59 The Otology Questionnaire Amsterdam: a generic patient reported outcome measure about the severity and impact of ear complaints 3 Discussion Comparisons with other studies. Comparisons with other studies To our knowledge, only one generic otologic PROM has been described in the English literature; the ‘Cambridge Otology Quality of Life Questionnaire’ (COQOL).15 The COQOL is a 24-item questionnaire and was designed to quantify the quality of life of patients attending otology clinics. An important difference between the COQOL and the OQUA is that the COQOL was designed to measure the construct ‘quality of life’, presented as one sum score or 24 separate item scores. The OQUA measures two constructs: ‘complaints’ and ‘impact’. The scores on the complaint-part are presented graphically per complaint and the scores on the impact-part are presented as one sum score. Clinical applicability of the study The current study presents the development of a Dutch generic PROM addressing ear complaints and their impact on daily life. The OQUA was developed, pilot-tested and fieldtested in a large group of ENT patients. The final version consists of 34 items, measuring eight types of ear complaints and the impact of ear complaints on daily life. The advantages of the OQUA are various: graphical representation of severity of complaints, easy to use in the outpatient clinic and easy comparison of patients’ perspectives of complaints and impact of these complaints before and after intervention. The OQUA can be used in addition to objective measurements so that it can be used to optimise otologic care. Further research is required to determine OQUA’s minimally important change. Strength and weakness of the study Following the guidelines of COSMIN, the required steps to develop a questionnaire were taken in the various phases of the study.10 The study population represented a heterogeneous group by including participants of different ages, experiencing different types of ear complaints and an even distribution of male and female participants. Another positive feature of this study is that there were only few missings (<0.3%). Moreover, the missings were obtained from few respondents (7%) and were distributed over various items. This suggests that missings were not caused by poor formulation of an item. A limitation of this study is that the origin of the participants was not evenly distributed across clinics. Fifty-eight participants (74%) in phase 1 and 303 participants (86%) in phase 2 originated from a tertiary clinic. This may have led to a selected display of distributions of complaints within the study population. However, every type of ear complaints was sufficiently represented in the study population. Another limitation of this study is the fact that the OQUA contains eight items answered by a VAS. Previous research has shown that not every patient,
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