New clinical guidelines significantly reduce opioid prescriptions after ear surgery

A new retrospective study published in OTO Open, the open-access journal of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF), demonstrates that the Clinical Practice Guideline (CPG) Opioid Prescribing for Analgesia After Common Otolaryngology Operations has had a measurable and sustained impact on prescribing practices following parotidectomy, which a surgical procedure to remove the parotid gland.

The study analyzed deidentified data from more than 25,000 patients across 80 U.S. healthcare organizations using the TriNetX database, spanning January 2013 through December 2023. Researchers found that following the publication of the CPG in April 2021, opioid prescribing in the postoperative period dropped immediately and significantly, and that the trend continued over time.

This study highlights the importance of clinical practice guidelines and the impact they can have on practice patterns." 

Viran J. Ranasinghe, MD, senior author, Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch

The research, which was first presented at the AAO-HNSF 2025 Annual Meeting & OTO EXPO, held October 11–14, 2025, in Indianapolis, Indiana, represents a meaningful shift toward the multimodal, non-opioid-first approach to postoperative pain management championed by the CPG.

About the AAO-HNSF Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

This CPG was developed to reduce the variation in postoperative pain management across the specialty and curb the risks associated with opioid overprescribing, including opioid use disorder (OUD), diversion, and overdose. Among its key action statements, the guideline issued strong recommendations that clinicians:

• Advocate for non-opioid medications as first-line management of pain following otolaryngologic surgery
• Screen patients for OUD risk factors before surgery when opioids are anticipated
• Counsel patients on secure storage and disposal of any unused opioids.

The guideline also emphasizes shared decision-making, multimodal analgesia strategies, and patient education, providing a comprehensive framework aimed at reducing opioid dependence risk while maintaining effective pain control.