One hundred and fifteen patients, between 6 months and 12 years of age, had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of signs, symptoms and examinations, and to determine the time that passed between aspiration and removal of the foreign body. The sensitivity of the symptoms choking and coughing was fairly high (81 and 78%), but the specificity was poor. The sensitivity of a chest radiograph was 82%, the specificity 44%. The sensitivity of radiographs on inspiration and expiration was 80%, the specificity 55%. The patients had been referred with the initial diagnosis foreign body aspiration (80), pneumonia (34), or subglottic laryngitis (1). In 85 patients a foreign body was identified and extracted. The other 30 patients had respiratory tract infections. The initial diagnosis of foreign body aspiration was correct in 61 out of 85 patients. In these cases, the period between aspiration and extraction of the foreign body was a mean 6 days, compared with 55 days, if the initial diagnosis was pneumonia or sub-glottic laryngitis. We conclude that the diagnosis of foreign body aspiration is too often missed, and that, apart from bronchoscopy, diagnostic tools are of little value.

Complication overviews may lead to measures directed toward quality improvement and to better information for patients. When evaluating the rhinological literature from 1979 to 1999, a detailed comparison could not be made because of differences in reporting. With the advent of electronically stored medical data, events can be registered better than before. To be able to compile very diverse data from electronic dossiers into concise overviews for feedback, a simple general scale with broad categories is needed. These feedback overviews enable insight in the complication rates of different kinds of sinus surgery and monitoring of changing trends in sinus surgery. An example of a general classification based on severity is presented for use when electronically storing medical data. This scale varies from adverse events (grade A) to death (grade D). A consensus on categorization of complications is a prerequisite for a valid comparison with other clinics. To instigate a discussion about consensus, this classification is presented as an example. Our proposal is presented together with an overview of sinus surgery complications in recent literature for reference.

Data relating to daily clinical practice were collected in an otologic database. Over a period of 3 years, information was gathered about 1,000 ear operations. This led to the following conclusions: the collection of data is difficult; the selection of data and the moment it should be fed into the systems are very important; there is a risk of using too many items and therefore reducing surgeon compliance. On the other hand, too few items result in irrelevant overviews. The collection of ear surgery data makes it easier to understand positive and negative outcomes.

No abstract