Practice area 150

Clinical PRIVILEGE WHITE PAPER

Otolaryngology

Background

An otolaryngologist, sometimes referred to as an ENT (ear, nose, and throat) physi-

cian, manages and treats adult and pediatric patients who have diseases and disorders
of the ear, nose, throat, and related structures of the head and neck.

According to the American Academy of Otolaryngology-Head and Neck Surgery

(­AAO-HNS), ear-related disorders that otolaryngologists treat include the medical and
surgical treatment of hearing, ear infections, balance disorders, ear noise (tinnitus),
nerve pain, and facial and cranial nerve disorders. They also manage congenital disor-
ders of the outer and inner ear.

Otolaryngologists also care for the nasal cavity and sinuses, often treating patients who
have chronic sinusitis—one of the most common health complaints in the United States.
Management of the nasal area includes allergies and sense of smell. They are also spe-
cialists in breathing and the appearance of the nose.

When treating the throat, otolaryngologists manage diseases of the larynx (voice box)
and the upper aerodigestive tract or esophagus, including voice and swallowing disor-
ders. In regard to the head and neck, otolaryngologists treat infectious diseases, benign
and malignant tumors, facial trauma, and deformities of the face. They perform both
cosmetic and plastic and reconstructive surgery.

To become an otolaryngologist, an individual must graduate from college and medical

school and complete a five-year residency in otolaryngology-head and neck surgery.
Otolaryngologists can then apply to become certified by the American Board of Otolar-
yngology (ABOto).

Some otolaryngologists choose to pursue a one- or two-year fellowship to obtain more

extensive training in one of eight subspecialty areas: pediatric otolaryngology, neurotol-
ogy, allergy, facial plastic and reconstructive surgery, head and neck, laryngology, rhinol-
ogy, and sleep. Some specialists limit their practices to one of these eight areas.

Core privileges in otolaryngology include the ability to admit, evaluate, diagnose, and
provide consultation and comprehensive medical and surgical care to patients of all

Please replace Clinical Privilege White Paper,

Otolaryngology—Practice area 150, with this updated version.

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Otolaryngology Practice area 150

ages presenting with diseases, deformities, or disorders of the head and neck that affect
the ears, nose, or throat, the respiratory and upper alimentary systems, and related struc-
tures of the head and neck. Head and neck oncology and facial plastic reconstructive sur-
gery and the treatment of disorders of hearing and voice are also included. Physicians
may provide care to patients in the intensive care setting in conformance with unit
policies. They also assess, stabilize, and determine disposition of patients with emergent
conditions consistent with medical staff policy regarding emergency and consultative
call services.

The core privileges for neurotology include the ability to admit, evaluate, diagnose,
treat, and provide consultation to patients of all ages presenting with diseases and dis-
orders of the petrous apex, infratemporal fossa, internal auditory canals, cranial nerves
(e.g., vestibular nerve section and joint neurosurgical-neurotological resection of the
intradural VIII nerve tumors), and lateral skull base (including the occipital bone, sphe-
noid bone, temporal bone, mesial aspect of the dura, and intradural management), in
conjunction with neurological surgery. Physicians may provide care to patients in the
intensive care setting in conformance with unit policies. They also assess, stabilize, and
determine disposition of patients with emergent conditions consistent with medical
staff policy regarding emergency and consultative call services.

The core privileges for plastic surgery within the head and neck include the ability to
admit, evaluate, diagnose, treat, and provide consultation to patients of all ages pre-
senting with conditions or disorders requiring reconstructive procedures within the
head, face, neck, and associated structures, including cutaneous head and neck oncol-
ogy and reconstruction, management of maxillofacial trauma, soft tissue repair, and
neural surgery. Physicians may provide care to patients in the intensive care setting in
conformance with unit policies. They also assess, stabilize, and determine disposition of
patients with emergent conditions consistent with medical staff policy regarding emer-
gency and consultative call services.

Involved specialties Otolaryngologists, facial plastic surgeons, neurologists, laryngolo-

gists, otolaryngic allergists, and sleep medicine physicians

Positions of societies The AAO-HNS represents specialists who treat the ear, nose,
and academies throat, and related structures of the head and neck. The acad-
AAO-HNS emy represents more than 12,000 otolaryngologists.

In its Delineation of Hospital Privileges, the AAO-HNS states that

the ultimate responsibility for delineating clinical privileges in
the hospital setting rests with the institution’s governing board
and is discharged through the organized medical staff. Fur-
ther, it states that board certification may be used to provide
­evidence of training and, to a certain degree, medical proficiency

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Otolaryngology Practice area 150

and judgment, but that it should not be used alone as a device

for defining the scope of practice privileges accorded.

The academy favors the granting of privileges as outlined by

The Joint Commission (formerly JCAHO), stating that a facil-
ity’s medical staff should devise a reasonable method of delin-
eating clinical privileges that indicates:
➤➤ Adequate documentation of previous training and
experience
➤➤ Clinical privileges request forms that identify, at minimum,
the specialty areas that have been identified by the boards
➤➤ An effort to match expertise with privileges to the extent
that it is practical for the individual hospital, taking into
account the complexity of its patient mix, location, and
available medical manpower

AAFPRS The American Academy of Facial Plastic and Reconstructive

Surgery (AAFPRS) is a membership organization for facial plas-
tic surgeons. The AAFPRS does not publish a position regard-
ing the delineation of privileges for otolaryngology. However,
the organization states that facial plastic surgeons are typically
board certified in otolaryngology, and these surgeons perform
the majority of elective facial plastic surgery procedures in the
United States. Facial plastic surgeons spend five to six years in
postgraduate surgical training. Training includes one year of
postgraduate training in general surgery and at least four addi-
tional years of specialty training in head and neck surgery and
facial plastic surgery.

The AAFPRS offers a fellowship providing postgraduate train-

ing in facial plastic surgery. Applicants to the fellowship pro-
gram must be physicians who are in or have completed an
otolaryngology or plastic surgery residency program accredited
by the Accreditation Council for Graduate Medical Education
(ACGME) or Royal College of Physicians and Surgeons of Can-
ada (RCPSC) or are board-certified in otolaryngology-head and
neck surgery or plastic surgery.

AAOA The American Academy of Otolaryngic Allergy (AAOA) is a

professional organization representing otolaryngologists who
dedicate part of their practice to treating allergic and other re-
lated disorders.

The AAOA does not publish information regarding the delinea-

tion of privileges for otolaryngology, but it does offer a ­certificate

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Otolaryngology Practice area 150

of added qualifications in otolaryngic allergy. To receive the

added qualification, candidates must:
➤➤ Be certified by the ABOto
➤➤ Be an active member of the AAOA for a minimum of one year
➤➤ Attend one complete basic course and one advanced
course prior to the exam deadline
➤➤ Have 40 additional AAOA-sponsored CME hours, all of
which must be completed prior to the exam
➤➤ Treat 10 immunotherapy patients within the past five
years for a period of at least six months

Candidates must then pass an oral and written examination.

