Perioperative tracheotomy complications are rare; however, the rate of death for all causes is high (22%) in this population. Obesity and the use of endotracheal tubes over 7.5 in size are major risk factors for the development of airway stenosis. Although percutaneous tracheotomy resulted in a significantly higher rate of postoperative bleeding (6.6%) than the open method (1.9%) (P<.05), the use of outer flange tracheostomy tube sutures may reduce this complication.

Background The coronavirus disease (COVID-19) is the latest pandemic of the digital age. With the internet harvesting large amounts of data from the general population in real time, public databases such as Google Trends (GT) and the Baidu Index (BI) can be an expedient tool to assist public health efforts. Objective The aim of this study is to apply digital epidemiology to the current COVID-19 pandemic to determine the utility of providing adjunctive epidemiologic information on outbreaks of this disease and evaluate this methodology in the case of future pandemics. Methods An epidemiologic time series analysis of online search trends relating to the COVID-19 pandemic was performed from January 9, 2020, to April 6, 2020. BI was used to obtain online search data for China, while GT was used for worldwide data, the countries of Italy and Spain, and the US states of New York and Washington. These data were compared to real-world confirmed cases and deaths of COVID-19. Chronologic patterns were assessed in relation to disease patterns, significant events, and media reports. Results Worldwide search terms for shortness of breath, anosmia, dysgeusia and ageusia, headache, chest pain, and sneezing had strong correlations (r>0.60, P<.001) to both new daily confirmed cases and deaths from COVID-19. GT COVID-19 (search term) and GT coronavirus (virus) searches predated real-world confirmed cases by 12 days (r=0.85, SD 0.10 and r=0.76, SD 0.09, respectively, P<.001). Searches for symptoms of diarrhea, fever, shortness of breath, cough, nasal obstruction, and rhinorrhea all had a negative lag greater than 1 week compared to new daily cases, while searches for anosmia and dysgeusia peaked worldwide and in China with positive lags of 5 days and 6 weeks, respectively, corresponding with widespread media coverage of these symptoms in COVID-19. Conclusions This study demonstrates the utility of digital epidemiology in providing helpful surveillance data of disease outbreaks like COVID-19. Although certain online search trends for this disease were influenced by media coverage, many search terms reflected clinical manifestations of the disease and showed strong correlations with real-world cases and deaths.

Objective Both endoscopic sinus surgery (ESS) and biologic therapies have shown effectiveness for medically‐refractory chronic rhinosinusitis with nasal polyps (CRSwNP) without severe asthma. The objective was to evaluate cost‐effectiveness of dupilumab versus ESS for patients with CRSwNP. Study Design Cohort‐style Markov decision‐tree economic model with a 36‐year time horizon. Methods A cohort of 197 CRSwNP patients who underwent ESS were compared with a matched cohort of 293 CRSwNP patients from the SINUS‐24 and SINUS‐52 Phase 3 studies who underwent treatment with dupilumab 300 mg every 2 weeks. Utility scores were calculated from the SNOT‐22 instrument in both cohorts. Decision‐tree analysis and a 10‐state Markov model utilized published event probabilities and primary data to calculate long‐term costs and utility. The primary outcome measure was incremental cost per quality‐adjusted life year (QALY), which is expressed as an Incremental Cost Effectiveness Ratio. One‐way and probabilistic sensitivity analyses were performed. Results The ESS strategy cost $50,436.99 and produced 9.80 QALYs. The dupilumab treatment strategy cost $536,420.22 and produced 8.95 QALYs. Because dupilumab treatment was more costly and less effective than the ESS strategy, it is dominated by ESS in the base case. One‐way sensitivity analyses showed ESS to be cost‐effective versus dupilumab regardless of the frequency of revision surgery and at any yearly cost of dupilumab above $855. Conclusions The ESS treatment strategy is more cost effective than dupilumab for upfront treatment of CRSwNP. More studies are needed to isolate potential phenotypes or endotypes that will benefit most from dupilumab in a cost‐effective manner. Level of Evidence 2C Laryngoscope, 131:E26–E33, 2021

Assessing speech discrimination skills in individual infants from clinical populations (e.g., infants with hearing impairment) has important diagnostic value. However, most infant speech discrimination paradigms have been designed to test group effects rather than individual differences. Other procedures suffer from high attrition rates. In this study, we developed 4 variants of the Visual Habituation Procedure (VHP) and assessed their robustness in detecting individual 9-month-old infants' ability to discriminate highly contrastive nonwords. In each variant, infants were first habituated to audiovisual repetitions of a nonword (seepug) before entering the test phase. The test phase in Experiment 1 (extended variant) consisted of 7 old trials (seepug) and 7 novel trials (boodup) in alternating order. In Experiment 2, we tested 3 novel variants that incorporated methodological features of other behavioral paradigms. For the oddity variant, only 4 novel trials and 10 old trials were used. The stimulus alternation variant was identical to the extended variant except that novel trials were Send correspondence to Derek M. Houston,