Increased breath naphthalene in children with asthma and wheeze of the All Age Asthma Cohort (ALLIANCE)

Exhaled breath contains numerous volatile organic compounds (VOCs) known to be related to lung disease like asthma. Its collection is non-invasive, simple to perform and therefore an attractive method for the use even in young children. We analysed breath in children of the multicenter All Age Asthma Cohort (ALLIANCE) to evaluate if 'breathomics' have the potential to phenotype patients with asthma and wheeze, and to identify extrinsic risk factors for underlying disease mechanisms. A breath sample was collected from 142 children (asthma: 51, pre-school wheezers: 55, healthy controls: 36) and analysed using gas chromatography-mass spectrometry (GC/MS). Children were diagnosed according to Global Initiative for Asthma guidelines and comprehensively examined each year over up to seven years. Forty children repeated the breath collection after 24 or 48 months. Most breath VOCs differing between groups reflect the exposome of the children. We observed lower levels of lifestyle-related VOCs and higher levels of the environmental pollutants, especially naphthalene, in children with asthma or wheeze. Naphthalene was also higher in symptomatic patients and in wheezers with recent inhaled corticosteroid use. No relationships with lung function or TH2 inflammation were detected. Increased levels of naphthalene in asthmatics and wheezers and the relationship to disease severity could indicate a role of environmental or indoor air pollution for the development or progress of asthma. Breath VOCs might help to elucidate the role of the exposome for the development of asthma. The study was registered at ClinicalTrials.gov (NCT02496468).

Update about Oralair® as a treatment for grass pollen allergic rhinitis

Sublingual immunotherapy (SLIT) is a well-tolerated, safe, and effective approach to treating allergic rhinitis (AR). Oralair® is a five-grass pollen SLIT tablet containing natural pollen allergens from five of the major grass species responsible for seasonal AR due to grass pollen allergy. Recommended use is in a pre-coseasonal regimen, starting daily treatment approximately 4 months before the start of the pollen season, with treatment then continued daily throughout the season; treatment should continue for 3–5 y. Clinical efficacy and safety of Oralair® in patients with grass pollen-induced AR has been demonstrated in a comprehensive clinical development program of randomized controlled trials. Effectiveness has been substantiated in subsequent observational studies with sustained efficacy following treatment cessation and a favorable level of adherence, quality of life, benefit, and satisfaction for the patients. Supportive evidence for a benefit in reducing the risk or delaying the development of allergic asthma is emerging.

Structured Digital Self-Assessment of Patient Anamnesis Prior to Computed Tomography: Performance Evaluation and Added Value

The aim of this study was to evaluate the performance of a tablet-based, digitized structured self-assessment (DSSA) of patient anamnesis (PA) prior to computed tomography (CT). Of the 317 patients consecutively referred for CT, the majority (n = 294) was able to complete the tablet-based questionnaire, which consisted of 67 items covering social anamnesis, lifestyle factors (e.g., tobacco abuse), medical history (e.g., kidney diseases), current symptoms, and the usability of the system. Patients were able to mark unclear questions for a subsequent discussion with the radiologist. Critical issues for the CT examination were structured and automatically highlighted as “red flags” (RFs) in order to improve patient interaction. RFs and marked questions were highly prevalent (69.5% and 26%). Missing creatinine values (33.3%), kidney diseases (14.4%), thyroid diseases (10.6%), metformin (5.5%), claustrophobia (4.1%), allergic reactions to contrast agents (2.4%), and pathological TSH values (2.0%) were highlighted most frequently as RFs. Patient feedback regarding the comprehensibility of the questionnaire and the tablet usability was mainly positive (90.9%; 86.2%). With advanced age, however, patients provided more negative feedback for both (p = 0.007; p = 0.039). The time effort was less than 20 min for 85.1% of patients, and faster patients were significantly younger (p = 0.046). Overall, the DSSA of PA prior to CT shows a high success rate and is well accepted by most patients. RFs and marked questions were common and helped to focus patients’ interactions and reporting towards decisive aspects.

