How Changing Signaling Volume Impacts the Importance of Away Rotations in the Otolaryngology Match

Q: How was signaling introduced in the otolaryngology match, and how did the number of signals change from 2021 to 2024?

Signaling was introduced in 2021, with 5 signals allotted in 2021, 4 in 2022, 7 in 2023, and 25 in 2024. The study evaluates how this changing signaling volume relates to away rotations and matching outcomes.

Q: What data and method were used to assess the relationship between away rotations and matching across different signaling eras?

The study used Texas STAR survey responses from otolaryngology applicants between 2018 and 2024. Multivariate logistic regression estimated odds of matching associated with away rotations and tested how odds varied across pre-volume (2018–2020), low-volume (2021–2023), and high-volume (2024) eras.

Q: What was the main finding about matching likelihood when away rotations were performed during the high-volume signaling era?

In the high-volume signaling era, applicants were significantly less likely to match at programs where away rotations were performed compared with the pre-signaling era (OR 0.56, 95% CI 0.33–0.95; P < .05). A similar direction was observed in the low-volume era but was not statistically significant.

Sep 30, 2026

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Objective: Signaling entered the otolaryngology match in 2021 with changing signal counts from 2021–2024. This cross-sectional study examined how signaling volume modifies the association between away rotations and matching from 2018 to 2024. Methods used multivariate logistic regression on Texas STAR survey responses, comparing pre-volume (2018–2020), low-volume (2021–2023), and high-volume (2024) signaling eras. Results showed lower odds of matching where away rotations were performed in the high-volume era. The most impactful factor was performing an away rotation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Objective

Study Design

Setting

Methods

Results

Conclusion

Level of Evidence

Background

Preference signaling and match challenges

How Changing Signaling Volume Impacts the Importance of Away Rotations in the Otolaryngology Match Maya G. Hatley, BA 1 , Ronald S. Wang, BS 1, Emmanuel Garcia Morales, PhD 1, Wenqing Yang, MA 1, Michele Santacatterina, PhD 1, Angela P. Mihalic, MD2, and Max M. April, MD 1 OTO Open 2026, Vol. 10(1):e70190 © 2026 The Author(s) . OTO Open published by Wiley Periodicals LLCon behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation. DOI: 10.1002/oto2.70190 [http://oto-open.org](http://oto-open.org) Abstract Objective. Signaling was introduced to the otolaryngology match in 2021, with 5 signals allotted to applicants in 2021, 4 in 2022, 7 in 2023, and 25 in 2024. This study investigated the modifying effect of signaling volume on the relationship between away rotations and matching in otolaryngology from 2018 to 2024. Study Design. Cross-sectional. Setting. National survey of US medical students. Methods. We used the Texas Seeking Transparency in Application to Residency (STAR) survey responses of otolaryngology applicants from 2018 to 2024 . Using multivariate logistic regression, we determined the odds of matching where away rotations were performed and how these odds varied across the pre-volume (2018- 2020), low-volume (2021-2023), and high-volume (2024) signaling eras. Results. In total, 28.3%(n = 855) of otolaryngology applicants from 2018 to 2024 completed the Texas STAR survey. Using multivariate logistic regression, adjusting for applicant characteristics, and including an interaction term between performing away rotations and signaling time period, applicants in the high-volume signaling era were found tobe signiﬁcantly less likely to match at programs where away rotations were performed (odds ratio [OR]: 0.56, 95% CI: 0.33-0.95; P < .05) compared to the pre-signaling era. The same trend was seen in the low-volume signaling era, though not statistically signiﬁcant (OR: 0.76, 95% CI: 0.47-1.22, P = .24). The most impactful factor on matching across all study years was performing an away rotation (OR: 12.1, 95% CI: 9.0-16.5, P < .001). Conclusion. The introduction of signaling and the recent increase in signal number are associated with decreased likelihood of matching at a program where an away rotation was performed compared to the presignaling era. Level of Evidence. V. Keywords away rotations, otolaryngology match, otolaryngology residency applications, preference signaling Received September 16, 2025; accepted December 13, 2025. O tolaryngology–Head & Neck Surgery ( OHNS) is a highly competitive specialty, with signiﬁcantly more applicants each year than available residency spots. 1,2 Consequently, applicants have adapted strategies to increase their odds of matching.3 The average number of applications per applicant was approximately 40 in 2006, 60 in 2014, and recently estimated at 86 in 2022 .3–5 Additionally, up to 90% of applicants report applying to and accepting interviews at programs they do not have a strong interest in, to increase their overall chance of matching.6 Naclerio et al reported in 2014 that the mean number of applications received per program rose from 159 in 2008 to 278 in 2014 .5 The growing volume of applications received by programs because of these applicant strategies has led to aninefﬁcient match system, requiring increasing time and resources from both applicants and otolaryngology 7,8 programs. Preference signaling was introduced in the 2021 match to address challenges stemming from COVID‐19 pandemic restrictions, such as the inability to conduct away rotations and in‐person interviews. Preference signaling 1 Department of Otolaryngology–Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA 2Department of Pediatrics—University of Texas Southwestern Medical Center, Dallas, Texas, USA Presented at Triological Society Annual Meeting at COSM; May 16-18, 2025; New Orleans, Louisian

FAQs

How was signaling introduced in the otolaryngology match, and how did the number of signals change from 2021 to 2024?

Signaling was introduced in 2021, with 5 signals allotted in 2021, 4 in 2022, 7 in 2023, and 25 in 2024. The study evaluates how this changing signaling volume relates to away rotations and matching outcomes.

What data and method were used to assess the relationship between away rotations and matching across different signaling eras?

The study used Texas STAR survey responses from otolaryngology applicants between 2018 and 2024. Multivariate logistic regression estimated odds of matching associated with away rotations and tested how odds varied across pre-volume (2018–2020), low-volume (2021–2023), and high-volume (2024) eras.

What was the main finding about matching likelihood when away rotations were performed during the high-volume signaling era?

In the high-volume signaling era, applicants were significantly less likely to match at programs where away rotations were performed compared with the pre-signaling era (OR 0.56, 95% CI 0.33–0.95; P < .05). A similar direction was observed in the low-volume era but was not statistically significant.

Sep 30, 2026

Uploaded by Pentious