82 Chapter 4 be compared with the OQUA-related domain, but will lack information on other ear complaints. Disease-specific questionnaires are difficult to compare with the OQUA as the questions in a disease-specific questionnaire will be tailored towards the specific group of patients with their specific complaints. These studies might be designed to evaluated response to treatment, but most likely will only focus on the patients’ ear complaints specific for that disease and discarding the possible other ear complaints which can occur after ear surgery (e.g. tinnitus or taste problems). Disease-specific questionnaires should preferably be combined with a separate QoL questionnaire to assess the relevance and impact of these complaints on the quality of life. Comparing cross-sectional ear-related quality-of-life questionnaires with the OQUA will be possible as the OQUA has a separate scoring system on impact. Current position of the OQUA In the systematic review that was mentioned in the introduction, one generic otologic questionnaire, the COQOL15, was identified. The COQOL was developed with the aim to asses quality of life and impact of ear complaints of patients visiting an ENT surgeon. The OQUA distinguishes itself from to the COQOL by having two separate scales/instead of one, measuring not only the impact on quality of life, but also the severity of all major ear complaints as separate domains. In line with their objective to measure impact/ quality of life, the COQOL validated its responsiveness compared with the SF36 questionnaire. The questionnaire does not include items about the severity of ear complaints. Despite this difference, the COQOL is mapped for economic evaluation16, which is still a future perspective of the OQUA. The OQUA is currently implemented in our electronic health record using EPIC version AUG 2019. After implementation, this construct file can be used across the country for all hospitals using Epic as well. Furthermore, the OQUA will also be build-in in other electronic health records (EHR) used across the country, for example Hix (Chipsoft). Future research The OQUA is designed to be easily applicable in daily practice, being able to be used on a computer, tablet/phone and on paper. With the scoring manual (Figure 2), a graphical representation can be developed according to the wishes of the ENT surgeon and in line with the capacity of their facility (electronic patient file, ICT department or institution). Future studies might focus on enablers of and barriers to its implementation. By adapting the graphical representation to the preferences of the users and having the OQUA being filled out days before consultation, the
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