ALA The American Laryngological Association (ALA) is a profession-

al membership organization for otolaryngologists who special-
ize in laryngology. Laryngologists manage diseases of the upper
aerodigestive tract, including diseases or dysfunction related to
voice production, swallowing, and breathing.

The ALA does not publish guidelines for the delineation of clin-
ical privileges for laryngology, but it does publish Laryngology
Fellowship Guidelines that outline the scope of knowledge for fel-
lowship education in laryngology. The guidelines state that lar-
yngology fellows should have completed an ACGME-­accredited
residency in otolaryngology or the equivalent that has provided
a knowledge base in the normal anatomy and physiology of
voice and swallowing. 

Advanced training in laryngology should focus on five areas:

neurolaryngology, professional voice care, neoplastic and non-
neoplastic diseases of the larynx, swallowing disorders, and dis-
orders of the upper airway.

Diagnostic training should include: in-office laryngoscopy: rigid

transoral and flexible techniques, laryngeal videostroboscopy
and other imaging techniques, transnasal esophagoscopy, la-
ryngeal electromyography, functional endoscopic evaluations
of swallowing, vocal function testing, correlation of histopa-
thology specimens with the clinical presentations, and imaging
studies of the larynx, trachea, and esophagus.
 
Interventional and surgical training should include: phonosur-
gery for non-neoplastic vocal fold lesions of the lamina propria,
injection laryngoplasty, medialization laryngoplasty via open ap-
proaches, Botox® and surgical treatment for spasmodic

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dysphonia, surgical management for neoplastic laryngeal dis-

ease, laser technology for laryngeal and airway disease, and
surgical management (open and endoscopic approaches) for
airway ­disorders.
 
Medical and behavioral management training should include:
chronic laryngeal pathology, including reflux-related, allergy-
related, and infectious and immune-related pathology, behav-
ioral voice disorders, and swallowing disorders.

Positions of other The ABOto certifies otolaryngologists. To become certified, a

interested parties candidate must graduate from college and medical school. He
ABOto or she must then complete a five-year ACGME-approved resi-
dency program in otolaryngology-head and neck surgery. At
least one year of the residency must be in general surgical train-
ing. It is preferred that the general surgical residency be taken
prior to otolaryngologic training, but it may not be taken after
otolaryngologic training. At least four years of the residency
must be in otolaryngology-head and neck surgery.

Individuals who enter training after July 1, 2005, must complete

five years of training in an ACGME-approved program with at
least nine months of basic surgical, emergency medicine, critical
care, and anesthesia training within the first year, including at
least 48 months of progressive education in the specialty.

The first year of training should include a minimum of five

months of structured education in at least three of the fol-
lowing: general surgery, vascular surgery, plastic surgery, and
surgical oncology. One month of structured education in each
of the following four clinical areas is also required: emergency
medicine, critical care unit, anesthesia, and neurological sur-
gery. An additional maximum of three months of otolaryn-
gology-head and neck surgery is optional, and any remaining
months of postgraduate year (PGY) one must be completed in
an ACGME-approved program.

The ABOto examination consists of two parts. A written exami-

nation qualifies the individual to sit for the oral examination.
If the candidate passes both exams, he or she is certified and is
referred to as an ABOto diplomate.

The purpose of the examination is to determine the candidate’s

knowledge and understanding of the following:

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Otolaryngology Practice area 150

➤➤ Morphology, physiology, pharmacology, pathology,

microbiology, biochemistry, genetics, and immunology
relevant to the head and neck; the respiratory and upper
alimentary systems; and the communication sciences,
including knowledge of audiology and speech-language
pathology, the chemical senses and allergy/immunology,
endocrinology, and neurology as they relate to the head
and neck
➤➤ Diagnosis and diagnostic methods, including audiologic
and vestibular assessments, electrophysiologic techniques,
and other related laboratory procedures for diseases and
disorders of the ears, the respiratory and upper alimentary
systems, and the head and neck
➤➤ Therapeutic and diagnostic radiology, including the inter-
pretation of medical imaging techniques relevant to the
head, neck, and including the temporal bone, skull, nose,
paranasal sinuses, salivary and thyroid glands, larynx,
neck, lungs, and esophagus
➤➤ Diagnostic evaluation and management of congenital
anomalies, allergy, sleep disorders, trauma, and other dis-
eases in the regions and systems mentioned
➤➤ Cognitive management, including operative intervention
with preoperative and postoperative care, of congenital,
inflammatory, endocrine, neoplastic, degenerative, and
traumatic states, including:
– Temporal bone surgery
– Paranasal sinus and nasal surgery
– Skull base surgery
– Maxillofacial surgery, including the orbits, jaws, and
facial skeleton
– Aesthetic, plastic, and reconstructive surgery of the face,
head, and neck
– Surgery of the thyroid, parathyroid, pituitary, and sali-
vary glands
– Head and neck reconstructive surgery relating to the
restoration of form and function in congenital anomalies
and head and neck trauma and neoplasms
– Endoscopy, both diagnostic and therapeutic
– Surgery of the lymphatic tissues of the head
and neck
➤➤ Habilitation and rehabilitation techniques and procedures
pertaining to respiration, deglutition, chemoreception, bal-
ance, speech, and hearing
➤➤ Current literature
➤➤ Research methodology

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Beginning in 2002, all ABOto diplomates must participate in

maintenance of certification to stay current with the specialty.
The program is a 10-year cycle that involves annual updates on
the individual diplomate, self-assessment, evaluation of perfor-
mance in practice, and an examination to renew the certificate.

The ABOto also offers certificates in two subspecialties: neu-

rotology and sleep medicine.

Neurotologists are ABOto-certified otolaryngologist-head and

neck surgeons who have been prepared by an ACGME-accred-
ited subspecialty fellowship program or who meet the alternate
pathway criteria to provide comprehensive medical and surgi-
cal care of patients with diseases and disorders that affect the
temporal bone, lateral skull base, and related structures of the
head and neck. Neurotologists can follow one of two pathways
to become certified.

To complete the standard pathway, a physician must:

➤➤ Complete an ACGME-accredited neurotology program
➤➤ Be a diplomate of the ABOto in good standing
➤➤ Have Subspecialty Resident Registry Evaluations submitted
annually by the program director
➤➤ Submit an application form signed by the program director
and ABOto diplomate
➤➤ Submit evidence of medical licensure showing nonrestricted
status and date of expiration
➤➤ Submit an operative experience report, which lists proce-
dures assisted in and performed by the applicant during
neurotology subspecialty residency, signed by the applicant
and the program director
➤➤ Possess high moral, ethical, and professional qualifications
as determined by, and in the sole discretion of, the board

The alternate pathway allows ABOto diplomates in good stand-

ing who have not completed an ACGME-accredited neurotology
subspecialty residency to sit for the neurotology subspecialty
certification examination. This pathway is only available through
the 2012 examination. To qualify for this pathway, a candi-
date must:
➤➤ Have at least seven years of clinical experience in neurotology.
➤➤ Demonstrate that he or she has participated in at least 10
cases of intracranial exposures (i.e., translabyrinthine, mid-
dle cranial fossa, infratemporal fossa, and/or posterior fossa)
over a two-year period preceding the year of ­application.

