A suite of new and updated best practice patient pathways are now available to support NHS Ear, Nose and Throat (ENT) teams as part of GIRFT’s ongoing drive to optimise the care of ENT patients in England. 

Eleven pathways have been developed or refreshed in collaboration with ENT-UK and other specialist organisations, and can now be viewed and downloaded from the GIRFT website or the GIRFT FutureNHS workspace. 

The pathways offer guidance from referral through to discharge and follow-up, including best practice for preoperative assessment, surgical planning and safe discharge protocols. 

GIRFT ENT clinical lead Jeremy Davis said:

“These pathways have been developed to support ENT teams to optimise their services, providing efficient, high-quality, patient centred care.” 

The refreshed suite includes three pathways for paediatric ENT teams. GIRFT clinical lead for paediatric ENT Sujata De added:

“These pathways are based on latest guidance for the most common presentations and operations in paediatric ENT; we hope they will offer colleagues a framework for a streamlined, collaborative, patient-centred approach that will in turn lead to high-quality effective and efficient care.” 

The new/updated pathways are: 

Ear pathways 

• Myringoplasty and tympanoplasty pathway: supporting ENT teams in delivering effective and consistent care for patients requiring surgical repair of the tympanic membrane and middle ear, guiding the full patient journey from referral and diagnosis to discharge, emphasising suitability for day case surgery and aligning with best practice standards. 

• Mastoidectomy pathway: supporting teams delivering care for patients undergoing mastoid surgery – typically for chronic ear disease or cholesteatoma – the pathway offers a clear approach from initial referral through to post-operative recovery, supporting day case surgery where clinically appropriate and improving consistency across units. 

• Stapedectomy pathway: supporting ENT teams to deliver safe, consistent and effective day case stapes surgery for patients with conductive or mixed hearing loss, including otosclerosis. 

• Paediatric recurrent acute otitis media (rAOM) pathway: supporting primary and secondary care teams in the effective assessment, triage, and management of children with rAOM, providing an end-to-end framework from initial presentation to surgical and non-surgical options, helping ensure timely, appropriate care and optimised use of ENT services. 

• Paediatric otitis media effusion (OME) pathway: created to support clinicians in the consistent and effective identification, assessment, and management of children presenting with hearing concerns related to OME, this guide offers a stepwise approach, ensuring timely and equitable care for children with OME across varying levels of clinical complexity. 

Nose pathways 

• Nasal airway surgery pathway: designed to optimise care for patients undergoing septoplasty, functional septorhinoplasty (SRP), or turbinate surgery, this pathway provides a streamlined, evidence-based framework guiding clinicians from initial referral through to follow-up, supporting surgical safety, efficiency, and consistent patient outcomes across ENT services. 

• Endoscopic sinus surgery (ESS) pathway: a comprehensive framework designed to support ENT teams, surgical coordinators, and primary care professionals in delivering efficient, safe, and standardised care for patients undergoing ESS. It provides a structured, step-by-step process from referral and assessment through to surgery, recovery, and follow-up – ensuring high-quality care and optimal outcomes. 

Throat pathways 

• Submandibular gland excision pathway: created to guide clinicians in delivering consistent, safe, and efficient care for patients undergoing excision of the submandibular gland, typically for sialolithiasis or chronic sialadenitis, this best practice pathway provides a clear, evidence-based structure from referral through to discharge, supporting day case delivery where clinically appropriate and ensuring optimal surgical planning, risk mitigation, and follow-up. 

• Parotidectomy pathway: a structured, evidence-based pathway supporting ENT teams in the effective and consistent management of patients undergoing parotid gland surgery. The pathway outlines each stage of care -from referral and diagnosis to discharge – optimising the safe delivery of parotidectomy as a day case procedure where appropriate. 

• Day case paediatric adenotonsillectomy pathway: this pathway offers an approach from initial referral through to discharge, enabling same-day surgery where appropriate and ensuring robust pre-operative assessment and post-operative planning. 

• Adult tonsillectomy pathway: supporting ENT teams in delivering safe, high-quality, and standardised care for adult patients undergoing tonsillectomy, the framework runs from referral through to discharge, ensuring appropriate selection for day case surgery and enhancing post-operative recovery.