Quality in middle ear surgery - a critical position determination. / Qualität in der Mittelohrchirurgie ­ eine kritische Standortbestimmung.

ABSTRACT

When evaluating the outcome of reconstructive middle ear surgery, it is insufficient to use only the achieved improvement of audiometric measurement results. Although, as functional parameters, they occupy a central position in the therapeutic assessment of the ear as a sensory organ, they must be supplemented by a number of modern quality control factors. Different perspectives for assessment of quality must be taken into account. What is important from the patient's point of view may not be the same factors as to the physician, while the physician places a high value on factors that are less significant for the medical insurance company. The international otological community, who would like to draw conclusions from middle ear surgery data, might set different criteria altogether for assessing quality of surgery.Hence, we propose to adapt the general concept of quality to middle ear surgery. This must be implemented on different levels and surgical therapy of middle ear diseases must be understood as a process.This means that quality assessment must comprise additional aspects, which include a structured description and recording of disease-specific symptoms, findings, and outcome of treatment. Furthermore, in today's world the use of internationally recognized classification systems must be regarded as a quality feature, in order to make results not only publishable but also capable of meta-analysis. Internationally developed and recognized reporting systems are available for this purpose. Their use in routine care not only makes the collected data internationally comparable, but also enables systematic evaluation within the institution for quality description and control.In addition to audiological measurement results, surgical quality indicators are considered. We also focus on emerging complications and the value of systematic and structured evaluation and documentation systems. Validated measuring instruments are already available for patient benefit assessment, the use of which should no longer be limited to scientific studies. In summary, quality assessment of surgery should be extended to include not only the "patient as a whole", but also to the "therapy process as a whole", incorporating features of structural and process quality.