To assess the implications of air conditioning and ventilation on droplet and airborne transmission of SARS-COV-2, several scientific research databases were searched and cross-referenced. Then, an analysis was conducted on the findings pertinent to interaction between several environmental variables affected by HVAC systems and their effect on Virus transmission. The results suggest that airflow velocity may interfere with the trajectories of large respiratory droplets and aerosols. Lower relative humidity provided suitable conditions for virus survival whereas higher temperatures increased aerosol formation, but were detrimental to virus survival. Suboptimal temperatures and humidity can compromise pathogen filtration functions in the nose, while proper use of HVAC functions can help preserve them. Transmission of SARS-COV-2 is not affected solely by the virus’s internal properties. Ambient conditions, whether natural or modified by HVAC systems can have a significant effect on the transmissibility and virulence of both the virus and virus-related sickness. The current infection prevention measures, such as social distancing, need to be revised in certain scenarios where natural ventilation or HVAC systems are involved. This will offer, hopefully, higher protection from infections with SARS-COV-2 and similar pathogens.

Background: This study evaluates outcome and patient benefit after plastic auricular reconstruction using a porous polyethylene framework and a temporoparietal fascia flap in both pediatric and adult patient collectives. Methods: Seventy-eight patients were asked to answer validated questionnaires determining the effects of the reconstruction on the patients' health-related quality of life (Glasgow Benefit Inventory or Glasgow Children's Benefit Inventory); Glasgow Benefit Inventory and Glasgow Children's Benefit Inventory scores can range from –100 (maximal adverse effect), through 0 (no effect), to 100 (maximal positive effect). Furthermore, patients were questioned regarding satisfaction, complaints, and complications with the reconstructed ear. Results: Sixty-five patients (83.3 percent) returned a valid questionnaire. In the adult collective (n = 45), the mean total Glasgow Benefit Inventory score was 21.2 (p < 0.001); 72.7 percent were satisfied with the aesthetic result, and 86.7 percent would again decide in favor of the operation. In the pediatric collective (n = 20), the mean total Glasgow Children's Benefit Inventory score was 27.7 (p < 0.001); 70.0 percent of the parents and 85.0 percent of the children were satisfied with the aesthetic result; 95.0 percent of the parents and 90.0 percent of the children would again decide in favor of the operation. The health-related quality of life was raised in 75.6 percent of the adults and 100 percent of the children. Scars and feel of the reconstructed ear were the main complaints in both collectives. Patients with acquired auricular defects were approximately two times as likely not to be satisfied with the result compared with patients with congenital defects. Conclusions: Auricular reconstruction using a porous polyethylene framework can significantly increase patients' health-related quality of life, and leads to a high rate of patient satisfaction.

Objectives: The presence of distant metastases affects the therapeutic regime in patients with head and neck squamous cell carcinoma. This study evaluated the necessity to undertake bone scanning. chest Computed tomography and abdominal Ultrasonography in patients presenting with primary advanced head and neck squamous cell carcinoma.Study design: Retrospective analysis, University setting.Methods: One hundred and sixty-three patients with head and neck squamous cell carcinoma who were scheduled for major surgery underwent screening for distant metastases. Chest, head and neck computed tomography, abdominal ultrasonography and bone scanning were performed in all patients.Results: Distant metastases were detected in 5.52 per cent of the 163 patients. All of these patients had locoregional advanced (stage IV) tumours. Computed tomography scanning of the lungs revealed metastases in six patients. Bone metastases were found in three patients. Only one patient with primary liver metastases was detected by abdominal ultrasonography; this patient also had pulmonary metastases.Conclusions: Computed tomography of the thorax is the most important technique for screening patients with head and neck squamous cell carcinoma.