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Otolaryngology Practice area 150

➤➤ Enter and submit his or her operative experiences over the

two-year period immediately preceding the date of appli-
cation. The report must be signed by the applicant and the
chief of staff or hospital director.
➤➤ Submit an application form signed by two ABOto
diplomates.
➤➤ Submit verification of all licenses to practice medicine,
showing nonrestricted status and date of expiration.
➤➤ Possess high moral, ethical, and professional qualifications
as determined by, and in the sole discretion of, the board.

For more on the sleep medicine subspecialty certification,

please see Clinical Privilege White Paper, Sleep medicine—Practice
area 117.

ABFPRS The American Board of Facial Plastic and Reconstructive Sur-

gery (ABFPRS) grants certification to surgeons specializing in
facial plastic and reconstructive surgery. To be eligible, appli-
cants must:
➤➤ Have completed a residency program approved by the
ACGME or the RCPSC in one of the two medical special-
ties containing identifiable training in facial plastic and
reconstructive surgery: otolaryngology-head and neck
surgery or plastic surgery
➤➤ Have earned prior certification by the ABOto, the Ameri-
can Board of Plastic Surgery, or the RCPSC in otolaryn-
gology-head and neck surgery or plastic surgery
➤➤ Have been in practice a minimum of two years
➤➤ Have 100 operative reports accepted by a peer review
committee
➤➤ Have passed the oral and written examination of the
­ABFPRS
➤➤ Operate in an accredited institution or office
➤➤ Hold the appropriate licensure and adhere to the ABFPRS
Code of Ethics

Surgeons who have completed accredited residencies in otolar-

yngology or plastic surgery may apply for ABFPRS certification
without also completing a fellowship in facial plastic surgery if
they have sufficient, acceptable surgical experience and meet
other certification requirements.

AOBOO-HNS The American Osteopathic Board of Otolaryngology-Head and

Neck Surgery (AOBOO-HNS) defines and determines the quali-
fications required of osteopathic physicians for certification

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Otolaryngology Practice area 150

in the field of otolaryngology and otolaryngology/facial plastic

surgery and any other specialty, subspecialty, and/or certifica-
tion of added qualifications.

According to the board, the practice of otolaryngology includes

the diagnosis and treatment of disorders and diseases of the ear,
nose, and throat and may include such other subspecialties that
have a definitive relationship to otolaryngology.

A candidate for certification by the board must meet the follow-

ing requirements:
➤➤ Have graduated from an American Osteopathic Association
(AOA)–accredited college of osteopathic medicine.
➤➤ Maintain an unrestricted license to practice in the state or
territory where his/her practice is conducted.
➤➤ Be a member in good standing of the AOA or the Cana-
dian Osteopathic Association throughout the certification
process.
➤➤ Have satisfactorily completed a one-year AOA-approved
traditional rotating internship. In otolaryngology/facial
plastic surgery, when applicable, a one-year specialty
track internship (which includes general surgery) is
acceptable.
➤➤ Have satisfactorily completed an AOA-approved residency
training program in one of the specialties under the juris-
diction of the board after the required year of internship.
The training program must encompass all aspects of the
particular specialty, including adequate training in the
basic medical sciences, with emphasis on the osteopathic
principles as related to the specialty. Otolaryngology and
otolaryngology/facial plastic surgery training includes
a minimum of three years of AOA-approved residency
training if training was begun prior to July 1, 1986. A
period of four years of AOA-approved training is required
if training was begun on or after July 1, 1986. After 1986,
following a one-year AOA-approved internship, one year
of general surgery is required prior to the four-year resi-
dency (except in the case of otolaryngology/facial plastic
surgery, which has a one-year specialty track internship
that includes general surgery).
➤➤ Pass a written and oral examination to evaluate an under-
standing of the scientific problems involved in otolaryngol-
ogy and otolaryngology/facial plastic surgery, familiarity
with the current advances in these specialties, and posses-
sion of sound judgment and high degree of skill in the

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diagnostic and therapeutic procedures involved in the

practice of these specialties.
➤➤ Recertify every 10 years.

The board has a Table of Specifications for the written qualifying

examination for certification in otolaryngology/facial plastic
surgery. It includes the following:
➤➤ Otology portion: audiology, congenital, external ear,
­internal ear, middle ear
➤➤ Rhinology portion: allergy, congenital, nasopharynx,
­rhinology, sinus
➤➤ Laryngology portion: larynx, laser, neck, oropharynx,
­salivary and endocrine
➤➤ Facial plastic surgery portion: facial plastics, reconstructive,
and trauma

The AOBOO-HNS also offers a certificate of added qualifications

(CAQ) in otolaryngic allergy. To be eligible to sit for an exami-
nation for a CAQ, the applicant must meet the following mini-
mum ­requirements:
➤➤ Be certified by this board in otolaryngology or otolaryngol-
ogy/facial plastic surgery.
➤➤ Have completed one year of AOA- or AOBOO-HNS–ap-
proved training in otolaryngic allergy (may consist of a
two- or three-year interrupted postresidency fellowship).
➤➤ Pass a written and oral examination that consists of mul-
tiple-choice questions covering all aspects of otolaryngic
allergy, including basic science, immunology, clinical per-
formance, testing, desensitization, etc. The oral examina-
tion consists of case studies as prescribed by this board.
Case studies must reflect techniques and methodologies
that adhere to approved methods. They must adhere to
accepted policies regarding set testing, in vitro testing, and
food testing. Cases must be from the past two years. Treat-
ment may consist of avoidance, chemotherapy, and/or
immunotherapy. Documentation must include diagnosis,
therapy, protocol, and response. Patients must have been
followed for at least six months.

ACGME The ACGME publishes Program Requirements for Graduate Medical

Education in Otolaryngology (effective July 1, 2007). In this docu-
ment, the council states that programs in this specialty provide
residents with education in the comprehensive evaluation, as
well as medical and surgical management, of patients of all ages
having diseases and disorders of the ears, upper respiratory and

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upper alimentary systems and related structures, and the head

and neck.

The educational program should include core knowledge, skills,

and understanding of the basic medical sciences relevant to the
head, neck, and the upper respiratory and upper alimentary
systems. This includes the communication sciences, including
knowledge of audiology, speech pathology, rehabilitation, and
the vestibular system; and the chemical senses, otolaryngic al-
lergy, endocrinology, and neurology as they relate to the head
and neck area.

