In otolaryngology most fellowships are either 1 or 2 years and usually dedicate the majority of time towards clinical training, though many also advertise 10-20% of dedicated research time. Most otolaryngology subspecialties are accredited, or are working towards accreditation, to ensure consistency and quality of training between programs. Currently, Neurotology, Pediatric Otolaryngology, and Sleep Medicine & Surgery are the only ACGME accredited fellowships, which means that fellows in these programs are governed by the same work hour restrictions and requirements that general otolaryngology residents observe. In contrast, laryngology, head and neck surgical oncology, rhinology and facial plastic surgery fellows are usually viewed as junior faculty and frequently take call, run an independent clinic several days a week, and receive variable pay and benefits.

In many ways Otolaryngology is a gateway specialty, providing opportunities for subspecialization in a diverse set of clinical areas. Head and neck surgical oncology and pediatric otolaryngology are similar in that they maintain a much broader purview than other otolaryngology subspecialties. On any given surgical day the head and neck surgeon may perform microlaryngoscopy, endoscopic skull base surgery, or oropharyngectomy with neck dissection. Similarly, the realm of the pediatric otolaryngologist is diverse, covering craniofacial reconstruction, sinus surgery, and pediatric ear surgery. In contrast, the focus of the neurotologist, facial plastic surgeon, and laryngologist is narrower. For example, aside from upper neck dissection for glomus jugulare resection, 7-12 anastomosis or infratemporal fossa dissection, the surgical realm of the neurotologist is primarily limited to the temporal bone and lateral skull base.  The trade-off of niche specialization is giving up the breadth of otolaryngology to become the definitive clinical expert and surgeon in all matters of your field.