CONCLUSION:In agreement with previously published findings, our results demonstrate that Pelizaeus Merzbacher disease (PMD) does not affect the development and morphology of the peripheral vestibulo-cochlear system.OBJECTIVE:PMD is a consequence of X-linked mutation of the main central nervous system (CNS) myelin protein resulting in a complex neurological syndrome. Otorhinolaryngological symptoms include nystagmus and alterations of auditory-evoked brainstem responses. To date no histopathological analysis of the inner ear has been performed.MATERIALS AND METHODS:The temporal bone morphology of an affected fetus was examined with light microscopy and synchrotron radiation-based micro computed tomography.RESULTS:The regular structure of the vestibulo-cochlear system was shown in this multi-modular analysis.

Hypothesis: Growth hormones have beneficial effects on increasing height in adults with Turner syndrome (TS) and may also affect auditory function. Background: Turner syndrome is the most common sex-linked chromosomal abnormality in female conceptions. Epidermal growth factor and its receptor (EGFR) affect differentiation, proliferation, and migration of epithelial cells and function as survival factors. The expression of EGFR is found in the developing and juvenile inner ear of experimental animals but is absent in adults. Methods: To determine whether EGFR plays a role in TS, its expression was analyzed in the cochlea of healthy fetus and fetus with TS and in healthy adults. Results: In healthy fetuses, EGFR protein expression was localized to the inner and outer hair cells and the Reissner membrane. The fetuses with TS on the 13th gestational week (GW) showed a similar pattern of immunoreactivity as the normal 16th and 20th GW cochlea. By the 23rd GW, EGFR immunoreactivity was not detectable in the TS hair cells or the Reissner membrane, and less intensive staining was found in the surrounding fibrocytes of the spiral ganglion. Conclusion: This is the first demonstration of EGFR immunoreactivity in the human cochlea and illustrates how EGFR expression is altered during development in TS. These findings indicate the importance of growth hormone receptors for inner ear development in humans.

Testicular teratomas may present in both prepubertal and adult males. The prognosis differs greatly between these two groups. In children, teratomas most often occur before the age of four. They are seen in their pure form, and behave a benign behavior. In adults, teratomas are usually part of a mixed GCTs, and have the potential to metastasize. The presence of neck metastasis in patients with testicular germ cell neoplasms is a rare but well known phenomenon. The incidence of neck metastasis in testicular carcinoma has been reported to be present in up to 5% of the cases.

Objectives: Turner syndrome (TS) is the most frequent sex chromosome abnormality, and sensorineural hearing loss is common. We aimed to determine whether there are consistent morphologic cochlear abnormalities during gestational development that could be associated with TS. Design: The histology of nine fetal temporal bones of TS autopsied after spontaneous abortion was studied. Results: Gross morphologic examination of the TS cochleae failed to reveal a pattern of structural abnormalities that would explain the development of sensorineural hearing loss. Mondini-like cochlear dysplasia was observed in one 13-wk-old TS fetus. Conclusion: We could not demonstrate a consistent pattern of cochlear malformations.

In this study different malformations of the cochlea could be demonstrated. Nevertheless, we could not delineate a distinct malformation of the inner ear, that can be linked to a neural tube defect. Neural tube defects are a frequent and heterogeneous group of malformations, ranging from the survivable spina bifida to fatal anencephaly. In multiple animal models an involvement of the vestibulocochlear system has been demonstrated. In this article human fetal temporal bones of neural tube defects were analysed in a multimodular work-up. The morphologic study was performed with light microscopy, transmission electron microscopy and synchrotron radiation-based microcomputed tomography. Immunohistochemistry for different neuronal markers such as peripherin, beta-III-tubulin and vimentin helped to evaluate ontogenetic tissue development. Eight fetal temporal bones with neural tube defects and five control temporal bones were included into the morphologic study. The morphologic results of the neural tube defect temporal bones showed six regularly developed cochleas and two with only a single cochlear turn. Three of the neural tube defect temporal bones were further examined with immunohistochemical analysis. No differences in the staining pattern for peripherin, beta-III-tubulin and vimentin were detected.

