Hyperbaric oxygen for sudden sensorineural deafness: when guideline development goes astray

Problem: This article uses a clinical example to describe the need, when formulating a guideline, to include all evidence levels in the deliberations leading to the recommendations. Methodology: A narrative review, in which the different viewpoints on a recent guideline from the Dutch Society of Otorhinolaryngology and Head & Neck Surgery are described. Results: The guideline committee on sensorineural hearing loss is not abiding by its own rules in respect of formulating their guideline. Furthermore, a narrow evaluation of the literature is not useful for practice guidelines. A restrictive interpretation of evidence-based medicine (EBM), as well as the formulation of overly directive recommendations, has adverse implications for maintaining the range of treatment options, which could be important in the context of shared decision-making. Conclusion: For a practice guideline, a broad approach to the presentation of evidence and practice-based recommendations is required