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Background: Despite National Institutes of Health and American Medical Association recommendations to publish online patient education materials at or below sixth-grade literacy, those pertaining to endoscopic skull base surgery (ESBS) have lacked readability and quality. ChatGPT is an artificial intelligence (AI) system capable of synthesizing vast internet data to generate responses to user queries but its utility in improving patient education materials has not been explored., Objective: To examine the current state of readability and quality of online patient education materials and determined the utility of ChatGPT for improving articles and generating patient education materials., Methods: An article search was performed utilizing 10 different search terms related to ESBS. The ten least readable existing patient-facing articles were modified with ChatGPT and iterative queries were used to generate an article de novo . The Flesch Reading Ease (FRE) and related metrics measured overall readability and content literacy level, while DISCERN assessed article reliability and quality., Results: Sixty-six articles were located. ChatGPT improved FRE readability of the 10 least readable online articles (19.7 ± 4.4 vs. 56.9 ± 5.9, p < 0.001), from university to 10th grade level. The generated article was more readable than 48.5% of articles (38.9 vs. 39.4 ± 12.4) and higher quality than 94% (51.0 vs. 37.6 ± 6.1). 56.7% of the online articles had "poor" quality., Conclusions: ChatGPT improves the readability of articles, though most still remain above the recommended literacy level for patient education materials. With iterative queries, ChatGPT can generate more reliable and higher quality patient education materials compared to most existing online articles and can be tailored to match readability of average online articles., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: Climbing is an increasingly popular sport. Yet, we have encountered numerous misdiagnosed climbing injuries, highlighting a gap in climbing-related literature and a need for heightened awareness within the sports medicine community. We present a case series that highlights the clinical manifestation of ulnar nerve entrapment and compression in three patients with initially misdiagnosed and mismanaged elbow tendinopathy. After a correct diagnosis of ulnar nerve pathology was made, each patient underwent a prescribed rehabilitation protocol that focused on nerve motility exercises (tensioning and flossing), resulting in a significant reduction in pain and a successful return to their pre-injury climbing performance. We thus aim to raise awareness of this often-mistreated presentation. Furthermore, we highlight other common upper extremity climbing misdiagnoses and provide relevant clinical recommendations to accurately identify and manage such injuries in climbers., (Copyright © 2024 by the American College of Sports Medicine.)

Background: Postoperative cerebrospinal fluid (CSF) leak remains a concerning complication of the endoscopic endonasal approach (EEA) for skull base pathology. Signs and symptoms suggesting CSF leak often trigger additional workup during the postoperative course. We systematically evaluate associations between subjectively reported clinical signs/symptoms noted during the immediate postoperative period and incidence of postoperative CSF leaks., Methods: Retrospective chart review was conducted at a tertiary academic medical centre including 137 consecutive patients with intraoperative CSF leak during EEA with primary repair between July 2018 and August 2022. Postoperative CSF leak associations with clinical signs and symptoms were evaluated using positive (PPV) and negative predictive values (NPV), sensitivity, specificity and odds ratio (OR) via univariate logistic regression., Results: Seventy-nine patients (57.7%) had high-flow leaks repaired and 5 (3.6%) developed CSF leaks postoperatively. Of reported symptoms, rhinorrhea was most common (n = 52, 38.0%; PPV [95% CI] = 7.6% [4.8%, 11.9%]), followed by severe headache (n = 47, 34.3%; 6.3% [3.1%, 12.5%]), dizziness (n = 43, 31.4%; 2.3% [0.4%, 12.1%]), salty or metallic taste (n = 20, 14.6%; 9.9% [3.3%, 25.8%]), and throat drainage (n = 10, 7.3%; 9.9% [1.7%, 41.4%]). Nausea or vomiting constituted the most reported sign concerning for CSF leak (n = 73, 53.3%; PPV [95% CI] = 4.1% [2.0%, 8.1%]). On univariate regression, no sign or symptom, including rhinorrhea (OR [95% CI] = 7.00 [0.76-64.44]), throat drainage (3.42 [0.35-33.86]), salty/metallic taste (4.22 [0.66-27.04]), severe headache (3.00 [0.48-18.62]), dizziness (0.54 [0.06-4.94]), fever (3.16 [0.50-19.99]), and nausea/vomiting (1.33 [0.22-8.21]), associated with postoperative CSF leak., Conclusions: A range of subjectively reported symptoms and signs failed to predict postoperative CSF leak. Further investigation is warranted to inform appropriate attention and response., (© 2024 John Wiley & Sons Ltd.)

Objective: Evaluate the effect of treatment delay on survival in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing primary surgical resection., Study Design: Retrospective cohort study using the 2010-2017 National Cancer Database., Setting: Multicenter database study., Methods: Patients >18 years old with OPSCC and known HPV status, treated surgically with or without postoperative radiation/chemotherapy were included. Two cohorts based on HPV status were grouped by time to treatment initiation (T D-TI , ≤30, 31-60, ≥61 days) and surgery to radiotherapy (T S-RT , ≤42, 43-66, ≥67 days). Univariate, Kaplan-Meier, and multivariate analyses assessed correlations between demographic and clinical factors with overall survival in treatment delay groups., Results: Included were 1643 HPV-positive OPSCC patients and 391 HPV-negative OPSCC patients. No associations between survival and gender, age, race, insurance, or radiotherapy length were observed. Regardless of HPV status, larger tumor size (>2 cm) and lymphovascular invasion predicted worse survival. HPV negative patients with >4 lymph nodes involved had 2.5× greater mortality risk (P = .039). Robotic surgery was associated with improved survival only in HPV positive patients (hazard ratio [HR]: 0.41, P < .001). In HPV positive patients, higher T D-TI related to lower mean survival, although this was not significant on multivariate analysis. HPV negative patients with >42 days of T S-RT had decreased survival (43-66 days, HR 1.63, P = .049; ≥67 days, HR 2.10, P = .032)., Conclusion: Longer T S-RT was associated with lower overall survival in HPV negative patients. Treatment delay was not associated with survival in HPV positive OPSCC according to multivariate analysis. These findings enhance knowledge about treatment delay effects in OPSCC, aiding providers in decisions and patient communication., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Key Points: The septal branch of the anterior ethmoid artery (sbAEA) is an underrecognized source of severe refractory epistaxis. Herein, we describe the presentation, predisposing factors, treatment strategies, and outcomes of a series of patients with this condition., (© 2024 ARS‐AAOA, LLC.)

