IMPORTANCE: The internet has changed the way that medical information by journals is disseminated, with a shift toward online distribution. Given this, it is important to include alternative metrics that measure online attention when determining the influence of otolaryngology journals. OBJECTIVE: To describe a ranking system for otolaryngology journals that reflects the amount of publicity received online and to determine factors associated with these rankings. DESIGN AND SETTING: In this cross-sectional study, online attention was measured using Altmetric Attention Scores obtained for all 26 112 articles published by the 43 journals classified under the Journal Citation Reports category of otorhinolaryngology from 2018 to 2022. Data were analyzed from January to June 2023. MAIN OUTCOMES AND MEASURES: Altmetric journal rankings were created from the top 500 articles with the highest Altmetric Attention Scores, using a rank sum weight-based method to assign credit for an article's attention online to its respective journal. The association of article content, study design and type, and social media presence on X (formerly Twitter) with ranking was examined. Comparisons between Altmetric journal rankings and bibliometric rankings (5-year Impact Factor) were also performed. RESULTS: Of 43 otolaryngology journals, JAMA Otolaryngology-Head & Neck Surgery had the highest Altmetric journal ranking. Most articles in the Altmetric top 500 were nonoperative clinical studies (220 articles [43.5%]) or described the natural history of disease (176 articles [34.9%]) and involved otology/neurotology (158 articles [29.9%]) or rhinology/allergy (134 articles [25.4%]). The COVID-19 pandemic was a common topic (169 articles [33.5%]). The presence of an active X account for the entire 5-year period was associated with a higher Altmetric total rank sum score for journals (η2 = 0.07
95% CI, 0.02-0.13 [moderate effect size]). There was a moderate statistically significant correlation between Altmetric journal rankings and 5-year Impact Factor rankings (r = 0.5
95% CI, 0.2-0.7). CONCLUSIONS AND RELEVANCE: This cross-sectional study demonstrates that metrics based on online attention provide an alternative way to assess the reach and influence of medical journals. Journals seeking to expand their influence online may benefit from a presence on social media.