Cytokine levels in children and adults with wheezing and asthma show specific patterns of variability over time

Levels of cytokines are used for in-depth characterization of patients with asthma; however, the variability over time might be a critical confounder. To analyze the course of serum cytokines in children, adolescents and adults with asthma and in healthy controls and to propose statistical methods to control for seasonal effects. Of 532 screened subjects, 514 (91·5%) were included in the All Age Asthma Cohort (ALLIANCE). The cohort included 279 children with either recurrent wheezing bronchitis (more than two episodes) or doctor-diagnosed asthma, 75 healthy controls, 150 adult asthmatics and 31 adult healthy controls. Blood samples were collected and 25 μl serum was used for analysis with the Bio-Plex Pr human cytokine 27-Plex assay. Mean age, body mass index and gender in the three groups of wheezers, asthmatic children and adult asthmatics were comparable to healthy controls. Wheezers (34·5%), asthmatic children (78·7%) and adult asthmatics (62·8%) were significantly more often sensitized compared to controls (4·5, 22 and 22·6%, respectively). Considering the entire cohort, interleukin (IL)-1ra, IL-4, IL-9, IL-17, macrophage inflammatory protein (MIP)-1- α and tumor necrosis factor (TNF)- α showed seasonal variability, whereas IL-1β, IL-7, IL-8, IL-13, eotaxin, granulocyte colony-stimulating factor (G-CSF), interferon gamma-induced protein (IP)-10, MIP-1 β and platelet-derived growth factor (PDGF)-BB did not. Significant differences between wheezers/asthmatics and healthy controls were observed for IL-17 and PDGF-BB, which remained stable after adjustment for the seasonality of IL-17. Seasonality has a significant impact on serum cytokine levels in patients with asthma. Because endotyping has achieved clinical importance to guide individualized patient-tailored therapy, it is important to account for seasonal effects.

COVID-19 stay-at-home order in Tyrol, Austria: sports and exercise behaviour in change?

Objectives

The aim of the study was to investigate differences in the frequency and types of engagement in sports before, during and after the coronavirus disease 2019 (COVID-19) stay-at-home order in Tyrol, Austria.

Study design

A representative population survey was conducted.

Methods

A sample of Tyroleans (N = 511) was questioned by a market research institute via an online questionnaire or telephone survey.

Results

During the stay-at-home order, participants engaged less in sports than before and after the restrictions. However, within-group analyses revealed increasing sport participation in less active groups when comparing the pre- and post-COVID-19 period.

Conclusions

Despite the restrictions during the stay-at-home order, respondents did engage in sports and promoted their health. Nevertheless, it is still necessary to investigate the long-term effects of the COVID-19 crisis on sports and exercise behaviour as well as the extent to which sports policy measures may be able increase sports participation.

•

In general, participants engaged less in sports during the coronavirus disease 2019 (COVID-19) stay-at-home order.

•

Within-group analyses showed increased sports participation in less active groups.

•

Respondents adhered to the outdoor sports ban and did home training instead.

•

Appropriateness of regulations implemented in the context of the COVID-19 pandemic was measured.

•

Crises such as COVID-19 might have a long-term impact on sports participation.

Carotid CTA at the Lowest Tube Voltage (70 kV) in Comparison with Automated Tube Voltage Adaption

BACKGROUND AND PURPOSE

CTA is the imaging modality of choice in many institutions for the evaluation of the supraaortic vessels, but radiation exposure remains a matter of concern. Our aim was to evaluate a 70-kV protocol for CT angiography of the carotid arteries with respect to image quality and radiation exposure compared with automated tube voltage adaption.

MATERIALS AND METHODS

A total of 90 consecutive patients were included in this prospective study and randomized to the study group (n = 45, 70 kV) or control group (n = 45, automated tube voltage adaptation). Volume CT dose indices and dose-length products were recorded in the examination protocol. Image quality was assessed as arterial vessel contrast, signal-to-noise ratio, contrast-to-noise ratio, and contrast-to-noise ratio in reference to the radiation dose. Subjective overall image-quality analysis, image-artifact analysis, and diagnostic evaluation were performed by 2 observers by using a 4-point Likert scale.

RESULTS

Radiation exposure was significantly lower in the study group (volume CT dose index reduced by 22%, dose-length product reduction by 20%; each P < .001). Contrast (P = .15), SNR (P = .4), and contrast-to-noise ratio (P = .5) did not show significant differences between the groups. The contrast-to-noise ratio in reference to the radiation dose was not significantly increased using the study protocol (P = .2). Subjective image quality and visualization of pathologic findings did not differ significantly between the groups.

CONCLUSIONS

Carotid CTA using the lowest available voltage (70 kV) is feasible at very-low-dose levels, while overall image quality is comparable with protocols using automated tube voltage selection.