The program should also include clinical aspects of the diagno-

sis, medical and/or surgical therapy, and the prevention of and
rehabilitation from diseases, neoplasms, deformities, disorders,
and/or injuries of the ears, upper respiratory and upper ali-
mentary systems, the face, the jaws, and other head and neck
systems; head and neck oncology; and facial plastic and recon-
structive surgery.

Residency programs in this specialty are five years in duration

with at least nine months of basic surgical, emergency and criti-
cal care, and anesthesia training occurring within the first year.
After this initial training, there must be at least 48 months of
progressive education in the specialty. The final year of educa-
tion must be a chief resident experience.

The PGY-1 must prepare residents for specialty training, allowing

them to participate in clinical and didactic activities in which they:
➤➤ Assess, plan, and initiate treatment of adult and pediatric pa-
tients with surgical and/or medical problems
➤➤ Care for patients with surgical and medical emergencies,
multiple organ system trauma, soft tissue wounds, ner-
vous system injuries and diseases, and peripheral vascular
and thoracic injuries
➤➤ Care for critically ill surgical and medical patients in the
ICU and emergency room settings
➤➤ Participate in the pre-, intra-, and postoperative care of
surgical patients
➤➤ Understand surgical anesthesia in hospital and ambulatory
care settings, including anesthetic risks and the management
of intra-operative anesthetic complications

The PGY-1 should include a minimum of five months of struc-

tured education in at least three of the following: general

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surgery, thoracic surgery, vascular surgery, pediatric surgery,

plastic surgery, and surgical oncology. It must also include one
month of structured education in each of the following four
clinical areas: emergency medicine, critical care unit (ICU,
trauma unit, or similar), anesthesia, and neurological sur-
gery. An additional maximum of three months of otolaryn-
gology-head and neck surgery is optional, and any remaining
months of the PGY-1 may be taken on the clinical services
listed above.

PGY-2 through PGY-5 should include at least 36 months of ro-

tations on otolaryngology-head and neck surgery and clinical
services. It should also include a structured research experience,
with instruction in research methods and design that includes
outcomes assessment. The program may also have rotations on
related services such as neuroradiology, surgical pathology of
the head and neck, audiology and vestibular assessment, speech
pathology and rehabilitation, radiation oncology, pulmonary
medicine, allergy/immunology, and oral and maxillofacial
­surgery.

In order to provide patient care that is compassionate, appropri-

ate, and effective for the treatment of health problems and the
promotion of health, residents in an otolaryngology program:
➤➤ Will use diagnosis and diagnostic methods, including au-
diologic, vestibular, and vocal function testing; biopsy and
fine needle aspiration techniques; and other clinical and
laboratory procedures related to the diagnosis of diseases
and disorders of the upper aerodigestive tract and the head
and neck.
➤➤ Will be proficient in therapeutic and diagnostic imaging,
specifically interpreting medical images of the head, neck,
and thorax, including studies of the temporal bone, skull,
nose, paranasal sinuses, salivary and thyroid glands, lar-
ynx, neck, lungs, and esophagus.
➤➤ Will diagnose, evaluate, and manage congenital anoma-
lies, otolaryngic allergy, sleep disorders, pain, and other
conditions affecting the regions and systems mentioned,
and the chemical senses, endocrinology, and neurology as
they relate to the head and neck.
➤➤ Will manage congenital, degenerative, idiopathic, infec-
tious, inflammatory, toxic, allergic, immunologic, vascular,
metabolic, endocrine, neoplastic, foreign body, and trau-
matic states through airway management, resuscitation,
local/regional anesthesia, sedation and universal precaution

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techniques, operative intervention, and preoperative and

postoperative care of the following major categories:
– General otolaryngology, including pediatric otolaryngol-
ogy, rhinology, bronchoesophagology, and laryngology
– Head and neck oncologic surgery
– Facial plastic and reconstructive surgery of the head
and neck
– Otology and neurotology
➤➤ Will completely perform habilitation and rehabilitation
techniques and procedures, including respiration, deglu-
tition, chemoreception, balance, and speech, as well as
auditory measures such as hearing aids and implantable
devices.
➤➤ Will diagnose and apply therapeutic techniques involv-
ing endoscopy of the upper aerodigestive tract, including
rhinoscopy, laryngoscopy, esophagoscopy, and bronchos-
copy, as well as the associated application of stroboscopes,
lasers, mechanical debriders, and computer-assisted guid-
ance devices.
➤➤ Will have experience with advances and emerging tech-
nology in otolaryngology and head and neck surgery.
➤➤ Should perform a sufficient number and variety of surgi-
cal procedures to ensure education in the entire scope of
the specialty. There must be adequate distribution and
sufficient complexity within the principal categories of the
specialty.
➤➤ Must work in a well-organized and well-supervised outpa-
tient service. This must operate in relation to an inpatient
service used in the program. Residents must have the op-
portunity to see patients, establish provisional diagnoses,
and initiate preliminary treatment plans. An opportunity
for follow-up care must be provided so the results of surgi-
cal care may be evaluated.
➤➤ Will function with an appropriate degree of responsibility
under adequate supervision, if they participate in preoper-
ative and postoperative care in a private office. Experience
should be provided in the procedures and management of
office practice.
➤➤ Must have experience in the emergency care of critically
ill and injured patients with otolaryngology-head and
neck conditions.
➤➤ Should have patient care responsibilities commensurate
with the individual resident’s knowledge, problem-solving
ability, manual skills, experience, and the severity and com-
plexity of each patient’s status. The program must provide

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residents with experience in direct and progressively respon-

sible patient management, including surgical experience as
assistant to the surgeon. This education must culminate in
sufficient independent responsibility for clinical decision-
making to evidence the fact that the graduating resident has
developed sound clinical judgment and possesses the ability
to formulate and carry out appropriate management plans.

