A nebulizer is a device which turns the liquid into a mist, and high concentration of medications can reach where it is needed using a nebulizer. Aerosol therapy with a nebulizer has been used for the treatment of inflammation in larynx. Therapy with a nebulizer also reduces the general side effect, because it is local therapy. Furthermore, it was reported that inflammation increased absorption of medication into the mucosa by the nebulizer therapy. However, the usefulness of nebulizer treatment has not been investigated in detail. And there is a possibility that a nebulizer has not been used with precision in an outpatient clinic. Therefore, it is necessary to examine a nebulizer therapy and to understand it exactly. To investigate how otolaryngologist performs aerosol therapy with a nebulizer, we sent questionnaires to Otorhinolaryngologist. Twenty-six questionnaires were returned. Consequently, it was found that dexamethasone sodium phosphate and betamethasone sodium phosphate were used at 14 and 12 institutes, respectively. The amounts of these steroids differed among institutes. There were 40 times differences in dexamethasone sodium phosphate, and more than 6 times differences in betamethasone sodium phosphate. Antibiotic was also used at 14 of 17 institutes. These suggested that species and amounts of medications differed among institutes. Considering these, it is necessary to found the most effective and safe methods for the control of inflammation in the larynx, and to establish standard method of aerosol therapy with a nebulizer. Further research is necessary to resolve these problems.
Inhaled corticosteroids (ICS) have the best efficacy for the treatment of asthmatic children. ICS act directly on asthmatic airways and relieve symptoms through suppression of airway inflammation. It is crucial that children with asthma receive personalized treatment plans depending on their inhaler competence to achieve control of their asthma. Insufficient inhaled drug delivery in children is strongly associated with their inadequate inhalation technique as well as with both anatomical and physiological differences in their airways relative to that of adults. This review summarizes the essential features of the Japanese Pediatric Guideline (JPGL) for the Treatment and Management of Asthma 2017 with respect to the choice of aerosol delivery devices (nebulizers or fixed-quantity inhalers) and inhalation aids (spacers) to increase the efficacy of aerosol delivery. Practical usage of each device in combination with both an inhalation aid and the appropriate education for successful inhalation therapy are also presented.
We examined the transition of the rhinopharynx bacteria test at Showa University Hospital in Japan.
We observed the results of the rhinopharynx bacteria test that was assessed by the Department of Otorhinolaryngology and Pediatrics. The observation period was 2012 through 2016. The study items were the number of bacteria in each year, the species of bacteria under 2 years old and 2 to younger than 15 years, the differences in each department, the species of bacteria in each year, and the resistance of Streptococcus pneumoniae and Haemophilus influenzae as delineated by the Clinical and Laboratory Standards Institute (CLSI).
The number of species were 1270, 1672, 1991, 2245, and 2316 in each year, respectively.
When we compared those under 2 years old with those under 15 years old and 2 years old or older, there was considerable coagulase-negative-Staphylococci (CNS) under 2 years old. We considered that there was no action so as to be young, and this searched the source of infection cyclopedically.
The rank of each bacterium showed similar results when rearranged in descending order as follows: CNS, Corynebacterium species, Staphylococcus aureus, Streptococcus species, Moraxella catarrhalis, S. pneumoniae, and H. influenzae.
The proportions of penicillin-resistant S. pneumoniae (PRSP) have been decreasing each year. However, the proportions of β-lactamase nonproducing ampicillin-resistant H. influenzae (BLNAR) have been increasing each year. This is why the use of cephalosporins has decreased in recent years and the use of penicillin antibiotics has increased.
We compared the results of otorhinolaryngology with those of pediatrics. There were more bacteria tested with pediatrics than otorhinolaryngology. We considered that the pediatrics is to perform rhinopharynx bacteria test for detecting the focus of fever.
A 63-year-old Japanese man was referred by another hospital with stomatitis and eruption of limbs and abdomen. Psoriasis vulgaris was diagnosed by Dermatology, but stomatitis and eruption were difficult to treat. So he was referred to our hospital. Intraoral examination revealed white erosion around both lips and mouth corners, and white mucosal plaques occurred frequently in the buccal mucosa, the palatal arch, and the tongue. Skin lesions, similar to psoriasis, accompanied with wetting red scales on fingers and palms, were observed. Pimple also appeared in trunk limbs. Clinical findings suggested Secondary Syphilis, but serological examination was negative for RPR. Whether antibodies of Treponema pallidum were present wasn’t investigated previously, so RPR and TP were tested for at our hospital. Both showed positive results, and Secondary Syphilis was diagnosed. Oral administration of penicillin was started and Stomatitis and Eruption were treated. We considered that it was difficult to diagnose because prozone phenomenon occurred and TP wasn’t examined. Thus, it is important for the diagnosis of Syphilis to examine both RPR and TP, due to the potential occurrence of prozone phenomenon.
In this case, Secondary Syphilis was diagnosed 6 months after developing skin lesions on the abdominal surface as well as the pharynx and oral mucosa. The symptoms suggested Secondary Syphilis, but it wasn’t originally diagnosed as such. This is likely due to the scarcity of cases, leading to a lack of experience in treating this disease, resulting in the diminishing knowledge of syphilis among general practitioners, including the several dermatologists and otolaryngologists that treated the patients in this case. We are now in a situation where the number of Syphilis patients has rapidly increased from 2014 onward, and there is a need to keep this in mind during treatment of patients with oral, pharynx or abdominal skin lesions as a major complaint.
Pyriform sinus fistula is one of the causes of deep neck abscess during childhood. Treatment typically involves treatment of the inflammation followed by fistula removal via an external incision or the intra-oral route. In this manuscript, we report two cases that made satisfactory progress after successful identification and extraction of the fistula tract via an external incision during both inflammatory and non-inflammatory stages. Additionally, we discuss the indications and optimal timing for surgical treatment. In patients with a neck abscess that requires external incision and drainage, in which a pyriform sinus fistula is the suspected cause, it is important to verify the fistulous tract intraoperatively before proceeding with the surgery.
Very few reports exist on pediatric deep neck abscesses and there are no clear criteria on the indications for their surgical incision and drainage. Pediatric cases are clinically distinct from their adult counterparts and rarely develop serious complications. Furthermore, the abscess is commonly localized to the lymph nodes. For these reasons, conservative treatment with antibiotics is usually recommended. Here, we present two pediatric cases with deep neck abscesses that required external incision and drainage of the neck, and discuss the indications for surgical treatment in such cases. We postulated that surgical incision and drainage should be performed when the abscess infiltrates deeper tissues in the neck other than the lymph nodes, when complications such as airway stenosis are observed, or when improvement is not seen within 48 hours of conservative treatment. It is important to distinguish high-risk cases that require surgery and to avoid overlooking the indications or missing the timing of surgical treatment.