[Physical activity as therapeutic intervention for depression]

AIM

This article gives a conspectus of the present state of research on the efficiency of exercise as a treatment for patients suffering from depression.

METHODS

A systematic review of articles published between December 1980 and March 2016 was carried out. The review focused on studies that examined the effects of exercise compared to control conditions in the treatment of depression. Extracted and analyzed information from the articles included details about participants, characteristics of exercise and control conditions, assessments, study design and outcomes.

RESULTS

A total of 34 of the 48 studies included in the literature search reported a significant reduction of depressive symptoms due to exercise interventions. There was a trend to reduced depressive symptoms following the exercise interventions in five studies. In nine studies no positive impact of exercise on depression and affective well-being could be detected.

DISCUSSION

This review article shows that physical activity decreases depressive symptoms and increases affective well-being in patients with depressive diseases; therefore, exercise should be recommended as a component of depression treatment within the framework of a multi-dimensional approach.

Treatment with rhDNase in patients with cystic fibrosis alters in-vitro CHIT-1 activity of isolated leucocytes

Recent data suggest a possible relationship between cystic fibrosis (CF) pharmacotherapy, Aspergillus fumigatus colonization (AC) and/or allergic bronchopulmonary aspergillosis (ABPA). The aim of this study was to determine if anti-fungal defence mechanisms are influenced by CF pharmacotherapy, i.e. if (1) neutrophils form CF and non-CF donors differ in their ability to produce chitotriosidase (CHIT-1); (2) if incubation of isolated neutrophils with azithromycin, salbutamol, prednisolone or rhDNase might influence the CHIT-1 activity; and (3) if NETosis and neutrophil killing efficiency is influenced by rhDNase. Neutrophils were isolated from the blood of CF patients (n = 19; mean age 26·8 years or healthy, non-CF donors (n = 20; 38·7 years) and stimulated with phorbol-12-myristate-13-acetate (PMA), azithromycin, salbutamol, prednisolone or rhDNase. CHIT-1 enzyme activity was measured with a fluorescent substrate. NETosis was induced by PMA and neutrophil killing efficiency was assessed by a hyphae recovery assay. Neutrophil CHIT-1 activity was comparable in the presence or absence of PMA stimulation in both CF and non-CF donors. PMA stimulation and preincubation with rhDNase increased CHIT-1 activity in culture supernatants from non-CF and CF donors. However, this increase was significant in non-CF donors but not in CF patients (P < 0·05). RhDNase reduced the number of NETs in PMA-stimulated neutrophils and decreased the killing efficiency of leucocytes in our in-vitro model. Azithromycin, salbutamol or prednisolone had no effect on CHIT-1 activity. Stimulation of isolated leucocytes with PMA and treatment with rhDNase interfered with anti-fungal defence mechanisms. However, the impact of our findings for treatment in CF patients needs to be proved in a clinical cohort.

[Children and Adolescents with Asthma Differ in Lung Function Parameters and Exhaled NO from Children and Adolescents with Obesity]

BACKGROUND

The prevalence of asthma and overweight/obesity in children and adolescents is continuously increasing over the last decades. It remains unclear if overweight/obesity raises the risk of developing asthma or if an uncontrolled asthma increases the risk of developing overweight/obesity by restricting physical activity.

OBJECTIVES

We aimed to elucidate, if children and adolescents with overweight/obesity differ from normal-weight asthmatics in lung functions parameters (FEV1, FEV1/VC, MEF50 and SRtot) and in exhaled nitric oxide (FeNO).

METHODS

Totally, n=142 children and adolescents aged 6-18 years were included in this study: group 1 comprised n=44 with overweight/obesity defined as a Body-Mass-Index (BMI)>90th percentile; group 2 n=44 with a doctors diagnosed bronchial asthma according to the GINA-guidelines, and group 3 with n=36 pulmonary healthy controls. N=18 children with both asthma and overweight/obesity were excluded from further analysis. We collected data about socio-demographic variables from a standardized questionnaire, bodyplethysmography (FEV1, FEV1/VC, MEF50 and SRtot) and FeNO.

