73 The Otology Questionnaire Amsterdam 4 Scoring system: In order to implement the OQUA in daily practice, a scoring manual was developed. Figure 2 presents the key components and calculations of the scoring system, providing a concise overview for practical use. The complete scoring model, including detailed explanations and examples, is available in the appendix at the end of this thesis. The expert panel decided that every ear complaint in the complaint domain should be equally weighted and also that the frequency (measured with VAS) and severity (measured with an ordinal adjectival rating scale) in the ear complaint domain should be equally weighted. Additionally, every ear complaint domain (e.g. tinnitus, hearing loss) should have one score and impact scale should have a separate score. It was decided that a total complaint score covering all domains is not desirable and should not be calculated as it hides differences that may occur in the scoring of the separate domain. For example, the tinnitus score could decrease, while at the same time, the hearing score could increase. This would have resulted in an unchanged total score. Whether it is practically correct to mathematically balance the items and complaints, as done now, is an issue that needs further investigation in future. In Figure 3, a graphical representation of how the OQUA result could look in the (electronic) patient file is shown.
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