122 Chapter 6 Although over-the-counter hearing aids are not widely available in the Netherlands, it is possible that a few participants with self-perceived mild hearing loss obtained hearing aids without referral to an ENT specialist and thus met our inclusion criteria. As this route is rarely reimbursed, we expect this number to be minimal. While this may have slightly influenced hearing-related subscale scores, it reflects real-world variation in the general population and supports the practical relevance of the normative data for use in early-stage or undiagnosed cases. Although study reports ear complaints in a large sample of the general population in the Netherlands normative data can vary between regions and countries. And despite translations and future cross cultural adaptations, these data cannot be adopted without critical review in other population outside the Netherlands. The primary design of the OQUA was to evaluate complaints in patients with ear complaints. It was not intended as a screeningtool. And although the outcome and items might have been the same, it should be noted that a screening tool might have different outcomes in a general population. The interpretabillity of the OQUA improves significantly with these data or ear complaints in the general population. Calculation of the Minimal Important Change (MIC) would have additional value for the interpratabillity. Implications of the study These data can be used to improve interpretability of the OQUA. For optimal use, the normative OQUA data needs to be incorporated in the Electronic Health Record (EHR) systems though. In the Amsterdam University Medical Centre, OQUA scores are available in EPIC Systems (worldwide provider of EHR software for large and mediumsized organizations).19 With repetitive measurements, improving or decreasing scores are visualized as previous shown in figure 2 with up- and downward pointing arrows. Red arrows explaining increase in complaints and blue arrows explaining decrease of complaints compared to previous measurement Normscores would need to be added to this visualization of OQUA scores. This incorporation ensures that healthcare teams can efficiently reference normative benchmarks to inform patients on treatment strategies, visualize progress in disease and impact of complaints, and evaluate (surgical) interventions. Ultimately, the integration of normative OQUA data into electronic patient charts serves as an important tool for patient-centric approach in otology.
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