(213) Current analysis of otolaryngology applicant letters of recommendation

Introduction: The otolaryngology residency application process includes obtaining and submitting letters of recommendation (LoR). Applicants are capped at a maximum of 4 letters, but there is no current research investigating how many letters applicants typically submit, whether letters from external rotations are commonly used, and if letters are typically written by department chairs, program directors, or other otolaryngologists.

Methods: Otolaryngology residency applications from the current 2025-2026 cycle received by the lead author’s institution were reviewed. Only United States-based applicants were included in the study. Each applicant’s LoR were examined, including whether they originated from “home” programs or external rotations, whether they were written by department chairs/program directors/or others, and the academic rank writers typically held.

Results: 105 US-based applications were received. An average of 3.8 letters were submitted by applicants, with a range of 3 to 4. 1.99 letters per applicant came from home institutions, while 1.36 were obtained from external rotations. 25.7% of applicants submitted letters attained from multiple external rotation sites. 59.0% had at least one letter from a department chair, while only 37.1% featured a letter from a program director. However, 26.7% had a combined chair/program director letter. Professor was the most common rank among letter writers, 58.8%. The Otolaryngology Program Directors Organization’s standardized LoR was utilized by at least one letter writer for 51.4% of applicants.

Conclusions: The majority of applicants submit 4 LoR, obtain most letters from their home programs, and feature a letter written by a department chair. This novel data provides advisors with insight into the composition of letter writers to better support applicants’ success.