Elevating Otolaryngology: Advancing Quality Care with CPGs and ECSs
How the AAO-HNSF Guidelines Task Force is transforming evidence-based care through systematic Clinical Practice Guidelines (CPGs) and Expert Consensus Statements (ECSs).
Margo K. McKenna, MD, Guideline Task Force Chair, Kaitlyn Tholen, AAO-HNSF Analyst, Research and Quality, Zarah Akrami, MPH, AAO-HNSF Analyst, Research and Quality, and Jacob S. Marzalik, MA, PMP, AAO-HNSF Director of Research and Quality
The AAO-HNSF Guidelines Task Force (GTF) was established in 2014 with the goal of providing evidence-based recommendations and statements to help guide clinicians in caring for patients with diseases of the ear, nose, throat, and head and neck.
There are two types of documents that are produced through the GTF:Clinical Practice Guidelines (CPGs) and Expert Consensus Statements (ECSs). The main difference between the two is related to the breadth and depth of literature that is available, with CPGs generally addressing topics with the most high-quality research. This systematic approach ensures that both emerging evidence and established research contribute to improving patient care across the specialty.
Understanding CPGs Versus ECSs
CPGs are multidisciplinary endeavors that usually include several otolaryngologist topic experts, as well as representatives from other disciplines related to the topic (i.e., infectious disease experts, emergency physicians, allergists, pulmonologists, etc.), advanced practice providers (APPs) working in otolaryngology, and at least one patient advocate. CPGs are developed using systematic literature reviews to find the best high-quality evidence to guide clinical decision-making. Multidisciplinary panels meet virtually and in-person over the course of 14-16 months to develop clinical guidance based on the literature. The statements in CPGs are actionable, meaning they state what the clinician should or should not do, based on the quality and strength of the evidence.
ECSs are produced when evidence is emerging or limited but expert agreement is strong. These statements are reached by consensus among experts using the Delphi method, a systematic process to determine consensus “to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting.”1 They list and explain where experts agree and disagree but generally do not include actionable statements about what clinicians should or should not do.
Both types of documents help reduce practice variation, improve patient outcomes, and provide a shared foundation for patient care across all providers in the healthcare team.
Recent and Upcoming Guidelines and Statements
Two CPGs related to sinus disease were published in 2025—one new CPG on Surgical Management of Chronic Rhinosinusitis and the most recent CPG Update on Adult Sinusitis. These guidelines represent the current best evidence and the collaborative work of multidisciplinary panels that represent a broad range of stakeholder perspectives. They are now published in Otolaryngology-Head and Neck Surgery (May and July issues, respectively) and are widely available for otolaryngologists, primary care providers, advanced practice providers, trainees, and students.
For those who may not have time to review the full updates, listen to the journal’s podcasts for quick, 30-minute highlights of these latest guidelines.
Currently, the GTF is updating both the 2014 CPG on Tinnitus and 2013 CPG on Bell’s Palsy. The Tinnitus Guideline Update Panel, chaired by Meredith E. Adams, MD, met in person in July 2025 and panel members are currently drafting the updated manuscript. The Bell’s Palsy Update Panel, chaired by Gregory J. Basura, MD, PhD, also met in person in early September 2025. We will begin work on two more new CPGs on pediatric hearing loss and sleep surgery for adults with obstructive sleep apnea later in 2025.
Strategic Innovations and Future Directions
Our queue of high-priority topics continues to grow. We have eight CPG topics, five CPG update topics, and one ECS topic that have been vetted and approved by the GTF and are now in line for development. As the demand for evidence-based guidance increases, the GTF is exploring new ways to optimize our CPG process. We are assessing the feasibility of living guideline models that allow our products to evolve with the evidence, rather than undergoing resource-intensive updates every five to 10 years. To learn more about this work, we encourage everyone to attend our presentation at the upcoming AAO-HNSF Annual Meeting & OTO EXPOSM, “Adapting Clinical Practice Guidelines for the Digital Age: A Feasibility Study” at 4 pm on October 12.
The GTF has a strategic plan to expand the reach and impact of our products. We are updating theCPG Manualto reflect changes in guideline technology and workflow, refining and creating better dissemination materials (replacing the outdated pocket guides, as paper tools like this have become virtually obsolete), developing electronic medical record templates based on our guidelines, and exploring how to track real-world usage of our guidelines in clinical settings.
Get Involved with Quality Improvement Opportunities
Participating in the guideline development process is a meaningful way for AAO-HNS members to positively impact the specialty. The AAO-HNSF Cochrane Scholars Program is one key pathway for developing future guideline chairs, assistant chairs, and methodologists. In September, the 2025 Cochrane Scholars, Corinna G. Levine, MD, MPH, Mathieu Bergeron, MD, Matthew G. Crowson, MD, MPA, MASc, FRCSC, and Alexander Chern, MD, will attend the 2025 Guidelines International Network Annual Meeting in Geneva, Switzerland along with Academy staff and GTF leadership to deepen their knowledge on systematic reviews and evidence appraisal.
Another way for members to be involved is by proposing topics for CPGs and ECSs through Academy committees. These proposals are reviewed each fall by the GTF and are selected for consideration based on factors including topic importance, applicability to a wide section of academy members, feasibility, and clinical priority. If your committee sees a clinical area in need of formal guidance or consensus, we encourage you to submit a topic proposal here.
Finally, members can get directly involved in CPGs and ECSs by volunteering as a guideline development panel member. Guideline leaders identify sister societies (e.g., the American Head and Neck Society, the American Rhinologic Society) and AAO-HNS/F committees for representation. These groups can then nominate members to represent their interests as guideline panel members. We encourage members to communicate your interests to your society or committee leadership. For those that have already served on a guideline panel, we hope you will consider serving in guideline leadership positions such as chairs, assistant chairs or methodologists.
Committed to Collaboration and Transparency
Every step of our development process—from topic selection and panel formation to public comment and peer review—emphasizes collaboration and transparency. Panel leadership and panel members discuss any potential conflicts of interest at every virtual and in-person meeting, to be sure any conflicts are managed appropriately. This ensures our guidelines reflect not only the best evidence but also the real-world expertise and unbiased perspectives of those delivering care.
As the landscape of healthcare continues to evolve, the GTF remains committed to advancing timely, rigorous, and accessible clinical guidance to empower clinicians and patients, and train the next generation of otolaryngologists. We are excited about the future of the GTF and are grateful to the members, academy staff, and search strategists who make our work possible.
For any questions, please contact Jacob Marzalik, AAO-HNSF Director, Research and Quality, at jmarzalik@entnet.org.
References
Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol. 2021 Jul 20;11(4):116-129. doi: 10.5662/wjm.v11.i4.116. PMID: 34322364; PMCID: PMC8299905.
