AUDIOLOGY Tinnitus
"last update: 19 May 2024"
- Methods
➡️ Methods of development
Stakeholder Involvement: Individuals who were involved
in the development process. included the above-mentioned Audiology Chief Manager,
Audiology Executive Manager, Assembly Board, Grading Board and Reviewing Board
Information about target population experiences, views and preferences were not applicable for this topic.
➡️Search method
Electronic database searched:
Pubmed, Medline, Egyptian Knowledge Bank, Medscape, WebMD, Google Scholar
➡️Keywords:
The adaptation cycle passed over: set-up phase, adaptation phase (Search and screen, assessment: currency, content, quality & /decision/selection) and finalization phase that included revision and external reviewing. We used modified adapt process that consisted of three main phases, including planning and set-up, adaptation, and development of a final product.
➡️Time periods searched: from January 2010 to March 2020).
➡️Results
Three audio-vestibular medicine experts assessed the six tinnitus guidelines, where the multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment, 2019 [2], gained the highest scores as regards the currency, contents, and quality (Annex 2: tables 1-3 [3]).
It was graded by 20 expert audio-vestibular medicine consultants and reviewed by 3 expert audio-vestibular medicine physicians reviewers, and 1 neurologist reviewer and 1 psychiatrist reviewer and 2 radiologists physicians reviewers, to improve quality, gather feedback on draft recommendations. The external review was done through a rating scale as well as open-ended questions.
➡️Intended Users of the guideline: ENT and Audio-Vestibular Medicine Physicians, to be used to make and inform clinical decisions regarding management of older children and adults with subjective tinnitus and/or appropriate referral.
Setting: Primary, secondary and tertiary care centers & hospitals, and related specialties.N.B. Levels of evidence: Quality of evidence for the treatment methods (treatment elements or protocols, devices, or procedures) was guided by the (GRADE Working Group, 2013). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to Decision frameworks (Table 1)
N.B. Levels of recommendation: The recommendation level for each treatment method (Treatment elements or protocols, devices, or procedures) was guided by the GRADE system [3], Interpretation of strong and conditional recommendations for an intervention is shown in table (1).
Table (1): The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to Decision frameworks (GRADE Working Group 2013) [3]
|
Grade |
Definition |
|
High |
We are very confident that the true effect lies close to that of the estimate of the effect. |
|
Moderate |
We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different |
|
Low |
Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. |
|
Very Low |
We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect |
[4] http://www.gradeworkinggroup.org.
Table (2): Interpretation of strong and conditional recommendations for an intervention [5]
|
Audience |
Strong recommendation |
Conditional recommendation |
|
Patients |
Most individuals in this situation would want the recommended course of action; only a small proportion would not. Formal decision aides are not likely to be needed to help individuals make decisions consistent with their values and preferences. |
Most individuals in this situation would want the suggested course of action, but many would not |
|
Clinicians |
Most individuals should receive the intervention. Adherence to the recommendation could be used as a quality criterion or performance indicator. |
Different choices will be appropriate for individual patients, who will require assistance in arriving at a management decision consistent with his or her values and preferences. Decision aides may be useful in helping individuals make decisions consistent with their values and preferences. |
|
Policymakers |
The recommendation can be adopted as policy in most situations. |
Policymaking will require substantial debate and involvement of various stakeholders. |
[5] WHO handbook for guideline development – 2nd ed. Chapter 10, page 129
