The 31st annual US News & World Report (USNWR) 2020-2021 Medical Specialties Ranking continues a trend in recent years of marked variability in the rankings of top hospitals for ear, nose, and throat care.1 Since 2005, USNWR has published annual rankings of the top 50 hospitals overall and by specialty to “help consumers determine…which hospitals provide the best care.”2(p1) There have been dramatic yearly fluctuations in the ranking positions in the past 5 years for the top 50 hospitals for the ear, nose, and throat specialty (and associated otolaryngology–head and neck surgery academic programs) that parallel changes in ranking methods (Figure, A). We believe that this variability in ranking reflects unreliable or imprecise methods rather than factual changes in program quality.