Background: Improved understanding of disease biology of head and neck squamous cell carcinoma (HNSCC) with nearly universal expression of EGFR has led to the introduction of targeted therapies to interrupt signalling of this negative prognostic marker. Objective: We performed a literature review on the mechanisms and efficacy of anti-EGFR antibodies and EGFR tyrosine kinase inhibitors in patients with locally advanced or recurrent/metastatic HNSCC. Results/conclusion: Clinical trials in HNSCC have administered EGFR directed drugs as single agents, in combination with chemotherapy or radiotherapy and demonstrated a good safety profile with antitumour activity in a subgroup of patients. The biology of responsiveness is still unclear, although there is growing evidence of an association of skin toxicity or presence of shorter EGFR intron 1 cytosine–adenine repeats with positive outcome.

OBJECTIVES:Although adenotonsillectomy is one of the most frequently performed surgical procedures in the pediatric population, there is little known about its impact on Health-related Quality of Life (HRQL). The aim of this study was to measure children's HRQL-benefit after adenotonsillectomy.DESIGN AND SETTING:The study was carried out as a retrospective postal survey utilising a proxy rating.PARTICIPANTS:In total, 447 parents of children who underwent adenotonsillectomy for the indication of chronic tonsillitis were included. 43% (n = 191) of the parents returned completed surveys.MAIN OUTCOME MEASURES:To quantify the benefit after pediatric adenotonsillectomy the Glasgow Children's Benefit Inventory (GCBI) was used.RESULTS:Mean GCBI-total score was 21 +/- 19 (-8 to 77), showing an improvement in all GCBI subscales.CONCLUSIONS:Adenotonsillectomy is a highly effective approach to treat children with tonsil disease. It has a positive impact on children's HRQL and other areas not directly associated with their tonsil disease. Moreover, this improvement in HRQL is durable and not temporary.

Somatic mutations in the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) are involved in tumorigenesis and response to targeted therapies in distinct cancer types. Squamous cell carcinomas of the head and neck (HNSCC) show an incidence of EGFR mutations varying from 7% in Asians to 0% to 4% in white patients. Mutational screening predominantly focuses on the analysis of hotspot regions of EGFR (exons 19 and 21).

OBJECTIVES:Endoscopic therapy for vesicoureteral reflux (VUR) using dextranomer/hyaluronic acid (Dx/HA) has become increasingly popular, but the subjective impact of this therapy and subsequent reflux resolution on health-related quality of life (HRQoL) remains unclear. The aim of this study was to address this issue.MATERIALS AND METHODS:One hundred children (65 girls, 35 boys; mean age 4.46 years) cured of primary VUR by endoscopic treatment were retrospectively reviewed. The Glasgow children's benefit inventory (GCBI) - a validated, reproducible, post-interventional questionnaire consisting of four subscales - supplemented by sociodemographic and disease-specific questions was employed. The HRQoL benefit was calculated on a scale ranging from -100 (complete failure) to +100 (complete success) and correlated with supplementary data.RESULTS:Total response rate was 88%. Mean total GCBI score was 28.4+/-20.3 representing a significant HRQoL amelioration. All GCBI subscores improved with the physical health subscale being most relevant. A gender-specific, significant difference in relative GCBI scores was discovered. Correlation with critical life events and time since operation proved the positive effect on HRQoL to be durable.CONCLUSIONS:Resolution of primary VUR secondary to Dx/HA treatment significantly improves HRQoL. HRQoL is positively affected in many areas and not only in those directly associated with VUR. These improvements are not temporary, suggesting that successful Dx/HA therapy may be superior to medical management in terms of children's quality of life.

