Characterizing internet search patterns for neurologic and neurosurgical conditions following celebrity diagnosis.

Social media and internet platforms have become significant drivers of mass-information. Highly publicized events, such as John McCain's announcement of his glioblastoma diagnosis, often drive national public interest in medical topics. Improved understanding of the temporality of interest spikes as well as the nature of the information that garners attention from outside the medical community can help inform ways in which the medical community can boost awareness of (and interest in) the field of neurosurgery. We utilized the "explore topics" feature on Google Trends to obtain web, news, and YouTube search data from May 1, 2015, to May 1, 2019 for the terms "glioblastoma," "brain tumor," "stroke," and "multiple sclerosis" to identify periods of visibly increased search interest. Search results for "glioblastoma" showed significantly elevated average interest during the period of July 3-23, 2017, as compared to that generated since this specific time period (42.6 vs. 8.73, P<0.001). This increased search activity therefore directly correlated with John McCain's public announcement of his glioblastoma diagnosis, and a similar search interest spike was evident using the search term "brain tumor" (87.3 vs. 64.2, P<0.001). Search results for "multiple sclerosis" showed - as a result of the online buzz created by Selma Blair's battle with the disease - significantly elevated average interest from October 8, 2018, to October 28, 2018, and February 11, 2019, to March 3, 2019, when compared to the average interest of the remaining time (59 vs. 40.16, P<0.001 and 69 vs. 40.16, P<0.001). Finally, there were no corresponding elevations in YouTube search interest for any of the terms associated with increased interest on Google Trends. Following major events related to the neurological disease of public figures there is an expected rise in Google search interest relevant to these topics. Our findings suggest that there is an optimal window of approximately 2 weeks following each of these events for activist and clinical groups to publicize their desired message, and for the field of neurosurgery and neurological science to increase public awareness regarding specific diseases, with a regression to baseline interest by 4 months following the event.

Impact of Age on Surgical Outcomes Following Mandible Fracture Repair.

OBJECTIVES: Open repair of mandibular fractures are frequently performed surgical procedures. Increasing rates of such fractures are seen in older adults following falls. This study assesses the impact of older age on early complications following mandible fracture repair. STUDY DESIGN: Retrospective analysis of national registry. METHODS: The 2013-2018 National Surgical Quality Improvement Program database was queried for all cases of open mandible fracture repair and cases were categorized into younger (18-40), middle (41-65), and older (>65) age cohorts. Demographics and comorbidities were compared between the age groups. Rates of surgical, medical, and wound complications within 30-days of surgery were determined. Multivariable logistic analyses were performed to assess the relationship between age and complications. RESULTS: Altogether, 1818 cases were included for analysis, of which 1269 (69.8%) were younger, 459 (25.2%) were middle, and 90 (5.0%) were older age. Increased rates of complications were seen in the older groups, including unplanned reoperation, unplanned readmission, wound disruption, and medical complications (p < 0.01). On unadjusted analysis, the older (>65) age group had an increased odds of experiencing a complication compared to the younger (18-40) group (OR: 4.19, p < 0.001). The older age group continued to have a significantly increased odds of medical complications after multivariable adjustment (adjusted OR: 8.64, p < 0.001). CONCLUSIONS: On this analysis of a national database, advanced age was associated with an increased frequency of early postoperative complications following open mandibular fracture repair. Following multivariable adjustment, advanced age continued to be associated with increased odds of postoperative medical complications within 30 days of surgery. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:287-293, 2023.

An analysis of lactate dehydrogenase (LDH) levels in advanced stage IV melanoma of the skin: prognostic capabilities and demographic variability.