RESULTS

Normal-weight children and adolescents with asthma had significantly lower FEV1/VC (Tiffenau-Index 90,9±12,8) and MEF50 (84.0% predicted±27.6) than children with overweight/obesity (97,6±12,4 p=0.001 respectively 99.1±20.9 p=0.001) and healthy controls (98±13,5 p=0,003; 96.7±19.3 p=0.011). Normal weight asthmatics had a significantly higher FeNO (38.3 ppb) than children and adolescents with overweight/obesity (14.0 ppb p=0.014).

CONCLUSIONS

Normal-weight children and adolescents with asthma differ significantly both in their lung function parameters as well as in their exhaled nitric oxide concentration from children and adolescents with overweight/obesity. For clinical practice it is important to note that children and adolescents with overweight/obesity have no signs of an obstructive airway diseases and are as resilient as healthy children and adolescents with regard to their lung function. The possible late-onset of asthma symptoms and lung function changes in children and adolescents with overweight/obesity requires further detailed longitudinal studies.

Oxaliplatin and 5-FU/folinic acid (modified FOLFOX6) with or without aflibercept in first-line treatment of patients with metastatic colorectal cancer: the AFFIRM study

BACKGROUND

The combination of aflibercept with FOLFIRI has been shown to significantly prolong overall survival in patients with metastatic colorectal cancer (mCRC) after progression on oxaliplatin-based therapy. This trial evaluated the addition of aflibercept to oxaliplatin-based first-line treatment of patients with mCRC.

PATIENTS AND METHODS

Patients with mCRC were randomized to receive first-line therapy with mFOLFOX6 plus aflibercept (4 mg/kg) or mFOLFOX6 alone. The primary end point of this phase II study was the progression-free survival (PFS) rate at 12 months in each arm. The analysis of efficacy between the arms was a pre-planned secondary analysis.

RESULTS

Of 236 randomized patients, 227 and 235 patients were evaluable for the primary efficacy analysis and safety, respectively. The probabilities of being progression-free at 12 months were 25.8% [95% confidence interval (CI) 17.2-34.4] for the aflibercept/mFOLFOX6 arm and 21.2% (95% CI 12.2-30.3) for the mFOLFOX6 arm. The median PFS was 8.48 months (95% CI 7.89-9.92) for the aflibercept/mFOLFOX6 arm and 8.77 months (95% CI 7.62-9.27) for the mFOLFOX6 arm; the hazard ratio of aflibercept/mFOLFOX6 versus mFOLFOX6 was 1.00 (95% CI 0.74-1.36). The response rates were 49.1% (95% CI 39.7-58.6) and 45.9% (95% CI 36.4-55.7) for patients treated with and without aflibercept, respectively. The most frequent treatment-emergent grade 3/4 adverse events (AEs) excluding laboratory abnormalities reported for aflibercept/mFOLFOX6 versus mFOLFOX6 were neuropathy (16.8% versus 17.2%) and diarrhea (13.4% versus 5.2%). Neutropenia grade 3/4 occurred in 36.1% versus 29.3%. The most common vascular endothelial growth factor inhibition class-effect grade 3/4 AEs for aflibercept/mFOLFOX6 versus mFOLFOX6 were hypertension (35.3% versus 1.7%), proteinuria (9.2% versus 0%), deep vein thrombosis (5.9% versus 0.9%) and pulmonary embolism (5.9% versus 5.2%).

CONCLUSION

No difference in PFS rate was observed between treatment groups. Adding aflibercept to first-line mFOLFOX6 did not increase efficacy but was associated with higher toxicity.

CLINICAL TRIAL NUMBER

NCT00851084, www.clinicaltrials.gov, EudraCT 2008-004178-41.

[Factors Associated with the Use of Protective Gear among Adults during Recreational Sledging]

BACKGROUND

Recreational sledging (tobogganing) is a very popular winter sport in the Alps. Therefore, injury prevention through the usage of protective gear seems important. Therefore, the aim of this study was to evaluate factors associated with the use of protective gear among adults during recreational sledging.

METHODS

Adult recreational sledgers were interviewed during the winter seasons 2012/13 and 2013/14 at six sledging tracks in Austria on demographics, skill level, sledging frequency, risk taking behaviour, sitting alone or with another person on the sledge, previous sledging-related injuries, and use of protective gear, respectively. Interviews were conducted on all days of the week.

