AAO-HNS Clinical Practice Guidelines and Clinical Consensus Statements Focused on Quality Improvement

July 2020 – Vol. 39, No. 6

With the goal of improving quality of care in otolaryngology, the AAO-HNSF has continued to develop guidance documents, in the form of Clinical Practice Guidelines (CPGs) and Clinical Consensus Statements (CCSs), on a range of topics prioritized by the Guideline Task Force (GTF). The GTF leadership and methodologists, David E. Tunkel, MD (GTF Chair), Richard M. Rosenfeld, MD, MPH, MBA (Senior Advisor and Methodologist for Quality Measures and Guidelines), Seth R. Schwartz, MD, MPH, and Stacey L. Ishman, MD, MPH, have led the methodological oversight of these documents. Their leadership, as well as that of each CPG and CCS chair, has helped produce publications that are highly cited and accessed not only by AAO-HNS members, but also by clinicians across multiple specialties, as well as by patients and the public. As the AAO-HNSF continues to develop new CPGs and CCSs, and update previously published CPGs, the catalogue of CPGs has also facilitated the development of quality measures. This has furthered the AAO-HNSF’s goal to take the lead in defining “quality care” for the specialty.

CCSs that have been published or initiated in 2019 and 2020 include:

  • CCS: Balloon Dilation of the Eustachian Tube (June 2019)
  • CCS: Ankyloglossia in Children (April 2020)
  • CCS: Drug Induced Sleep Endoscopy (In progress)

CPGs that have been published and initiated in 2020 include:

  • CPG: Nosebleed (Epistaxis) (January 2020)
  • CPG: Meniere’s Disease (April 2020)
  • CPG: Opioid Prescribing for Analgesia After Common Otolaryngology Operations (In progress)
  • CPG: Tympanostomy Tubes in Children (Update) (In progress)
  • CPG: Surgical Management of Rhinosinusitis (In progress)

To support the dissemination and implementation of a CPG that is published as a supplement in Otolaryngology–Head and Neck Surgery, the AAO-HNSF produces resources including a plain language summary, executive summary, patient handouts (printable, customizable, and available in Spanish), slide set, podcast episodes, and, in collaboration with Guideline Central, a quick-reference pocket guide and app. In addition, CPGs and CCSs are presented at the AAO-HNSF Annual Meeting & OTO Experience prior to publication and are shared with relevant organizations in order to request endorsement.

Clinical Consensus Statement: Ankyloglossia in Children

The new Clinical Consensus Statement (CCS): Ankyloglossia in Children was published online in Otolaryngology–Head and Neck Surgery on April 14, 2020. Anna H. Messner, MD, chaired the CCS development panel, which was composed of a panel of experts in the field of pediatric otolaryngology. The purpose of the CCS is to promote appropriate, evidence-based care of the infant and child with possible ankyloglossia and/or upper lip tie.

The panel was able to reach consensus on 41 statements after three iterative Delphi method surveys related to the clarification of diagnosis, management, and treatment of ankyloglossia in children up to 18 years of age. An additional 17 statements were near consensus, and 28 statements failed to achieve consensus. The statements were grouped into the following categories: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum. Areas where knowledge gaps and lack of evidence exist identified opportunities for future research. In the meantime, this information should prove helpful for otolaryngologists treating patients with ankyloglossia. The AAO-HNSF recognizes the valuable contributions made by Dr. Messner and the panel in the development of this new CCS.

Read CCS: Ankyloglossia in Children now by visiting https://journals.sagepub.com/doi/full/10.1177/0194599820915457.

A podcast, moderated by John H. Krouse, MD, PhD, MBA, Editor in Chief of Otolaryngology–Head and Neck Surgery, with Jennifer J. Shin, MD, SM, and Dr. Messner, is also available at http://sageotolaryngology.sage-publications.libsynpro.com/oto-clinical-consensus-statement-ankyloglossia-in-children

To access the published CPGs, CCSs, and supplemental resources, visit www.entnet.org/CPG.