Despite its limitations, in part due to decreased specificity in advanced disease, serum lactate dehydrogenase (LDH) is one of few serum factors used in cancer staging. This study quantifies the predictive capabilities of LDH in stage IV melanoma of the skin and explores the validity of suggested demographic discrepancies which may exist in its use. The 1975-2017 Surveillance Epidemiology and End Results (SEER) database was queried for stage IV cutaneous melanoma cases. Demographic characteristics were compared between LDH groups using chi-square and t tests. Subsequent Cox multivariable regression was performed to assess survival differences. 334 cases of stage IV cutaneous melanoma (average age: 63.0 years) with measured serum LDH levels were identified. Of these patients, 150 (44.9%) had normal LDH, 112 (33.5%) had LDH < 1.5 × upper limit of normal (ULN), 57 (17.1%) had LDH 1.5-10 × ULN, and 15 (4.5%) had LDH > 10 × ULN. Lower incomes were associated with higher LDH; individuals with incomes < $50,000 had the greatest proportion of LDH 10 × ULN (19.2%; p = 0.0031). LDH > 10 × ULN also had the lowest proportion of White patients (p = 0.04). On Cox multivariable survival analysis, increasing LDH levels showed increased risk of death (LDH < 1.5 × ULN: HR = 2.05, p = 0.01; LDH 1.5-10 × ULN: HR = 1.46, p < 0.001; LDH > 10 × ULN: HR = 5.91, p < 0.001). This study reaffirms the utility of LDH as a significant predictor of mortality with incremental severity, suggesting possible use for mortality projections. We note that Black patients and those with lower incomes may be more likely to have an elevated LDH. Older age groups and presence of ulceration among patients with stage IV melanoma were also associated with a greater risk of mortality.

Applying Machine Learning to Determine Popular Patient Questions About Mentoplasty on Social Media.

PURPOSE: Patient satisfaction in esthetic surgery often necessitates synergy between patient and physician goals. The authors aim to characterize patient questions before and after mentoplasty to reflect the patient perspective and enhance the physician-patient relationship. METHODS: Mentoplasty reviews were gathered from Realself.com using an automated web crawler. Questions were defined as preoperative or postoperative. Each question was reviewed and characterized by the authors into general categories to best reflect the overall theme of the question. A machine learning approach was utilized to create a list of the most common patient questions, asked both preoperatively and postoperatively. RESULTS: A total of 2,012 questions were collected. Of these, 1,708 (84.9%) and 304 (15.1%) preoperative and postoperative questions, respectively. The primary category for patients preoperatively was "eligibility for surgery" (86.3%), followed by "surgical techniques and logistics" (5.4%) and "cost" (5.4%). Of the postoperative questions, the most common questions were about "options to revise surgery" (44.1%), "symptoms after surgery" (27.0%), and "appearance" (26.3%). Our machine learning approach generated the 10 most common pre- and postoperative questions about mentoplasty. The majority of preoperative questions dealt with potential surgical indications, while most postoperative questions principally addressed appearance. CONCLUSIONS: The majority of mentoplasty patient questions were preoperative and asked about eligibility of surgery. Our study also found a significant proportion of postoperative questions inquired about revision, suggesting a small but nontrivial subset of patients highly dissatisfied with their results. Our 10 most common preoperative and postoperative question handout can help better inform physicians about the patient perspective on mentoplasty throughout their surgical course. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nasal valve repair (NVR) utilization and economic impact in the U.S. medicare population: 18-year trends.

PURPOSE: Nasal valve repair (NVR) is an otolaryngological procedure indicated for the surgical correction of airway obstruction or collapse. Despite its growing popularity, the deployment and financial impact for NVR have not been well-described. Here, we evaluate trends in NVR utilization in the U.S. Medicare population on the state and national levels from 2001 to 2018. MATERIALS AND METHODS: Historical utilization and reimbursement databases compiled by the U.S. Centers for Medicare & Medicaid Services (CMS) were queried for current procedural terminology (CPT) code 30465. Analyses were performed using Microsoft Excel v16. RESULTS: Nationally, we observed a 989.60% increase in the total number of NVRs performed annually (611.07% adjusted to growing enrollment). Concomitantly, total reimbursement increased by 2025.52% (878.29% adjusted), though the average cost per procedure only rose moderately (37.58%). From 2013 to 2018, the majority of providers were male (74.79%), with an M.D. (71.37%), practicing as individuals (76.5%), operating in a facility setting (93.59%), and classified as otolaryngologists (63.25%). In 2018, Indiana had the highest utilization rate, whereas Oregon received the largest reimbursement. Connecticut had the lowest values in both categories. CONCLUSIONS: The utilization and financial impact of NVR have increased substantially among the U.S. Medicare population over the last two decades.