RESULTS

A total of 1968 adult sledgers (49.4 % females) with a mean age of 37.1 ± 14.4 years participated in this study. A (ski) helmet, sun or snow goggles, a back protector, and wrist guards were used by 42.3 %, 71.0 %, 5.9 %, 2.6 % of sledgers, respectively. Helmet use was significantly higher with increasing age and increasing skill level as well as when sitting alone compared to sitting together with another person. Females, Austrians, persons sitting alone on the sledge, a higher frequency of sledging and a higher skill level were significantly associated with an increasing use of goggles. A back protector was significantly more often worn by younger people, more risky sledgers, and persons with a previous sledging-related injury. Wrist guards were significantly more often used by persons with a previous sledging-related injury.

CONCLUSION

During recreational sledging, the factors age, sex, nationality, skill level, sitting alone compared to sitting together with another person on the sledge, sledging frequency, and injury experience were associated with the frequencies of usage of different types of protective gear. These factors should be considered when implementing preventive measures for recreational sledging.

[Equipment, Risk Awareness and Safety-Relevant Behaviour of Via Ferrata Climbers]

BACKGROUND

Climbing via ferrata routes is becoming more and more popular. The growing number of via ferrata climbers is associated with an increasing number of accidents. In addition to adequate equipment and its correct handling, knowledge of specific risks and safety-related behaviour play an important role for safety on via ferrata routes. The goal of this study was to collect data on equipment, via ferrata-specific risk knowledge, safety-related behaviour, and general risk-taking behaviour of via ferrata climbers.

METHODS

In this survey, data of 332 climbers of different via ferrata routes in Tyrol (Austria) were collected using a standardised data entry form including socio-demographic data, the use of via ferrata-specific equipment and first aid equipment. Knowledge of via ferrata-specific risks was assayed by a questionnaire including 4 questions. Additionally, safety-related behaviour and general risk-taking behaviour of the via ferrata climbers were evaluated.

RESULTS

92 % of the interviewed persons were wearing a helmet and helmet use was significantly lower in females (86 %) compared to males (96 %). In total, 10 % of the via ferrata climbers used inadequate belaying equipment or no equipment at all. The 4 questions related to via ferrata-specific risks were correctly answered by an average of 46 % of the climbers. A partner check was carried out by 76 % before starting the tour. 96 % of the climbers stated they ask the climber ahead of them for the possibility to overtake and wait for a suitable and safe spot. 64 % reported that they would not pass without self-belay. General risk-taking behaviour was scored at 4.26 ± 1.75 with significant differences between female and male via ferrata climbers (3.79 ± 1.37 vs. 4.53 ± 1.88).

CONCLUSION

Although most of the via ferrata climbers use adequate equipment, helmet use could be optimised in females. Via ferrata climbers should be better informed of the risks of climbing via ferrata routes and safety-related behaviour. Preventive measures including information panels at the entrances of the via ferrata routes and broad information campaigns could contribute to reduce the number of accidents.

[Frequencies of injuries and causes of accidents during ski touring on ski slopes - a pilot study]

INTRODUCTION

Ski touring along ski slopes (slope touring) increased in recent years on Austrian ski slopes. However, ascending on the border of the slope and skiing downhill on the slope might be associated with a certain injury risk. Thus, the aim of this pilot study was to evaluate frequencies of injuries, causes of accidents and potential risk factors during slope touring.

METHODS

Slope-tourers were interviewed from March to April 2014 at the bottom of 4 Austrian ski areas. Interviews were conducted during the week and at the weekend from 7.30 a. m. to 8.45 p. m.

RESULTS

A total of 451 slope-tourers (60.1 % males) with a mean age of 39.3 ± 14.4 years were interviewed. Interviewed persons reported that they perform about 20.6 ± 16.0 slope tours per season mainly with a partner (48 %) and during the day (51 %). Ski helmet use was 60 %. A total of 57 persons (12.6 %) reported that they suffered at least once from an injury during slope touring needing medical care. This corresponds to a rate of 6 injuries per 1000 slope tours. Main injury causes were a fall (78 %) and a collision with another person (15 %) and the main injured body part was the knee (36 %). Slope-tourers with an injury were wearing more often back protectors, and were falling more often during downhill skiing, and were abstaining less often from alcohol and were listening more often to music during downhill skiing compared to slope-tourers without an injury.

CONCLUSION

Based on the findings of this pilot study we recommend abstaining from alcohol and not listening to music during downhill skiing to reduce the injury risk during slope touring.