Background: Improved understanding of disease biology of head and neck squamous cell carcinoma (HNSCC) with nearly universal expression of EGFR has led to the introduction of targeted therapies to interrupt signalling of this negative prognostic marker. Objective: We performed a literature review on the mechanisms and efficacy of anti-EGFR antibodies and EGFR tyrosine kinase inhibitors in patients with locally advanced or recurrent/metastatic HNSCC. Results/conclusion: Clinical trials in HNSCC have administered EGFR directed drugs as single agents, in combination with chemotherapy or radiotherapy and demonstrated a good safety profile with antitumour activity in a subgroup of patients. The biology of responsiveness is still unclear, although there is growing evidence of an association of skin toxicity or presence of shorter EGFR intron 1 cytosine-adenine repeats with positive outcome.

BACKGROUND:In the last decade, the analysis of volatile organic compounds (VOC) has undergone a rapid development. In this pilot study, patients with HNSCC were tested with a proton transfer reaction-mass spectrometry in order to establish a minimal invasive screening method. METHODS:Overall in a period of 2 years, 22 carcinoma patients were recruited for the study. All patients had a newly diagnosed histologically secured squamous cell carcinoma of the upper aerodigestive tract. These results were statistically compared with 3 control groups: healthy controls, high-risk, and posttherapy patients. RESULTS:Two hundred nine different masses were measured; 188 of these were evaluated. The statistical workup of the 4 study groups produced 42 different masses, which showed a statistically significant difference from the carcinoma group compared with the control groups. CONCLUSION:A screening method for HNSCC using VOC seems to be possible, but further investigation is necessary.

Pre- and perinatal asphyxia is known to be an important risk factor in the development of neonatal hearing impairment. This study aims to evaluate the role of apoptosis, which is known to play an essential role in the development of the inner ear structures, in the development of neonatal hearing loss caused by pre- and perinatal asphyxia. Eight temporal bones of six different newborns were included. We performed a morphologic analysis by both light microscopy, and transmission electron microscopy, as well as immunohistochemical staining to detect the cleaved form of caspase 3 as apoptosis marker and Bcl 2 as anti-apoptotic marker. Early and late phases of apoptosis were evidenced by condensation of chromatin (electron-dense, black structure along nuclear membrane) and fragmentation of the nucleus, respectively. Changes in nuclear morphology during apoptosis correlate with cleavage by caspase 3 located downstream of Bcl 2 action. The immunohistochemistry for cleaved caspase 3 showed a particular predilection for the inner and outer hair cells, spiral ganglion cells and the marginal cells of the stria vascularis. The brain of all examined cases did not show signs of apoptosis. In summary, this investigation suggests that apoptosis takes place before brain tissue apoptosis and is probably an earlier event than thought. Apoptosis of the cochlea is known to play an essential role in the development of the inner ear. Additionally, this study shows that apoptosis may play an important role in the development of hearing impairment, caused by pre- and perinatal asphyxia.

Accessory parotid glands are an anatomic variation. Pathologic alterations, which occur in these tissues, are related to those found in the parotid gland. At this time, first-line therapy consists of total resection. In consideration of the delicate anatomy in this region, a careful approach through a lateral parotidectomy or a facelift incision is recommended. In this report, we give an account of a minimally invasive surgical alternative through a peroral approach with facial nerve monitoring. The histologically secured pleomorphic adenoma was completely removed. During surgery, a branch of the facial nerve was detected and secured with active nerve monitoring. We are confident that the peroral resection, supported by active and passive facial nerve monitoring, is a discussable alternative for well-selected tumors of accessory parotid glands.

OBJECTIVE:The aim of this study was to validate the German Glasgow Children's Benefit Inventory (GCBI) in children with different surgical interventions.MATERIAL AND METHODS:The GCBI was translated by using accepted forward-backward translation techniques and mailed to 741 parents whose children underwent either an otorhinolaryngological (n = 641) or an urological intervention (n = 100). The assessment was performed in a retrospective manner at the Medical University Innsbruck, Austria between January and March 2006. An exploratory principal component factor analysis with varimax rotation using factor loadings of >or=0.40 to allocate items to a scale was performed. Frequencies, means and standard deviations were used to describe patient, clinical, sociodemographic, and scale characteristics.RESULTS:The questionnaire was completed and returned by 325 patients (43.9%). The GCBI showed a high internal consistency (alpha = 0.84). The four-factor solution, emotional, vitality, learning and physical health explained 55.7% of variance.CONCLUSION:The German version of the GCBI was proven to be valid and reliable. It is suitable for subjective outcome analysis of different paediatric interventions from infants to adolescents.