Patterns of Care and Outcomes of Primary Adenoid Cystic Carcinoma of the Trachea.

OBJECTIVE: Primary tracheal malignancies are relatively rare cancers, representing 0.1% to 0.4% of all malignancies. Adenoid cystic carcinoma (ACC) is the second most common histology of primary tracheal malignancy, after squamous cell carcinoma. This study aims to analyze demographic characteristics and potential influencing factors on survival of tracheal ACC (TACC). METHODS: This was a retrospective cohort study utilizing the National Cancer Database (NCDB). The NCDB was queried for all cases of TACC diagnosed from 2004 to 2016 (n = 394). Kaplan-Meier (KM) and Cox proportional-hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes. RESULTS: Median age of diagnosis was 56 (IQR: 44.75-66.00). Females were affected slightly more than males (53.8% vs 46.2%). The most prevalent tumor diameter range was 20 to 39 mm (34.8%) followed by greater than 40 mm in diameter (17.8%). Median overall survival (OS) was 9.72 years with a 5- and 10-year OS of 70% and 47.5%, respectively. Localized disease was not associated with a survival benefit over invasive disease (P = .388). The most common intervention was surgery combined with radiation therapy (RT) at 46.2%, followed by surgery alone (16.8%), and standalone RT (8.9%). When adjusting for confounders, surgical resection was independently associated with improved OS (HR 0.461, 95% CI 0.225-0.946). Tumor size greater than 40 mm was independently associated with worse OS (HR 2.808; 95% CI 1.096-7.194). CONCLUSION: Our data suggests that surgical resection, possibly in conjunction with radiation therapy, is associated with improved survival, and tumor larger than 40 mm are associated with worse survival.

Assessing Patient Satisfaction Following Blepharoplasty Using Social Media Reviews.

BACKGROUND: Because patient satisfaction is a significant qualitative consideration in measuring aesthetic surgery outcome, it is important to characterize the individual factors that shape the patient perspective about blepharoplasty. OBJECTIVES: This study analyzed reviews by blepharoplasty patients on the aesthetic surgery social media platform RealSelf.com to determine which aspects of the surgical process have the most significant impact on patient satisfaction. METHODS: Blepharoplasty reviews were gathered from RealSelf.com with an automated web crawler. These reviews were characterized as positive or negative, then given a specific category that more specifically defined the theme of the review. Additional variables, including the specialty of the reviewed physician and any patient self-reported ratings, were documented. RESULTS: A total of 1991 reviews pertaining to blepharoplasty were collected. Among reviews with self-reported "worth it" ratings, 93.5% were positive. Following categorization of all reviews, 1865 (93.7%) were positive and 126 (6.3%) were negative. Of the positive reviews, the most common overall themes were bedside manner (n = 899, 48.2%), aesthetic result (n = 859, 46.1%), and overall comfort (n = 58, 3.1%). Among negative reviews, most pertained to aesthetic result (n = 100, 79.4%), and bedside manner (n = 14, 11.1%). The most frequently encountered physician specialties performing blepharoplasty were plastic surgery (n = 1101, 55.3%), ophthalmology (n = 634, 31.8%), and otolaryngology (n = 69, 3.5%). CONCLUSIONS: The majority of reviews were positive. The most prominent factor driving positive reviews was bedside manner, followed by aesthetic results. Negative reviews were most frequently attributed to suboptimal aesthetic results. Most blepharoplasties in our study cohort were performed by plastic and oculoplastic surgeons.

Facial paralysis and vaccinations: a vaccine adverse event reporting system review.

