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Laryngoscopy corresponding with laryngeal electromyography (LEMG) is essential in diagnosing vocal fold paresis. However, baseline asymmetry or other diseases oftentimes confound the exam, making diagnosis difficult. There is currently no agreed upon endoscopic criteria proven to reliably correlate with LEMG findings. We define a set of endoscopic findings termed "paresis triad" that, when present together, reliably correlate with LEMG. The paresis triad consists of (1) hypocontraction of the weak side of the larynx with increased ventricular show, (2) hypercontraction of the intact side with bulging of the false fold covering the ventricle, and (3) tilting of the interarytenoid cleft to the weak side.We performed a retrospective review of patients with laryngeal asymmetry on laryngoscopy. Patients were divided into two groups: those with consistent paresis triad findings across all pitches and intensities, and those without. All patients underwent LEMG by a neurolaryngologist blinded to the laryngoscopic findings. The endoscopies were then rereviewed in a blinded manner by a second laryngologist to assess inter- and intrarater reliability for identification of the triad.Twelve patients met inclusion criteria (age 50 +/-15, 7F:5M). Nine had the paresis triad. Three had an inconsistent triad. All patients with the paresis triad had LEMG findings consistent with neurologic injury on the suspected side. All patients with inconsistent triad findings had normal LEMG.Our findings suggest the proposed laryngoscopic paresis triad may be useful objective criteria to diagnose paresis without the need for LEMG. Further prospective studies should examine a larger series of patients.4 Laryngoscope, 2022.

Objectives Deep interarytenoid notch (DIN) is a congenital variation of the larynx often associated with dysphagia and aspiration (DA) in young children. Feeding therapy with thickeners and surgical management with injection larygoplasty (IL) are used with various efficacies. Thickeners address the functional domain and IL addresses the anatomical domain of treatment. Our objective was to evaluate DIN patients managed with both interventions. Methods We conducted a retrospective pilot descriptive study of DIN patients with DA aged 1–3 years receiving thickeners and IL. Patients received a systematic weekly reduction of thickeners, referred to as the Thickener Weaning Protocol (TWP), based on clinical signs and symptoms of DA. The outcomes were assessed by the rate of thickener level reduction and DA-related sign/symptom frequency achieved at 6 months post-treatment. Results Thirteen patients with DIN associated DA were analyzed. The TWP was initiated within 2 months in 77% of patients, and within 4 months in 100% of patients. Thickener scores improved from an average of 5.76 (3/4 honey) to 2.15 (thin) (p = 0.001). DA-related signs/symptoms frequency improved from an average of 3.3 to 0.84 (p = 0.05). Conclusions These findings suggest that treatment of DIN associated DA with a combination of thickeners and IL results in significant clinical improvements in young children.

Objective: Due to COVID-19, patients who had sinus or skull base surgery in February and early March 2020 were unable toreceive standard postoperative care. Currently, there is a lack of data on the short- and long-term impacts of this. Wesought to examine the effects of the interruption of care due to COVID-19 on sinus and skull base surgery patientoutcomes. Study Design: Retrospective chart review. Methods: A retrospective review was conducted examining outcomes and healthcare utilization of patients at our institutionwho underwent sinus or skull base surgery in February and March of 2020, and who experienced an interruption inpostoperative care due to the pandemic. We then compared these measures with those of patients from the same timeperiod in 2019, who did not experience an interruption in care. Patient characteristics including age, indication for surgery,extent of surgery, polyps, preoperative Lund-Mackay and sinonasal outcome (SNOT22) scores and history of prior sinus orskull base surgery were recorded. Study outcomes included 3 and 6 month postoperative SNOT22 and Modified Lund-Kennedy endoscopy scores, antibiotic usage, sinonasal debridements performed, and number of telephone calls andtelehealth visits in the postoperative period. Results: A total of 107 patients were included. Of the SNOT22 scores available, the average change between preoperativeand 3 month postoperative SNOT22 scores for 2020 ( n = 15) compared to 2019 patients ( n = 30) was not significantlydifferent (a decrease of 17.27 and 19.93, respectively;p = 0.68). The average change between preoperative and 6-monthpostoperative SNOT22 scores for 2020 ( n = 13) compared to 2019 patients ( n = 26) was also not significantly different (adecrease of 18.69 and 20.77, respectively;p = 0.75). The average number of oral postoperative antibiotics received did notsignificantly differ between 2020 ( n = 52) and 2019 ( n = 55) cohorts (0.18 vs. 0.09, respectively;p = 0.53). The averagenumber of postoperative telephone calls did not significantly differ between 2020 and 2019 patients (1.51 vs. 1.19;p = 0.95). Patients in 2019 received an average of 2.35 postoperative sinonasal debridements compared to 1.90 in 2020 ( p =0.03). The average number of postoperative telehealth visits for 2020 patients was 0.72. Of the 2020 patients, 50% werelost to follow-up at 3 months postoperatively compared to 18% in 2019 ( p = 0.0005) and 71% were lost to follow-up at 6months postoperatively in 2020 compared to 36% in 2019 ( p = 0.0003). Conclusion: Although there was an interruption in postoperative care due to COVID-19, patients in 2020 who returned forfollow-up 3 and 6 months after surgery did not report significantly different subjective sinonasal outcomes compared topatients in 2019. A significantly greater number of patients have been lost to follow-up in 2020 compared to 2019 and havenot received routine postoperative care. Further study is required to determine the impact of the interruption of care due toCOVID-19 on sinus and skull base surgery outcomes.

