Clinical practice guidelines (CPGs) are created to address quality improvement opportunities for all clinicians, optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in patient care. Tremendous resources are invested in creating CPGs we can trust. Once a guideline is created, however, how is it maintained to reflect the most up-to-date clinical evidence? This article reviews protocols for reviewing and maintaining CPGs with particular attention to the protocols established by the American Academy of Otolaryngology-Head and Neck Surgery.