BACKGROUND: Vaccinations are a cornerstone of preventative medicine in the USA. However, growing concerns regarding facial nerve palsy following vaccination exist. OBJECTIVE: This study aims to assess the occurrence of facial palsy as reported by the Vaccine Adverse Event Reporting System (VAERS) database. METHODS: A retrospective analysis of the VAERS database was performed for cases of 'Facial Palsy', 'Bell's Palsy', 'Facial Paralysis' and 'Ramsay Hunt Syndrome' between 2009 and 2018. Subgroup analysis was performed to determine gender, age, history of facial palsy, type of vaccine used, number of days until onset of symptoms and overall facial palsy rate. RESULTS: Nine hundred and forty-four entries met our inclusion criteria with 961 vaccine administrations resulting in facial paralysis. Facial palsy following vaccinations was evenly distributed across all age cohorts with two peaks between 60 and 74 years old and between 0 and 14 years old. Most patients were female (N = 526, 55.7%) without a reported history of facial palsy (N = 923, 97.8%). In 2009, reported incidence rate was 0.53%, as compared with 0.23% in 2018. The influenza vaccine had the greatest number of cases (N = 166, 17.3%), followed by the varicella (N = 87, 9.1%) and human papillomavirus vaccines (N = 47, 4.9%). CONCLUSIONS: With the SARS-CoV-2 pandemic and recent approvals of the vaccinations, there is growing concern of facial palsy following vaccination. Although it is a known adverse event following vaccination, the likelihood of facial palsy following vaccination is low, with only 0.26% of overall reported cases over a 10-year span.

The Vascularized Occipital Fascial Flap (OFF): A Novel Reconstructive Technique for Posterior Fossa Surgery.

BACKGROUND: Posterior fossa surgery is particularly prone to cerebrospinal fluid (CSF) leakage. Several methods have been introduced to address and/or prevent this complication. However, to the best of our knowledge, the use of a vascularized fascial flap based on the occipital artery for the purpose of reconstruction has not been reported. We introduce the occipital fascial flap (OFF) for reconstruction of a craniectomy defect after the retrosigmoid approach. METHODS: A 57-year-old woman with a large cerebellar metastasis underwent gross total resection of the mass followed by reconstruction of the craniectomy defect using OFF. RESULTS: Postoperative imaging showed flap viability and no CSF leak occurred during follow-up. CONCLUSIONS: We report the first use of OFF for reconstruction of a craniectomy defect in a retrosigmoid approach. The vascularized fascial flap in posterior fossa surgery is a potentially helpful technique to reduce the risk of CSF leak in high-risk patients.

Adverse events following injection laryngoplasty: An analysis of the MAUDE database.

OBJECTIVE: Injection laryngoplasty (IL) is considered safe in both the operating room and clinical setting. However, safety data is limited to single-institution studies with reduced sample sizes. The objective of this study is to examine a national database for adverse events related to IL in an effort to further confirm the safety of this procedure and better characterize potential complications. MATERIALS AND METHODS: Retrospective analysis of the Manufacturer and User Facility Device Experience (MAUDE) database for reported adverse events of IL procedures utilizing calcium hydroxyapatite (CAHA), hyaluronic acid (HA) and carboxymethylcellulose (CMC) implants from 2009 to 2020. RESULTS AND ANALYSIS: We identified 47 reported adverse events. The average patient age was 54 years old. 59.3% of patients were female. Adverse events more frequently involved the use of CAHA compared to HA or CMC (n = 27, 57.4%, n = 13, 27.7% and n = 7, 14.9%, respectively). The most common adverse events were laryngeal edema (n = 18, 39.1%), improper placement of injected material (n = 12, 26.1%), persistent dysphonia (n = 13, 28.3%), and post-injection dysphagia or odynophagia (n = 11, 23.9%). Major events, defined as requiring emergency room treatment, hospitalization, or surgical intervention accounted for 29 (60.4%) of cases. Four cases of edema required intubation, and one patient necessitated a surgical airway. CONCLUSION: Complications arising from IL range from minor events to airway obstruction and may happen with a variety of injectable materials including CAHA, HA and CMC. Few cases of airway obstruction requiring immediate intervention were identified, confirming the safety of IL in both the operative and office setting.

