Indications, procedural standards, and training requirements for flexible nasolaryngoscopy in pulmonology - a Delphi study protocol.

Flexible nasolaryngoscopy (FNL) is a well-established, minimally invasive procedure for assessing the nasal passages, nasopharynx, and larynx. Its role in pulmonology is expanding, particularly for evaluating vocal cord dysfunction/inducible laryngeal obstruction, chronic cough, and other upper airway conditions relevant to the "united airways" model of care. However, no consensus-based guidance currently exists on the indications, procedural standards, or training requirements for FNL performed by pulmonologists. This protocol describes a modified two-round Delphi study that will survey an international, purposively sampled panel of pulmonologists and otolaryngologists via an online platform hosted by Monash University, using a five-point Likert scale and pre-specified consensus thresholds (≥70% agreement). Findings will be discussed in a structured expert roundtable to support interpretation and contextualization. • Establishes expert consensus on clinical indications and contraindications for FNL in pulmonology practice. • Develops consensus on procedural standards, curriculum, and competency requirements for FNL training in pulmonology. • Identifies priority areas for future research to support integration of FNL into pulmonology services.