Statistical historical biogeographical methods rely on the use of models that assume various biogeographic processes. Until recently model selection remains an explored topic and the impacts of using different models on inferring biogeographic history are poorly understood. Focusing on the Neotropical weevils in theExophthalmusgenus complex (Insecta: Curculionidae: Entiminae), we compare three commonly used biogeographic models – DIVA (Dispersal-Vicariance Analysis), DEC (Dispersal-Extinction-Cladogenesis) and BayArea (Bayesian Analysis of Biogeography), and examine the impact of modeling founder-event jump dispersal on biogeographic history estimation. We also investigate the biogeographic events that have shaped patterns of distributions, diversification, and endemism in this group of weevils. We sample representatives of 65 species of theExophthalmusgenus complex and 26 outgroup terminals from the Neotropics including Caribbean islands and mainland. We reconstruct a molecular phylogeny based on six genes and performed molecular dating using a relaxed clock with three fossil calibration points. We conduct biogeographic history estimations and compare alternative biogeographic models with the R package BioGeoBEARS. Model selection strongly favors biogeographic models that include founder-event jump dispersal. Without modeling jump dispersal, estimations based on the three biogeographic models are dramatically different, especially at early diverging nodes. When jump dispersal is modeled, however, the three biogeographic models perform similarly. Accordingly, we show that the Neotropical mainland was colonized by Caribbean species in the early Miocene, and thatin situdiversification accounts for a majority (~75%) of the biogeographic events in theExophthalmusgenus complex. Our study highlights the need for testing for wide-ranging historical biogeographic processes in the study of Caribbean biogeography and the importance of comparing and selecting the best-fitting model in statistical biogeographic inferences. We demonstrate that modeling founder-event jump dispersal significantly improves the fit of the biogeographic history estimation of Caribbean and Neotropical mainland weevils. We establish thatin situdiversification acts as a dominant biogeographic force in the evolution of theExophthalmusgenus complex. The colonization of the Neotropical mainland from Caribbean islands reinforces the notion that islands can be an important source of continental diversity.

Background Rhinovirus (RV) infections are the most common cause of viral upper respiratory infections (URIs), and in the majority of persons they are self-limiting. However, in others, viral URIs can progress to bacterial sinusitis and induce chronic rhinosinusitis (CRS) exacerbations. Methods We conducted a comprehensive Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review through April 2018 based on MEDLINE, EMBASE, Web of Science-Science Citation Index (SCI), and Conference Proceedings Citation Index- Science (CPCI-S) using keywords: RV, respiratory virus, sinusitis, and airway epithelial cells. The goal of this systematic review was to: (1) determine the prevalence between RV and CRS, (2) study the changes that occur after experimental RV inoculation, (3) investigate the pathophysiologic mechanisms by which RV induces sinonasal inflammation, and (4) explore the treatment options available for RV-associated sinusitis. Data regarding study design, research question, intervention, subjects, outcomes, and biases was extracted. Results The initial search yielded 2395 unique abstracts, of which 614 were selected for full-text review; 147 were included in the final review. We determined that (1) the prevalence of RV infections is increased in those with CRS, (2) humans challenged in vivo with RV secrete local inflammatory mediators with radiographic mucosal thickening, (3) RV species RV-A and RV-C challenges in vitro to sinonasal epithelia produce robust cytokine responses and differential gene changes, and (4) no current therapies have produced consistent and significant resolution of disease. Conclusion RV infections are common in persons with CRS, and incite inflammatory reactions that may result in CRS exacerbations and progression of disease. Further studies assessing RV species, and the host-virome response are required to develop new strategies targeting RV-induced CRS.

Introduction Optimal enoxaparin dosing for deep venous thrombosis (DVT) prophylaxis remains elusive. Prior research demonstrated that trauma patients at increased risk for DVT based upon Greenfield’s risk assessment profile (RAP) have DVT rates of 10.8% despite prophylaxis. The aim of this study was to determine if goal directed prophylactic enoxaparin dosing to achieve anti-Xa levels of 0.3–0.5 IU/ml would decrease DVT rates without increased complications. Materials and methods Retrospective review of trauma patients having received prophylactic enoxaparin and appropriately timed anti-Xa levels was performed. Dosage was adjusted to maintain an anti-Xa level of 0.3–0.5 IU/ml. RAP was determined on each patient. A score of ≥5 was considered high risk for DVT. Sub-analysis was performed on patients who received duplex examinations subsequent to initiation of enoxaparin therapy to determine the incidence of DVT. Results 306 patients met inclusion criteria. Goal anti-Xa levels were met initially in only 46% of patients despite dosing of >40 mg twice daily in 81% of patients; however, with titration, goal anti-Xa levels were achieved in an additional 109 patients (36%). An average enoxaparin dosage of 0.55 mg/kg twice daily was required for adequacy. Bleeding complications were identified in five patients (1.6%) with three requiring intervention. There were no documented episodes of HIT. Subsequent duplex data was available in 197 patients with 90% having a RAP score >5. Overall, five DVTs (2.5%) were identified and all occurred in the high-risk group. All patients were asymptomatic at the time of diagnosis. Conclusion An increased anti-Xa range of 0.3–0.5 IU/ml was attainable but frequently required titration of enoxaparin dosage. This produced a lower rate of DVT than previously published without increased complications.