Complications associated with deep brain stimulation for Parkinson's disease: a MAUDE study.

INTRODUCTION: Deep brain stimulation (DBS) is a common surgical option for the treatment of medically refractory Parkinson's disease (PD). Manufacturer and User Facility Device Experience (MAUDE), a United States Food and Drug Administration (FDA)-compiled database of adverse event reports related to medical devices, is a public resource that can provide insight into the relative frequency of complications and patient complaints. MATERIALS AND METHODS: We accessed the MAUDE database and queried for adverse reports for deep brain stimulators implanted for PD from January 1, 2009 to December 31, 2018. Complaints were classified into device malfunction, patient non-compliance, patient complaint, surgically managed complications (i.e. complications that are corrected via surgery), and death. Patient complaints were further stratified into ineffective stimulation, shock, overstimulation, battery-related problems, or pain at the pulse generator site. Surgically managed complications were classified as intraoperative complications, impedance, migration, erosion, infection, lead fracture, and lead disconnection. Each event could receive multiple classifications and subclassifications. RESULTS: A total of 4,189 adverse event reports was obtained. These encompassed 2,805 patient complaints. Within this group, 797 (28%) events were classified as ineffective stimulation. There were 1,382 surgically managed complications, 104 (8%) of which were intraoperative complications, 757 (55%) documented impedance issues, 381 (28%) infections, and 413 (30%) lead-related issues. There were 53 documented deaths. CONCLUSIONS: The MAUDE database has potential use as a real time monitor for elucidating the relative occurrence of complications associated with deep brain stimulation. It also allows for the analysis of device-related complications in specific patient populations. Although the database is useful in this endeavor, it requires improvements particularly in the standardization of reporting adverse events.

Adverse Events Associated with Intranasal Sprays: An Analysis of the Food and Drug Administration Database and Literature Review.

BACKGROUND: Intranasal sprays (INSs) are commonly used medications for the treatment of many rhinologic conditions. Despite their popularity, an analysis of a nationwide reporting database and comparison to the available literature has never been performed. METHODS: The Food and Drug Administration Adverse Event Reporting System (FAERS) database was accessed to obtain adverse event (AE) records from 2014 to 2019 for varying INSs, including: 10 corticosteroids, 1 alpha adrenergic, and 3 antihistamines. The Proportional Reporting Ratios (PRR) and Reporting Odds Ratios (ROR) were calculated for dyspnea, anosmia, ageusia/dysgeusia, epistaxis, and headache. A PRR ≥ 2 or ROR ≥ 1 was considered significant. RESULTS: Corticosteroids had 98 864 total reported AEs to the database, followed by antihistamines (7011) and alpha adrenergics (2071). In total, dyspnea was reported 5843 times, followed by headache (4230), epistaxis (1205), ageusia/dysgeusia (920), and anosmia (312). Overall, PRR and ROR values for dyspnea ranged from 0.51 to 4.25 and 0.51 to 4.49; for dysgeusia/ageusia from 0.56 to 6.09 and 0.56 to 6.12; and for epistaxis from 1.03 to 27.24 and 1.03 to 30.76, respectively. All medications which listed anosmia within the top AEs had PRR and ROR values exceeding 2 and 1, respectively. The PRR for headache exceeded 2 for 1 medication and the ROR exceeded 1 in 7 medications. CONCLUSION: The AEs of dyspnea, anosmia, ageusia/dysgeusia, epistaxis, and headache are reported within the FAERS database for commonly prescribed INSs. When compared against the existing scientific literature, the clinical significance of this reporting tool from the FDA for these classes of medications remains unvalidated.

YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy.