Medical knowledge Residents must demonstrate knowledge of established and evolv-

ing biomedical, clinical, epidemiological, and social-behavioral
sciences, as well as the application of this knowledge to patient
care. Residents:
➤➤ Must learn within a comprehensive, well-organized, and ef-
fective curriculum, including the cyclical presentation of core
specialty knowledge supplemented by the addition of current
information. Residents must learn in a variety of educational
settings, such as clinics, classrooms, operating rooms, bed-
sides, and laboratories, employing accepted principles.
➤➤ Must have a structured educational experience in basic
science. Ordinarily, this should be provided within partici-
pating sites of the residency program. Any program that
provides the requisite basic science experience outside the
approved participating sites must demonstrate that the
educational experience provided meets these designated
criteria. Faculty must participate in basic science educa-
tion, resident attendance must be monitored, education
must be evaluated, and content must be integrated into
the educational program.
➤➤ Will become familiar with the broad scope of otolaryngol-
ogy-head and neck surgery. This requires that the program
provide basic science, medical, and surgical education in
the following areas:
– Basic sciences, as relevant to the head and neck and
upper aerodigestive system, including anatomy, embry-
ology, physiology, pharmacology, pathology, microbiol-
ogy, biochemistry, genetics, cell biology, immunology,
the communication sciences (including a knowledge of
audiology and speech-language pathology and the voice
sciences as they relate to laryngology), as well as the
chemical senses, endocrinology, and neurology as they
relate to the head and neck.
– Basic science education, which should include instruc-
tion in anatomy, biochemistry, cell biology, embryology,
immunology, molecular genetics, pathology, pharmacology,

14 A supplement to Briefings on Credentialing 781/639-1872 01/10

Otolaryngology Practice area 150

physiology, and other basic sciences related to the head

and neck.
– Communication sciences as they relate to otology and
laryngology, including audiology, speech-language
pathology, and voice science.
– Anatomy, which should include the study and dissec-
tion of cadaver anatomic specimens, including the tem-
poral bone, with appropriate lectures and other formal
­sessions
– Pathology, which should include formal instruction
in correlative pathology in which gross and micro-
scopic pathology relating to the head and neck area are
included. The resident should study and discuss with
the pathology service tissues removed at operations
and autopsy material. It is desirable to have residents
assigned to the department of pathology.

The ACGME also publishes requirements for neurotology and

pediatric otolaryngology.

The Joint Commission The Joint Commission has no formal position concerning the
delineation of privileges for otolaryngologists. However, in its
Comprehensive Accreditation Manual for Hospitals, The Joint Com-
mission states, “The hospital collects information regarding
each practitioner’s current license status, training, experience,
competence, and ability to perform the requested privilege”
(MS.06.01.03).

In the rationale for MS.06.01.03, The Joint Commission states

that there must be a reliable and consistent system in place to
process applications and verify credentials. The organized medi-
cal staff must then review and evaluate the data collected. The
resultant privilege recommendations to the governing body are
based on the assessment of the data.
 
The Joint Commission further states, “The organized medical
staff reviews and analyzes information regarding each ­requesting
practitioner’s current licensure status, training, experience, cur-
rent competence, and ability to perform the requested privilege”
(MS.06.01.07).
 
In the EPs for standard MS.06.01.07, The Joint Commission says
the information review and analysis process is clearly defined.
The organization, based on recommendations by the organized
medical staff and approval by the governing body, develops criteria

A supplement to Briefings on Credentialing 781/639-1872 01/10 15

Otolaryngology Practice area 150

that will be considered in the decision to grant, limit, or deny a

request for privileges.
 
The Joint Commission further states, “Ongoing professional practice
evaluation information is factored into the decision to maintain ex-
isting privilege(s), to revise existing privileges, or to revoke an exist-
ing privilege prior to or at the time of renewal” (MS.08.01.03).
 
In the EPs for MS.08.01.03, The Joint Commission says there is
a clearly defined process facilitating the evaluation of each prac-
titioner’s professional practice, in which the type of information
collected is determined by individual departments and approved
by the organized medical staff. Information resulting from the
ongoing professional practice evaluation is used to determine
whether to continue, limit, or revoke any existing privilege.

CRC draft criteria The following draft criteria are intended to serve solely as a
starting point for the development of an institution’s policy re-
garding this practice area.

Basic education: MD or DO
Minimal formal training: Applicants must have completed an
ACGME-/AOA-accredited residency training program in otolar-
yngology-head and neck surgery and/or current certification or
active participation in the examination process (with achieve-
ment of certification within [n] years) leading to certification in
otolaryngology by the ABOto or the AOBOO-HNS.

Minimal formal training for the subspecialty of neurotology en-

tails the successful completion of an ACGME- or AOA-­accredited
residency in otolaryngology, followed by an accredited fellowship
in neurotology and/or current subspecialty certification or active
participation in the examination process (with achievement of
certification within [n] years) leading to subspecialty certification
in neurotology by the ABOto.

Minimal formal training for the subspecialty of plastic surgery

within the head and neck entails the successful completion of
an ACGME- or AOA-accredited residency program in otolaryn-
gology, followed by additional postgraduate training in plastic
surgery within the head and neck.

Required previous experience: Applicants for initial appoint-

ment must be able to demonstrate performance of at least 50

16 A supplement to Briefings on Credentialing 781/639-1872 01/10

Otolaryngology Practice area 150

otolaryngologic surgery procedures, reflective of the scope of

privileges requested, during the previous 12 months or demon-
strate successful completion of an ACGME- or AOA-accredited
residency, clinical fellowship, or research in a clinical setting
within the previous 12 months.

Applicants for initial appointment for neurotology must be able

to demonstrate performance of neurotological surgery, reflec-
tive of the scope of privileges requested, at least 50 times during
the prior 12 months or demonstrate successful completion of an
ACGME- or AOA-accredited residency, clinical fellowship, or
research in a clinical setting within the prior 12 months.

Applicants for initial appointment for plastic surgery within the

head and neck must be able to demonstrate the performance
of at least 50 plastic surgery within the head and neck proce-
dures, reflective of the scope of privileges requested, in the pre-
vious 12 months or demonstrate successful completion of an
ACGME- or AOA-accredited residency, clinical fellowship, or
research in a clinical setting within the previous 12 months.

References A letter of reference should come from the director of the appli-
cant’s otolaryngology training program. Alternatively, a letter of
reference should come from the chief of otolaryngology at the
institution where the applicant most recently practiced.

Core privileges in Core privileges in otolaryngology include the ability to admit,

otolaryngology evaluate, diagnose, and provide consultation and comprehen-
sive medical and surgical care to patients of all ages presenting
with diseases, deformities, or disorders of the head and neck
that affect the ears, nose, or throat, the respiratory and upper
alimentary systems, and related structures of the head and
neck. Head and neck oncology and facial plastic reconstructive
surgery and the treatment of disorders of hearing and voice are
also included. Physicians may provide care to patients in the
intensive care setting in conformance with unit policies. They
also assess, stabilize, and determine disposition of patients with
emergent conditions consistent with medical staff policy regard-
ing emergency and consultative call services. Core privileges in
otolaryngology include but are not limited to:
➤➤ All forms of surgery on the auditory canal, the tympanic
membrane, and the contents of the middle ear
➤➤ Bronchoscopy (rigid or flexible) with biopsy, foreign body
removal, or stricture dilatation
➤➤ Caldwell Luc procedure

