I understand what you're saying, but what if you have a 240, middle of the pack class rank and little research? I've got a 246/254 (Step I/StepII) decent clinical grades (2 H, rest HP) and mediocre preclinical grades. Add that in with the fact that I'm only now getting started with research. From what it seems to me, all I've got to hang my hat on are board scores and a decent personality. So where do I fit in with the pack?
I wouldnt' worry too much if you come from a school with an ENT program and have decent letters. Only thing that may prevent you from matching is a bad letter or bad interviewing skills.