incus joint were examined intraoperatively. A pure tone audiogram at four frequencies, a tympanometry with simultaneous video-oculography (VOG), caloric testing, and posturography with and without simultaneous tympanometry were performed six days before surgery, six weeks and three months after surgery, respectively. RESULTS: The mean air bone gap improved significantly from 25 (±8) dB preoperatively to 10 (±6) dB after surgery. In the tympanometry with simultaneous VOG only two patients showed nystagmus beats into the operated ears during only one of the two follow-up appointments. All other patients did not show any vestibular symptoms or nystagmus during any of the follow-up appointments. In the combined testing of posturography and tympanometry no patient showed any pathological findings. CONCLUSION: In patients who underwent stapes surgery with a piston prosthesis no vestibular symptoms can be provoked by pressure changes in the external auditory canal.

Semiexperimental and mass-dependent structures by the mixed regression method: Accurate equilibrium structure and failure of the Kraitchman method for ethynylcyclohexane.

The mixed regression method for determination of molecular structures is reviewed and applied to the investigation of ethynylcyclohexane, using both semiexperimental and mass-dependent methods. This methodology provides an efficient and computationally affordable route to obtain accurate molecular reference data, preventing ill-conditioning in the structural least-squares determinations from experimental rotational constants. New supersonic-jet microwave measurements are reported to obtain inertial data for the axial and equatorial species of ethynylcyclohexane, together with all 13C isotopologues of the equatorial form. The semiexperimental equilibrium (reSE) and mass-dependent (rm(2)) structures of the molecule are compared with high-level ab initio optimizations, showing that both methods deliver compatible structures with accuracies of about 0.002 Å for bond lengths and 0.2° for bond angles. We confirm that dependable predicates can be obtained for a large variety of bonds. Finally, we verify that the substitution method completely fails to determine a reliable structure for the title compound.

Bone-Conditioned Medium Obtained From Calvaria, Mandible, and Tibia Cause an Equivalent TGF-ß1 Response In Vitro.

Bones with different embryological origin and mode of ossification are supposed to vary in their capacity for supporting graft consolidation. The aim of the current pilot study was to assess the TGF-ß1 activity of bone chips obtained from distinct anatomic locations. Conditioned medium was prepared from bone chips harvested from pig calvaria, mandible, and tibia. Human oral fibroblasts were exposed to bone-conditioned medium (BCM) followed by reverse transcriptase polymerase chain reaction of the TGF-ß1 target genes. Also an immunoassay for interleukin 11 (IL-11) and TGF-ß1 was performed. The impact of BCM on alkaline phosphatase activity was determined with murine MC3T3-E1 osteogenic cells. The authors report here that BCM contains TGF-ß1 in the ng/mL range. Bone chips prepared from pig calvaria, mandible, and tibia femur had a similar capacity for increasing the expression of the TGF-ß1 target genes IL-11, NOX4, and PRG4. Correspondingly, immunoassays revealed similar production of IL-11 by human oral fibroblasts. Furthermore, conditioned medium obtained from the 3 bones decreased alkaline phosphatase activity in MC3T3-E1 osteogenic cells. These preliminary data demonstrate that particulated bone grafts, regardless of embryological origin, mode of ossification and morphology, release a similar TGF-ß1 activity.

Axial-equatorial isomerism and semiexperimental equilibrium structures of fluorocyclohexane.

An experimental-computational methodology combining rotational data, high-level ab initio calculations and predicate least-squares fitting is applied to the axial-equatorial isomerism and semiexperimental equilibrium structure determination of fluorocyclohexane. New supersonic-jet microwave measurements of the rotational spectra of the two molecular conformations, together with all 13C isotopologues of both isomeric forms are reported. Equilibrium rotational constants are obtained from the ground-state rotational constants corrected for vibration-rotation interactions and electronic contributions. Equilibrium structures were determined by the mixed estimation (ME) method. Different computational methods were tested for the evaluation of predicate values of the structural parameters, and a computationally effective procedure for estimating reliable dihedral angles is proposed. Structural parameters were fitted concurrently to predicate parameters and moments of inertia, affected with appropriate uncertainties. The new structures of the title compound are regarded as accurate to 0.001 Å and 0.2°, illustrating the advantages of this methodology. Structural comparisons are offered with the cyclohexane prototype, revealing subtle substituent effects. For comparison purposes the equilibrium structures for the two fluorocyclohexane isomers and cyclohexanone are computed from high-level ab initio theory with inclusion of adjustments for basis set dependence and correlation of the core electrons.

Repetitive freshwater diving: risk factors and prevalence of barotrauma.

OBJECTIVE: The aim was to investigate the influence of repetitive scuba diving in fresh water on the middle ear mucosa. The prevalence of middle ear barotrauma (MEB) and risk factors for MEB were evaluated. STUDY DESIGN: Prospective cohort study, Level of evidence 1b. METHODS: During three days, 23 divers made 144 repetitive dives in a freshwater lake. Participants underwent otoscopic examinations and were questioned about ENT-related complaints in the morning before the first dive, in between the dives and after the last dive. Otoscopic findings were documented and classified according to the TEED scale (0 = normal eardrum to 4 = perforation), for the right and the left ear separately. RESULTS: In total, 416 examinations were performed. ENT-related complaints during diving, mostly failed pressure equalization (74%), were reported after 10% of all dives. Most common pathology was MEB (TEED 1-3, 26%). Valsalva maneuver was possible during all exams. Significant increase of MEB (TEED⟩0) occurred with an increasing cumulative number of dives per day (P ⟨ .0001). Diving depth significantly influenced the MEB distribution (P = .035). MEB with higher TEED levels (2 and 3) was present only in the less experienced and intermediate divers. With increasing TEED level, more participants reported ENT-related problems (P ⟨ .0001). However, 74.4% of divers with MEB were still asymptomatic. CONCLUSION: During three days of diving, the MEB prevalence increased with a cumulative number of dives per day. The major risk factors were diving depth and diving experience. Higher TEED level correlated with an increasing number of subjective ENT-related disorders during diving.