A supplement to Briefings on Credentialing 781/639-1872 01/10 17

Otolaryngology Practice area 150

➤➤ Cervical esophagectomy
➤➤ Cryosurgery
➤➤ Endoscopic sinus surgery and open sinus surgery
➤➤ Endoscopy of the larynx, tracheobronchial tree, and esoph-
agus to include biopsy, excision, and foreign body removal
➤➤ Esophageal surgery including diverticulectomy, cervical
esophagectomy
➤➤ Esophagoscopy (rigid or flexible) with biopsy, foreign body
removal, or stricture dilatation
➤➤ Excision of skull base tumor
➤➤ Excision of tumor ethmoid/cribriform
➤➤ Facial plastic surgery, including cosmetic surgery, chemical
peel, rhytidectomy, mentoplasty and correction of aural
atresia, liposuction, and implantation of autogenous, ho-
mologous, and allograft, and repair of lacerations
➤➤ Harvesting of skin, fat, or bone grafts of the head and neck,
hip, trunk, and extremities
➤➤ Ligation of head and neck vessels
➤➤ Lip surgery including lip shave, partial or total resection
with primary repair or by local or distant flaps
➤➤ Myocutaneous flap (pectorales, trapezius, sternocleidomastoid)
➤➤ Otoplasty
➤➤ Parathyroidectomy
➤➤ Perform history and physical exam
➤➤ Radical surgery of the head and neck, including radical
neck dissection and radical excision of the maxillary
antrum for tumor
➤➤ Ranula excision
➤➤ Reconstructive procedure of the upper airway
➤➤ Reduction of facial fractures
➤➤ Repair of CSF leaks with sinus or mastoid surgery
➤➤ Repair of fistulas—oral-antral, oral-nasal, oral-maxillary,
oral-cutaneous, pharyngocutaneous, tracheo-cutaneous,
esophagocutaneous
➤➤ Rhinoplasty, septoplasty, and turbinate surgery
➤➤ Salivary gland and duct surgery, including plastic repair of
salivary complex
➤➤ Skin grafting procedures, full thickness or split thickness
➤➤ Surgery of the larynx, including biopsy, partial or total
laryngectomy, fracture repair
➤➤ Surgery of the nasopharynx, including nasal septoplasty,
surgery on the frontal and maxillary sinuses, and ethmoid
sinuses, and surgery of the nasal mucosa and turbinates
➤➤ Surgery of the oral cavity, including soft palate, tongue,
mandible, composite resection, and neck dissection

18 A supplement to Briefings on Credentialing 781/639-1872 01/10

Otolaryngology Practice area 150

➤➤ Surgery of the oral pharynx, hypopharynx, arytenoid car-

tilages, and epiglottis
➤➤ Surgical removal of teeth in association with radical resection
➤➤ Suspension microlaryngoscopy
➤➤ Tongue surgery, reduction and local tongue flaps
➤➤ Tonsillectomy, adenoidectomy, parotidectomy, and facial
nerve repair
➤➤ Tracheal resection and repair
➤➤ Tracheostomy
➤➤ Transsternal mediastinal dissection
➤➤ Tympanoplasty, mastoidectomy, and middle ear surgery
➤➤ Use of energy sources as an adjunct to privileged procedures

The core privileges for neurotology include the ability to admit,

evaluate, diagnose, treat, and provide consultation to patients
of all ages presenting with diseases and disorders of the petrous
apex, infratemporal fossa, internal auditory canals, cranial
nerves (e.g., vestibular nerve section and joint neurosurgical-
neurotological resection of the intradural VIII nerve tumors),
and lateral skull base (including the occipital bone, sphenoid
bone, temporal bone, mesial aspect of the dura, and intradural
management), in conjunction with neurological surgery. Physi-
cians may provide care to patients in the intensive care setting
in conformance with unit policies. They also assess, stabilize,
and determine disposition of patients with emergent conditions
consistent with medical staff policy regarding emergency and
consultative call services. Core privileges in neurotology include
but are not limited to:
➤➤ Cochlear implantation
➤➤ Decompression membranous labyrinth­­cochleosaculotomy,
encolymphatic sac operation
➤➤ Electrophysiologic monitoring of cranial nerves VII, VII, X,
XI, and XII
➤➤ Excision of glomus tumor
➤➤ Interpret imaging techniques of the temporal bones and
lateral skull base
➤➤ Labyrinthectomy
➤➤ Middle/post-fossa skull base surgery
➤➤ Osseo-integrated implants, for auricular prosthesis, for
bone-anchored hearing aid
➤➤ Perform history and physical exam
➤➤ Petrous apiectomy plus radical mastoid
➤➤ Reconstruction congenital aural atresia
➤➤ Repair fistula (OW, RW)
➤➤ Resection CP angle tumor

A supplement to Briefings on Credentialing 781/639-1872 01/10 19

Otolaryngology Practice area 150

➤➤ VII nerve decompression

➤➤ VII nerve repair/substitution
➤➤ VIII nerve section

The core privileges for plastic surgery within the head and neck
include the ability to admit, evaluate, diagnose, treat, and pro-
vide consultation to patients of all ages presenting with condi-
tions or disorders requiring reconstructive procedures within the
head, face, neck, and associated structures, including cutaneous
head and neck oncology and reconstruction, management of
maxillofacial trauma, soft tissue repair, and neural surgery. Phy-
sicians may provide care to patients in the intensive care setting
in conformance with unit policies. They also assess, stabilize,
and determine disposition of patients with emergent conditions
consistent with medical staff policy regarding emergency and
consultative call services. Core privileges in plastic surgery with-
in the head and neck include but are not limited to:
➤➤ Accessory-facial nerve transfer
➤➤ Blepharoplasty
➤➤ Brow lift
➤➤ Chemical peel
➤➤ Dermabrasion
➤➤ Endoscopic facial surgery
➤➤ Facial plastic surgery, including cosmetic surgery, chemical
peel, rhytidectomy, mentoplasty and correction of aural
atresia, liposuction, and implantation of autogenous, ho-
mologous, and allograft, and repair of lacerations
➤➤ Fascial sling procedures
➤➤ Hair transplantation, punch or strip
➤➤ Hypoglossal-facial nerve transfer
➤➤ Implantation of autogenous, homologous, and allograft
➤➤ Liposuction or lipo-injection procedure for contour resto-
ration, head and neck; trunk and extremities
➤➤ Mentoplasty and correction of aural atresia
➤➤ Orthognathic surgery
➤➤ Perform history and physical exam
➤➤ Reconstruction aural microtia
➤➤ Reconstruction eyelid, ptosis repair
➤➤ Repair of lacerations, scar revision, removal of lesions
➤➤ Rhytidectomy
➤➤ Upper lid gold weight placement

Special requests in If desired, noncore privileges are requested individually in

otolaryngology addition to requesting the core. Each individual requesting
noncore privileges must meet the specific threshold criteria

20 A supplement to Briefings on Credentialing 781/639-1872 01/10

Otolaryngology Practice area 150

governing the exercise of the privilege requested, including

training, required previous experience, and maintenance of
clinical ­competence.

