[The practice guideline 'Hearing impairment' (first revision) from the Dutch College of General Practitioners; a response from the perspective of otorhinolaryngology and clinical audiology].

The effort to use evidence-based medicine as a starting point for the revision of the guideline 'Hearing impairment' from the Dutch College of General Practitioners is much appreciated. The guideline advocates an active attitude towards hearing impairment in the elderly. Idiopathic sensorineural hearing loss is described as a clinical entity and the guideline stresses the importance of timely referral to an otolaryngologist. The sceptical attitude towards the practical applicability of tuning-fork tests may be questioned. The guideline's suggestions concerning chronic otorrhoea and traumatic tympanic membrane perforation are inadequate and partly incorrect. The specific expertise of the disciplines involved in the field of hearing impairment could have been made more explicit. Nevertheless, this revision of the guideline is considered to be a material improvement compared to the former version.