INTRODUCTION: YouTube is an unregulated platform that patients are using to learn about treatment options. AIM: To assess the reliability of YouTube videos (YTVs) related to male hypogonadism and testosterone therapy. METHODS: Searching on YouTube by relevance and view count, we analyzed the top 10 videos (80 videos total) for the following search terms: low testosterone, testosterone replacement therapy, AndroGel, and hypogonadism. MAIN OUTCOME MEASURE: We recorded the number of views for each video, evaluated videos using the DISCERN score (DS) criterion, and compared the DS for videos including board-certified physicians and videos without. A second comparison was made between videos with board-certified physicians in urology, endocrinology, other MD, and those without any physician. RESULTS: The YTVs analyzed received a total of 38,549,090 views, a median of 25,201 and 17.30 views/day. Videos that featured physicians had significantly fewer views/day than videos that did not (39.48 CI 9,72 vs 1,731 CI 330, 3,132; P = .019). Most YTVs studied were unreliable. The median DS across all videos was 2. However, most videos created by physicians were found to be reliable with a median DS of 4. In addition, YTVs that did not feature a physician were found to be significantly less reliable than videos that featured a physician (3.22 CI 3.06, 4.09 vs 1.87 CI 1.56, 2.18; P < .001). There was no significant difference in the reliability or viewership of YTVs stratified by physician type. CONCLUSION: Most YTVs related to male hypogonadism/testosterone therapy were unreliable, but there are reliable YTVs available. Reliable videos usually feature a physician and receive fewer views than unreliable YTVs. Physicians and academic societies should work to provide verified videos to provide patients with reliable information about male hypogonadism and testosterone therapy. CJ Warren, J Wisener, B Ward, et al. YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy. Sex Med 2021;9:100324.

Evaluating YouTube as a Resource for Trigeminal Neuralgia Patient Education.

PURPOSE: The objective of this study was to examine the educational value of YouTube as a source of patient information regarding trigeminal neuralgia and its treatment. We also sought to determine the degree of bias that is present in the top videos regarding this condition. MATERIALS AND METHODS: We selected 6 search terms related to trigeminal neuralgia to examine on YouTube for quality and bias using the DISCERN criteria. Filtering by relevance and total view count, we determined the top 20 results for each search term and evaluated all videos for overall educational quality and creator bias. We categorized the type of content creator and compared overall DISCERN scores and bias scores between creator type and search term. RESULTS: There were 80 unique and 40 duplicate videos. There were 10,745,574 total views across all videos, with an average view count of 89,546. The mean DISCERN score for all videos was 1.7, and the mean bias score was 2.2. Based on individual search terms, the highest mean DISCERN score was for trigeminal neuralgia surgery (2.1) and the highest mean bias score was for tic douloureux (2.8). Among creator types, medical professionals had significantly higher overall (2.2) and bias (2.6) scores. CONCLUSIONS: Overall, YouTube is a relatively poor source of unbiased information about trigeminal neuralgia. Among the existing content, medical professionals provide educational material that is the highest quality and the most unbiased.

Septic Arthritis of the Temporomandibular Joint: A Systematic Review.

PURPOSE: The purpose of this study was to describe the characteristics of the patient history, clinical findings, laboratory tests, treatment, and long-term function of septic arthritis of the temporomandibular joint (SATMJ). METHODS: All articles in the English literature related to SATMJ were queried using PubMed, Embase, and the Cochrane Library (1950 to July 1, 2020). The reference lists were reviewed for additional articles. RESULTS: A preliminary search of the literature returned 241 results, of which 37 met inclusion criteria, with an additional article from reference review. There were 93 total cases, with a mean age of 35.7 years (0.1 to 85). Symptoms mostly consisted of pain in the temporomandibular joint/preauricular region (n = 84, 90.3%), trismus (n = 73, 78.5%), and facial/preauricular swelling (n = 68, 73.1%). Most patients had no systemic symptoms (n = 80, 86.1%). The mean degree of mouth opening was 13.1 mm (5 to 35). Diagnosis was made with the following imaging modalities: radiograph (n = 48, 51.6%), CT scan (n = 35, 37.6%), MRI (n = 25, 26.9%), and ultrasound (n = 3, 3.2%). Staphylococcus aureus (n = 19, 20.4%) was most commonly isolated. About 92 patients (98.9%) received antibiotics and 85 patients underwent surgery (eg, arthrocentesis, arthroscopy, etc.), of which 15 patients (17.6%) required repeat surgery. Most long-term outcomes were favorable. Sequelae occurred in 26 of 85 patients (30.6%) with documented follow-up. CONCLUSIONS: SATMJ should be suspected in the presence of trismus, jaw pain, and preauricular swelling. Management includes prompt evaluation and treatment with broad-spectrum antibiotics. Surgery is not always indicated but can be life-saving in severe cases.