Objectives: As research in otolaryngology continues to expand rapidly, it is important to identify core journals to keep clinicians updated with the latest advances. This study is the first to characterize core journals in otolaryngology., Methods: Using h-index and impact factor (IF), the top 15 NLM-indexed otolaryngology journals were selected for analysis. The references from all articles published in these journals in one randomized quarter were compiled into a citation rank list, with the most cited journal ranked the highest. Citation zonal distribution analysis was conducted to identify the zonal distribution of otolaryngology journals., Results: A total of 3150 journals containing 26876 articles were cited in otolaryngology literature in April-June 2019. Laryngoscope was the most cited journal containing 1762 citations. IF is significantly associated with the h-index for the top 10 otolaryngology journals (p = 0.032). Three core journal zones were identified, with Zone 1 containing 8 journals, Zone 2 containing 36 journals, and Zone 3 containing 189 journals. A linear relationship between the log journal rank for Zones 1-3 and a cumulative number of citations was found (R 2  = 0.9948)., Conclusion: Eight core journals for otolaryngology were identified: Laryngoscope, Otolaryngology-Head and Neck Surgery, Otology & Neurotology, JAMA Otolaryngology-Head & Neck Surgery, Head & Neck, European Archives of Oto-Rhino-Laryngology, International Journal of Pediatric Otorhinolaryngology, Annals of Otology, Rhinology & Laryngology. In the face of rapidly evolving research and a multitude of journals, the high citation density within these core journals highlights their utility in updating busy clinicians., Level of Evidence: NA Laryngoscope, 133:3346-3352, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: We aim to evaluate the impact of MetS on the short-term postoperative outcomes of complex head and neck surgery patients., Methods: This is a retrospective cohort analysis of the 2005 to 2017 National Surgical Quality Improvement Program (NSQIP) database. NSQIP database was queried for 30-day outcomes of patients undergoing complex head and neck surgeries, defined as laryngectomy or mucosal resection followed by free tissue transfer, similar to prior NSQIP studies. Patients with hypertension, diabetes, and body mass index (BMI) >30 kg/m 2 were defined as having MetS. Adverse events were defined as experiencing readmission, reoperation, surgical/medical complications, or mortality., Results: A total of 2764 patients (27.0% female) with a mean age of 62.0 ± 11.7 years were included. Patients with MetS (n = 108, 3.9%) were more likely to be female ( P  = .017) and have high ASA classification ( P  = .030). On univariate analysis, patients with MetS were more likely to require reoperation (25.9% vs 16.7%, P  = .013) and experience medical complications (26.9% vs 15.4% P  = .001) or any adverse events (61.1% vs 48.7%, P  = .011) compared to patients without MetS. On multivariate logistic regression after adjusting for age, sex, race, ASA classification, and complex head and neck surgery type, MetS was an independent predictor of medical complications (odds ratio 2.34, 95% CI 1.28-4.27, P  = .006)., Conclusion: Patients with MetS undergoing complex head and neck surgery are at increased risk of experiencing medical complications. Identifying patients with MetS can therefore aid surgeons in preoperative risk assessment and help improve postoperative management., Level of Evidence: N/A.

Background: The high prescription drug cost in the United States may negatively affect patient prognosis and treatment compliance., Objective: To fill the knowledge gap and inform clinicians regarding rhinology medications price changes by evaluating trends in price changes of highly used nasal sprays and allergy medications., Methods: The 2014-2020 Medicaid National Average Drug Acquisition Cost database was queried for drug pricing information for the following classes of medications: intranasal corticosteroids, oral antihistamines, antileukotrienes, intranasal antihistamines, and intranasal anticholinergics. Individual medications were identified by Food and Drug Administration-assigned National Drug Codes. Per unit, drug prices were analyzed for average annual prices, average annual percentage price changes, and inflation-adjusted annual and composite percentage price changes., Results: Beclometasone (Beconase AQ, 56.7%, QNASL, 77.5%), flunisolide (Nasalide, -14.6%), budesonide (Rhinocort Aqua, -1.2%), fluticasone (Flonase, -6.8%, Xhance, 11.7%), mometasone (Nasonex, 38.2%), ciclesonide (Omnaris, 73.8%), combination azelastine and fluticasone (Dymista, 27.3%), loratadine (Claritin, -20.5%), montelukast (Singulair, 14.5%), azelastine (Astepro, 21.9%), olopatadine (Patanase, 27.3%), and ipratropium bromide (Atrovent, 56.6%) had an overall change in inflation-adjusted per unit cost between 2014 and 2020 (% change). Of 14 drugs evaluated, 10 had an increase in inflation-adjusted prices, for an average increase of 42.06% ± 22.27%; 4 of 14 drugs had a decrease in inflation-adjusted prices, for an average decrease of 10.78% ± 7.36%., Conclusion: The rising cost of highly used medications contributes to increased patient acquisition costs and may pose barriers of drug adherence to particularly vulnerable populations., (Copyright © 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.