Reappointment Reappointment should be based on unbiased, objective results

of care according to the organization’s existing quality assurance
mechanism.

Applicants must demonstrate that they have maintained com-

petence by showing evidence that they have provided otolaryn-
gology-head and neck services or performed surgery for at least
50 patients annually over the reappointment cycle. Surgery
should include the operative interventions for which privileges
are requested. In addition, continuing education related to oto-
laryngology should be required.

For more information For more information on this practice area, contact:

Accreditation Council for Graduate Medical Education

515 North State Street, Suite 2000
Chicago, IL 60654
Telephone: 312/755-5000
Fax: 312/755-7498
Web site: www.acgme.org

American Academy of Facial Plastic and Reconstructive Surgery

310 South Henry Street
Alexandria, VA 22314
Telephone: 703/299-9291
Web site: www.aafprs.org

American Academy of Otolaryngic Allergy & Foundation

1990 M Street NW, Suite 680
Washington, DC 20036
Telephone: 202/955-5010
Fax: 202/955-5016
Web site: www.aaoaf.org

American Academy of Otolaryngology-Head and Neck Surgery

1650 Diagonal Road
Alexandria, VA 22314-2857
Telephone: 703/836-4444
Web site: www.entnet.org

A supplement to Briefings on Credentialing 781/639-1872 01/10 21

Otolaryngology Practice area 150

American Board of Facial Plastic Reconstructive Surgery

115C South St. Asaph Street
Alexandria, VA 22314
Telephone: 703/549-3223
Fax: 703/549-3357
Web site: www.abfprs.org

American Board of Otolaryngology

5615 Kirby Drive, Suite 600
Houston, TX 77005
Telephone: 713/850-0399
Fax: 713/850-1104
Web site: www.aboto.org

American Laryngological Association

Web site: www.alahns.org

American Osteopathic Board of Otolaryngology-Head and Neck

Surgery
P.O. Box 24810
Huber Heights, OH 45424
Telephone: 800/575-2145
Fax: 937/235-9795
Web site: www.aoboo.org

The Joint Commission

One Renaissance Boulevard
Oakbrook Terrace, IL 60181
Telephone: 630/792-5000
Fax: 630/792-5005
Web site: www.jointcommission.org

22 A supplement to Briefings on Credentialing 781/639-1872 01/10

Otolaryngology Practice area 150

Privilege request form

Otolaryngologist

To be eligible to request clinical privileges as an otolaryngologist, an applicant must meet

the following minimum threshold criteria:

➤➤ Basic education: MD or DO

➤➤ Minimal formal training: Applicants must have completed an ACGME-/AOA-accredited

residency training program in otolaryngology-head and neck surgery and/or current cer-
tification or active participation in the examination process (with achievement of certifi-
cation within [n] years) leading to certification in otolaryngology by the ABOto or the
AOBOO-HNS.

Minimal formal training for the subspecialty of neurotology entails the successful completion
of an ACGME- or AOA-accredited residency in otolaryngology, followed by an accredited fel-
lowship in neurotology and/or current subspecialty certification or active participation in the
examination process (with achievement of certification within [n] years) leading to subspecialty
certification in neurotology by the ABOto.

Minimal formal training for the subspecialty of plastic surgery within the head and neck
entails the successful completion of an ACGME- or AOA-accredited residency program in
otolaryngology, followed by additional postgraduate training in plastic surgery within the
head and neck.

➤➤ Required previous experience: Applicants for initial appointment must be able to demon-
strate performance of at least 50 otolaryngologic surgery procedures, reflective of the scope of
privileges requested, during the previous 12 months or demonstrate successful completion of
an ACGME- or AOA-accredited residency, clinical fellowship, or research in a clinical setting
within the previous 12 months.

Applicants for initial appointment for neurotology must be able to demonstrate perfor-
mance of neurotological surgery, reflective of the scope of privileges requested, at least 50
times during the prior 12 months or demonstrate successful completion of an ACGME- or
AOA-accredited residency, clinical fellowship, or research in a clinical setting within the
prior 12 months.

Applicants for initial appointment for plastic surgery within the head and neck must be able
to demonstrate the performance of at least 50 plastic surgery within the head and neck proce-
dures, reflective of the scope of privileges requested, in the previous 12 months or demonstrate
successful completion of an ACGME- or AOA-accredited residency, clinical fellowship, or
research in a clinical setting within the previous 12 months.

A supplement to Briefings on Credentialing 781/639-1872 01/10 23

Otolaryngology Practice area 150

➤➤ References: A letter of reference should come from the director of the applicant’s otolaryngol-
ogy training program. Alternatively, a letter of reference should come from the chief of otolar-
yngology at the institution where the applicant most recently practiced.

➤➤ Core privileges in otolaryngology: Core privileges in otolaryngology include the ability to

admit, evaluate, diagnose, and provide consultation and comprehensive medical and surgical
care to patients of all ages presenting with diseases, deformities, or disorders of the head and
neck that affect the ears, nose, or throat, the respiratory and upper alimentary systems, and
related structures of the head and neck. Head and neck oncology and facial plastic reconstruc-
tive surgery and the treatment of disorders of hearing and voice are also included. Physicians
may provide care to patients in the intensive care setting in conformance with unit policies.
They also assess, stabilize, and determine disposition of patients with emergent conditions con-
sistent with medical staff policy regarding emergency and consultative call services. Core privi-
leges in otolaryngology include but are not limited to:
––All forms of surgery on the auditory canal, the tympanic membrane, and the contents of
the middle ear
––Bronchoscopy (rigid or flexible) with biopsy, foreign body removal, or stricture dilatation
––Caldwell Luc procedure
––Cervical esophagectomy
––Cryosurgery
––Endoscopic sinus surgery and open sinus surgery
––Endoscopy of the larynx, tracheobronchial tree, and esophagus to include biopsy, excision,
and foreign body removal
––Esophageal surgery including diverticulectomy, cervical esophagectomy
––Esophagoscopy (rigid or flexible) with biopsy, foreign body removal, or stricture dilatation
––Excision of skull base tumor
––Excision of tumor ethmoid/cribriform
––Facial plastic surgery, including cosmetic surgery, chemical peel, rhytidectomy, mentoplasty
and correction of aural atresia, liposuction, and implantation of autogenous, homologous,
and allograft, and repair of lacerations
––Harvesting of skin, fat, or bone grafts of the head and neck, hip, trunk, and extremities
––Ligation of head and neck vessels
––Lip surgery including lip shave, partial or total resection with primary repair or by local
or distant flaps
––Myocutaneous flap (pectorales, trapezius, sternocleidomastoid)
––Otoplasty
––Parathyroidectomy
––Perform history and physical exam
––Radical surgery of the head and neck, including radical neck dissection, and radical excision
of the maxillary antrum for tumor
––Ranula excision
––Reconstructive procedure of the upper airway
––Reduction of facial fractures