[The flexibility of family medicine]

We are a European academic group of family doctors and we propose a definition of flexibility in family medicine. A review of the literature shows that flexibility and complexity are emerging concepts in the field of family practice. The outcomes of a workshop at the WONCA-Europe congress in 2014 are discussed. The flexibility is a capability of the general practitioner to deal with complex clinical situations in a biomedical and societal changing world. Flexibility is framed by ethics. It could improve the quality of care, be useful against burnout and used in medical research. In conclusion, family medicine should adopt a specific definition of the flexibility describing its specificity, a useful and teachable capacity.

[Current incidence of accidents on Austrian ski slopes]

BACKGROUND

Alpine skiing and snowboarding are the most popular winter sports. These sports are also associated with a certain injury risk which, however, has steadily decreased during the past decades. During the winter season 2002/2003 the last large survey on ski injuries in Austria was performed. Among others, modern skiing equipment and optimized slope preparation may impact on the injury risk. We hypothesise that these changes may have led to a further decrease in ski injuries during the past decade.

METHODS

In the winter season 2012/2013, skiing injuries were recorded in 26 Austrian ski areas. Data were collected from rescue personnel on ski slopes and by physicians in the hospital or doctors practice with the help of a questionnaire.

RESULTS

A total of 7325 injured skiers and snowboarders (age: 34.8 ± 17.8 years) were recorded (49 % males and 51 % females; 80 % skiers, 14 % snowboarders, 6 % others). The most frequent causes of injury were self-inflicted falls (87 %) and collisions with other skiers/snowboarders (8 %). Most affected injury locations among skiers were the knee (41 %; predominantly in female skiers, > 50 %), shoulder/back (18 %) and arms (10 %). Most affected injury locations among snowboarders were arms (38 %) and shoulder/back (23 %). Head injuries were found at the same frequency (8 %) in skiers and snowboarders. The calculated injury rate was about 0.6 injuries per 1000 skier days and has decreased by more than 50 % during the past decade.

CONCLUSIONS

Modern skiing equipment and optimised slope preparation may be at least partly responsible for the decreased injury risk on ski slopes which is supported by the observation of a reduced falling frequency. Future preventive measures should focus on a reduction of knee injuries in female skiers.

[Disease modification and duration of omalizumab treatment in patients with severe allergic asthma]

BACKGROUND AND METHODS

Omalizumab is a monoclonal anti-IgE-antibody that is used to treat severe allergic asthma. The aim of this review was to evaluate the available evidence in a panel of experts and to provide recommendations on therapy duration with omalizumab.

RESULTS

A direct or indirect interaction between omalizumab and IgE production seems likely. Pharmacokinetic-pharmakodynamic models suggest that omalizumab modulates IgE production. This hypothesis is currently investigated in clinical studies. In addition, available evidence suggests that omalizumab mitigates different factors of airway remodeling. However, based on the currently available data, no recommendations can be given in regard to reduction of dosage or discontinuation of omalizumab in long term treated patients.

CONCLUSIONS

Currently, neither dose reductions nor treatment withdrawal can be recommended in patients with severe allergic asthma and long term treatment with omalizumab. Clinical studies addressing these issues are being conducted.

Effect of wearing a ski helmet on perception and localization of sounds

Helmet use on ski slopes has steadily increased worldwide over the past years. A common reason reported for helmet non-use, however, is impaired hearing. Therefore, an intra-subject design study was conducted to compare hearing thresholds and sound source localization of 21 adults with normal hearing in an anechoic chamber when wearing a ski helmet and ski goggles or wearing a ski cap and ski goggles to the condition head bare. Hearing thresholds while wearing a ski helmet (6.8 ± 1.6 dB HL) and ski cap (5.5 ± 1.6 dB HL) were significantly different (p = 0.030, d = 0.44). Compared to head bare (2.5 ± 1.2 dB HL), a significant difference was found for the ski helmet only (p = 0.040, d = 1.57). Regarding sound source localization, correct scores in the condition head bare (90%) showed a highly significant difference compared with those of condition cap (65%) and helmet (58%), respectively (p < 0.001; d > 2.5). Compared to the ski cap, wearing the helmet significantly reduced correct scores (p = 0.020, d = 0.59) irrespective of the tested sound pressure levels. In conclusion, wearing a ski helmet impairs hearing to a small though significantly greater extent compared with a cap, the degree, however, being less than what is termed as a hearing impairment. Compared to the condition head bare, wearing a ski cap or a ski helmet significantly reduced one's ability of sound source localization.