Characterizing Patient Questions Before and After Rhinoplasty on Social Media: A Big Data Approach.

BACKGROUND: As an aesthetic surgery, a successful rhinoplasty is often assessed by patient satisfaction, subject to a diverse array of qualitative factors including patient expectations and happiness with care provided. While substantial effort has been dedicated to understanding patients' post-operative concerns, addressing patients' pre-operative questions has been comparatively less studied. This study analysed pre- and post-operative questions about rhinoplasty on social media to gain insights into patients' concerns and develop targeted educational material. METHODS: The most viewed rhinoplasty questions on Realself.com, a social media platform for discussions about cosmetic surgeries, were collected and analysed. Questions were then stratified into pre- and post-operative and further assigned categories based on common topics found in the data. Using a machine learning approach, the most common pre- and post-operative questions were determined. RESULTS: 2014 rhinoplasty questions were collected in total, with 957 pre-operative and 1057 post-operative. The most commonly asked pre-operative questions were about appearance (n = 441, 46.1%), function (n = 102, 10.7%), and cost (n = 94, 9.8%). The most commonly asked post-operative questions were about appearance (n = 502, 47.5%), behaviour allowed/disallowed (n = 283, 26.8%), and symptoms after surgery (n = 235, 22.2%). An educational handout with the 10 most common pre- and post-operative questions was developed using machine learning analysis, with the majority of questions about appearance. CONCLUSIONS: Patients primarily expressed concern about appearance when asking questions about rhinoplasty on social media, along with other aspects of their pre- and post-operative course. The educational handout developed by this study can be applied to address commonly asked patient questions during pre-operative education. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quality, Reliability, and Readability of Online Information on Rhinoplasty.

BACKGROUND: With an ever-growing reliance on technology, patients are increasingly resorting to websites for their medical information. This study evaluates the readability, quality, and reliability of online information available on rhinoplasty provided by academic centers or impartial reference sources and private practice websites. METHODS: A cross-sectional study from July to August 2019 was performed looking at the first 42 informational websites on a Google search for the term nose job. Websites were categorized as belonging to impartial sources and academic centers or private practices. Two independent reviewers evaluated websites on their quality, readability, reliability, and technical qualities using several validated measures. The Health on the Net code (HONcode) and DISCERN questionnaire were used to assess the quality and reliability of the information presented on the websites. Significance tests were performed using SPSS Version 25. RESULTS: Of the 42 websites, 23 were impartial sources or academic centers (54.8%) and 19 were private practice websites (47.6%). The mean (±SD) for the HONcode and DISCERN scores were 5.7 (±2.8) and 2.6 (±0.7), respectively. The mean (SD) HONcode scores for impartial sources and private practice websites were 7.1 (±2.9) and 4.1 (±1.5), respectively (P < 0.001). The mean (±SD) DISCERN scores were 2.9 (±0.7) and 2.3 (±0.5), respectively (P = 0.009). There was no statistically significant difference in scores for readability and technical qualities. CONCLUSIONS: While impartial sources and academic centers score higher on quality and reliability scores, their scores were also low. These findings are concerning as many consumers use the information provided by online websites to guide decisions regarding their health.