Otolaryngology content commonly referenced by physicians includes a combination of evidence-based clinical practice guidelines and landmark randomized trials. The following 10-item framework reflects widely used sources that inform diagnosis, management, and treatment decisions across otolaryngology.

1. American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) Foundation Clinical Practice Guideline: Adult Sinusitis (2015, updated) — The AAO–HNS Foundation updated its Clinical Practice Guideline: Adult Sinusitis following publication of new primary studies and systematic reviews. The guideline provides recommendations for the diagnosis and management of adult rhinosinusitis, including the use of diagnostic testing, watchful waiting for uncomplicated acute bacterial rhinosinusitis, antibiotic therapy, systemic and topical therapy, and management considerations for chronic rhinosinusitis and certain chronic conditions. The update also includes recommendations regarding biologic therapy for chronic rhinosinusitis with nasal polyps and advises against using empiric antibiotics solely to meet requirements for surgery or imaging.

2. AAO–HNS Foundation Clinical Practice Guideline: Sudden Hearing Loss (2019 Update) — The AAO–HNS Foundation updated its Clinical Practice Guideline: Sudden Hearing Loss following publication of new clinical practice guidelines, systematic reviews, randomized controlled trials, and other published evidence. The guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of adults with sudden hearing loss, with an emphasis on idiopathic sudden sensorineural hearing loss. Recommendations address distinguishing sensorineural from conductive hearing loss, obtaining audiometry within 14 days of symptom onset, evaluating for retrocochlear pathology, use of corticosteroids and hyperbaric oxygen therapy, follow-up audiometric testing, patient education, and audiologic rehabilitation. The guideline also recommends against routine computed tomography of the head, routine laboratory testing, and routine use of antivirals, thrombolytics, vasodilators, or vasoactive substances.

3. AAO–HNS Foundation Clinical Practice Guideline: Tonsillectomy in Children (2019 Update) — The AAO–HNS Foundation updated its Clinical Practice Guideline: Tonsillectomy in Children incorporating 1 new clinical practice guideline, 26 systematic reviews, and 13 randomized controlled trials. The guideline provides evidence-based recommendations for the preoperative, intraoperative, and postoperative care of patients aged 1 to 18 years being considered for tonsillectomy. Recommendations address indications for surgery, watchful waiting for recurrent throat infection, assessment of patients with obstructive sleep-disordered breathing, use of polysomnography in selected patients, perioperative pain management, overnight inpatient monitoring for selected patients following tonsillectomy, and postoperative follow-up. The guideline also recommends against perioperative antibiotics and against prescribing codeine following tonsillectomy in children younger than 12 years.

4. Veterans Affairs Laryngeal Cancer Study (1991) — The Department of Veterans Affairs Laryngeal Cancer Study Group conducted a prospective, randomized study comparing induction chemotherapy followed by radiation therapy with conventional laryngectomy followed by postoperative radiation therapy in patients with previously untreated stage III or IV laryngeal squamous cell carcinoma. After a median follow-up of 33 months, estimated 2-year survival was 68% in both treatment groups. The larynx was preserved in 64% of patients, without compromising overall survival.

5. Ménière Disease Clinical Practice Guideline (AAO–HNS) — The AAO–HNS Foundation developed this clinical practice guideline to improve the diagnostic workup and treatment of Ménière disease using the best available scientific and clinical evidence. The guideline includes recommendations intended to improve diagnostic evaluation, guide appropriate medical and surgical treatment, and reduce unindicated diagnostic testing and imaging. It also includes recommendations intended to reduce vertigo episodes and manage hearing loss, tinnitus, and aural fullness associated with the disease.

6. Radiation Therapy Oncology Group (RTOG) 91-11 Trial (2003) — The RTOG 91-11 trial compared induction chemotherapy followed by radiotherapy, radiotherapy with concurrent cisplatin, and radiotherapy alone in patients with locally advanced laryngeal cancer. After a median follow-up of 3.8 years, radiotherapy with concurrent cisplatin achieved higher rates of laryngeal preservation and locoregional control than either induction chemotherapy followed by radiotherapy or radiotherapy alone. Overall survival was similar across the three treatment groups.

7. ORATOR Trial (2019) — The ORATOR trial was a randomized phase 2 study comparing radiotherapy with transoral robotic surgery plus neck dissection in patients with T1–T2, N0–2 oropharyngeal squamous cell carcinoma. At 1 year, patients treated with radiotherapy had higher swallowing-related quality of life scores than those treated with transoral robotic surgery plus neck dissection, although the difference did not represent a clinically meaningful change. The investigators also reported different toxicity patterns between the treatment groups.

8. RTOG 91-11 Long-Term Follow-up (2013) — The long-term follow-up of the RTOG 91-11 trial reported outcomes after a median follow-up of 10.8 years among patients with stage III or IV glottic or supraglottic squamous cell carcinoma. Compared with radiotherapy alone, both induction chemotherapy followed by radiotherapy and concurrent cisplatin with radiotherapy improved laryngectomy-free survival. Concurrent cisplatin with radiotherapy also resulted in higher rates of larynx preservation and improved locoregional control than either induction chemotherapy followed by radiotherapy or radiotherapy alone, while overall survival did not differ significantly among the treatment groups.

9. E3311 Trial (2022) — The phase 2 E3311 trial evaluated transoral surgery followed by postoperative radiotherapy based on pathologic findings in patients with resected stage III to IVa human papillomavirus–associated oropharyngeal cancer. Intermediate-risk patients were randomly assigned to receive reduced-dose or standard-dose postoperative radiotherapy. After a median follow-up of 35.2 months, the 2-year progression-free survival rate was 94.9% in the reduced-dose group and 96.0% in the standard-dose group. The trial also measured quality of life and swallowing outcomes following treatment.

10. AAO–HNSFoundation Clinical Practice Guideline: Hoarseness (Dysphonia) (2018 Update) — The AAO–HNS Foundation updated its Clinical Practice Guideline: Hoarseness (Dysphonia) following incorporation of 3 new clinical practice guidelines, 16 systematic reviews, and 4 randomized controlled trials. The guideline provides evidence-based recommendations for the evaluation and management of patients with dysphonia. Recommendations address identifying patients who require expedited laryngeal evaluation, performing laryngoscopy when indicated, use of voice therapy, surgery, and botulinum toxin for appropriate patients, and documenting treatment outcomes. The guideline also recommends against routine antibiotic use, imaging before visualization of the larynx, empiric antireflux therapy for isolated dysphonia before laryngeal visualization, and routine corticosteroid use before visualization of the larynx.

Sources: American Academy of Otolaryngology–Head and Neck Surgery Foundation, Otolaryngology–Head and Neck Surgery, The New England Journal of Medicine, The Lancet Oncology, Journal of Clinical Oncology