24 A supplement to Briefings on Credentialing 781/639-1872 01/10

Otolaryngology Practice area 150

––Repair of CSF leaks with sinus or mastoid surgery

––Repair of fistulas—oral-antral, oral-nasal, oral-maxillary, oral-cutaneous, pharyngocutaneous,
tracheo-cutaneous, esophagocutaneous
––Rhinoplasty, septoplasty, and turbinate surgery
––Salivary gland and duct surgery, including plastic repair of salivary complex
––Skin grafting procedures, full thickness or split thickness
––Surgery of the larynx, including biopsy, partial or total laryngectomy, fracture repair
––Surgery of the nasopharynx, including nasal septoplasty, surgery on the frontal and maxillary
sinuses, and ethmoid sinuses, and surgery of the nasal mucosa and turbinates
––Surgery of the oral cavity, including soft palate, tongue, mandible, composite resection, and
neck dissection
––Surgery of the oral pharynx, hypopharynx, arytenoid cartilages, and epiglottis
––Surgical removal of teeth in association with radical resection
––Suspension microlaryngoscopy
––Tongue surgery, reduction and local tongue flaps
––Tonsillectomy, adenoidectomy, parotidectomy, and facial nerve repair
––Tracheal resection and repair
––Tracheostomy
––Transsternal mediastinal dissection
––Tympanoplasty, mastoidectomy, and middle ear surgery
––Use of energy sources as an adjunct to privileged procedures

The core privileges for neurotology include the ability to admit, evaluate, diagnose, treat,
and provide consultation to patients of all ages presenting with diseases and disorders of
the petrous apex, infratemporal fossa, internal auditory canals, cranial nerves (e.g., ves-
tibular nerve section and joint neurosurgical-neurotological resection of the intradural
VIII nerve tumors), and lateral skull base (including the occipital bone, sphenoid bone,
temporal bone, mesial aspect of the dura, and intradural management), in conjunction
with neurological surgery. Physicians may provide care to patients in the intensive care
setting in conformance with unit policies. They also assess, stabilize, and determine dispo-
sition of patients with emergent conditions consistent with medical staff policy regarding
emergency and consultative call services. Core privileges in neurotology include but are
not limited to:
––Cochlear implantation
––Decompression membranous labyrinth cochleosaculotomy, encolymphatic sac operation
––Electrophysiologic monitoring of cranial nerves VII, VII, X, XI, and XII
––Excision of glomus tumor
––Interpret imaging techniques of the temporal bones and lateral skull base
––Labyrinthectomy
––Middle/post-fossa skull base surgery
––Osseo-integrated implants, for auricular prosthesis, for bone-anchored hearing aid
––Perform history and physical exam
––Petrous apiectomy plus radical mastoid

A supplement to Briefings on Credentialing 781/639-1872 01/10 25

Otolaryngology Practice area 150

––Reconstruction congenital aural atresia

––Repair fistula (OW, RW)
––Resection CP angle tumor
––VII nerve decompression
––VII nerve repair/substitution
––VIII nerve section

The core privileges for plastic surgery within the head and the neck include the ability to
admit, evaluate, diagnose, treat, and provide consultation to patients of all ages presenting
with conditions or disorders requiring reconstructive procedures within the head, face,
neck, and associated structures, including cutaneous head and neck oncology and recon-
struction, management of maxillofacial trauma, soft tissue repair, and neural surgery.
Physicians may provide care to patients in the intensive care setting in conformance with
unit policies. They also assess, stabilize, and determine disposition of patients with emer-
gent conditions consistent with medical staff policy regarding emergency and consultative
call services. Core privileges in plastic surgery within the head and neck include but are
not limited to:
––Accessory-facial nerve transfer
––Blepharoplasty
––Brow lift
––Chemical peel
––Dermabrasion
––Endoscopic facial surgery
––Facial plastic surgery, including cosmetic surgery, chemical peel, rhytidectomy, mentoplasty
and correction of aural atresia, liposuction, and implantation of autogenous, homologous,
and allograft, and repair of lacerations
––Fascial sling procedures
––Hair transplantation, punch or strip
––Hypoglossal-facial nerve transfer
––Implantation of autogenous, homologous, and allograft
––Liposuction or lipo-injection procedure for contour restoration, head and neck; trunk and
extremities
––Mentoplasty and correction of aural atresia
––Orthognathic surgery
––Perform history and physical exam
––Reconstruction aural microtia
––Reconstruction eyelid, ptosis repair
––Repair of lacerations, scar revision, removal of lesions
––Rhytidectomy
––Upper lid gold weight placement

➤➤ Reappointment: Reappointment should be based on unbiased, objective results of care according

to the organization’s existing quality assurance mechanism.

26 A supplement to Briefings on Credentialing 781/639-1872 01/10

Otolaryngology Practice area 150

Applicants must demonstrate that they have maintained competence by showing evidence that
they have provided otolaryngology-head and neck services or performed surgery for at least 50
patients annually over the reappointment cycle. Surgery should include the operative interven-
tions for which privileges are requested. In addition, continuing education related to otolaryngol-
ogy should be ­required.

I understand that by making this request, I am bound by the applicable bylaws or policies
of the hospital, and hereby stipulate that I meet the minimum threshold criteria for this
request.

Practitioner’s signature: _________________________________________________________

Typed or printed name: _________________________________________________________

Date: _________________________________________________________________________

A supplement to Briefings on Credentialing 781/639-1872 01/10 27

Otolaryngology Practice area 150

Editorial Advisory Board Clinical Privilege White Papers

Associate Group Publisher: William J. Carbone Stephen H. Hochschuler, MD Beverly Pybus

Erin Callahan, Chief Executive Officer Cofounder and Chair Senior Consultant
American Board of Physician Specialties Texas Back Institute The Greeley Company,
ecallahan@hcpro.com
Atlanta, GA Phoenix, AZ a division of HCPro, Inc.
Associate Editor: Marblehead, MA
Darrell L. Cass, MD, FACS, FAAP Bruce Lindsay, MD
Julie McCoy, Codirector, Center for Fetal Surgery Professor of Medicine Richard A. Sheff, MD
jmccoy@hcpro.com Texas Children’s Hospital Director, Cardiac Electrophysiology Chair and Executive
Houston, TX Washington University School Director
of Medicine The Greeley Company,
Jack Cox, MD
St. Louis, MO a division of HCPro, Inc.
Senior Vice President/Chief Quality Officer
Marblehead, MA
Hoag Memorial Hospital Presbyterian
Newport Beach, CA

The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own
local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted
for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing
Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained.

Reproduction in any form outside the recipient’s institution is forbidden without prior written permission. Copyright © 2010 HCPro, Inc., Marblehead, MA 01945.

28 A supplement to Briefings on Credentialing 781/639-1872 01/10