OBJECTIVES Tonsillectomy is one of the most frequently performed surgical procedures. Nevertheless there is less known about the impact of this procedure on Health-Related Quality of life (HRQOL). The two different most common used surgical techniques are "cold" (CT) and "hot" (HT) tonsillectomy. The aim of this study was to measure patients' HRQOL-benefit after adult tonsillectomy with the indication of chronic tonsillitis and to compare HT and CT. METHODS The Glasgow Benefit Inventory (GBI) was used to quantify the health benefit of CT and HT retrospectively in 600 patients aged 16 years and older. RESULTS 227 of the patients returned the completed surveys. Mean total GBI score was 15.8 (18 SD, 13.2-18.4 CI) for CT and 11.6 (15 SD, 7-16.3 CI) for HT (p = 0.214). Patients reported an improvement in HRQOL in all GBI subscales. We could not find a significant difference in reported HRQOL benefit between HT and CT. CONCLUSION Adult tonsillectomy, HT as well as CT, for the indication of chronic tonsillitis provides an improvement in HRQOL. This positive impact of tonsillectomy in patients with chronic tonsillitis should be considered in the clinical decision-making process for tonsillectomy.

BACKGROUND:Smith-Lemli-Opitz syndrome (SLOS) (MIM 270 400) is an autosomal recessive multiple congenital anomalies/mental retardation syndrome caused by mutations in the Delta7-sterol reductase (DHCR7, E.C.1.3.1.21) gene. The prevalence of SLOS has been estimated to range between 1:15000 and 1:60000 in populations of European origin.METHODS AND RESULTS:We have analysed the frequency, origin, and age of DHCR7 mutations in European populations. In 263 SLOS patients 10 common alleles (c.964-1G>C, p.Trp151X, p.Thr93Met, p.Val326Leu, p.Arg352Trp, p.Arg404Cys, p.Phe302Leu, p.Leu157Pro, p.Gly410Ser, p.Arg445Gln) were found to constitute approximately 80% of disease-causing mutations. As reported before, the mutational spectra differed significantly between populations, and frequency peaks of common mutations were observed in North-West (c.964-1G>C), North-East (p.Trp151X, p.Val326Leu) and Southern Europe (p.Thr93Met). SLOS was virtually absent from Finland. The analysis of nearly 8000 alleles from 10 different European populations confirmed a geographical distribution of DHCR7 mutations as reported in previous studies. The common Null mutations in Northern Europe (combined ca. 1:70) occurred at a much higher frequency than expected from the reported prevalence of SLOS. In contrast the most common mutation in Mediterranean SLOS patients (p.Thr93Met) had a low population frequency. Haplotypes were constructed for SLOS chromosomes, and for wild-type chromosomes of African and European origins using eight cSNPs in the DHCR7 gene. The DHCR7 orthologue was sequenced in eight chimpanzees (Pan troglodytes) and three microsatellites were analysed in 50 of the SLOS families in order to estimate the age of the three major SLOS-causing mutations.CONCLUSIONS:The results indicate a time of first appearance of c.964-1G>C and p.Trp151X some 3000 years ago in North-West and North-East Europe, respectively. The p.Thr93Met mutations on the J haplotype has probably first arisen approximately 6000 years ago in the Eastern Mediterranean. Together, it appears that a combination of founder effects, recurrent mutations, and drift have shaped the present frequency distribution of DHCR7 mutations in Europe.