Nasal involvements associated with various rheumatological disorders were described. Nasal mucosa is characterized by high vascularity, which makes it a target of vasculitis such as Wegener's granulomatosis. In addition, since the nasal septum consists of chondral tissue, it may be involved in recurrent polychondritis. Although these conditions are relatively rare, nasal symptoms often precede the systemic disease onset.
We report three cases of acute suppurative thyroiditis arising from a piriform sinus fistula. The patients were a 14-year-old boy, a 14-year-old girl and a 6-year-old girl. They had left anterior neck pain and inflammatory swelling in the region of the left lobe of the thyroid gland, with or without fever. Laboratory studies revealed mild to moderate inflammation and normal thyroid function. During acute infection, the involvement of the left thyroid lobe was verified by ultrasonography. Barium swallow examination was the diagnostic finding indicating that all 3 patients had a left-sided fistula. These 3 patients underwent an operation (2 cases with fistulectomy, one with ligation of a fistula) and showed a good postoperative course without recurrence. Piriform sinus fistula is the most common underlying abnormality in patients with acute suppurative thyroiditis. A better understanding of this rare branchial anomaly is of clinical importance. Ultrasonography is useful for the diagnosis of acute suppurative thyroiditis and piriform sinus fistula.
Psychogenic deafness is a functional deafness in the absence of organic pathology. With the awareness of traumatic events, auditory brain stem responses (ABRs) are needed for confirmation of the diagnosis, especially in more complex cases. In our hospital, distortion product otoacoustic emission (DPOAE) testing is routinely used as an objective method. We present the results of ABR and DPOAE in two cases and report finding that DPOAE is a helpful tool for rapid and reliable diagnosis. In the first case, a 10-year-old agirl, who had varied hearing loss from 40 dB HL to 90 dB HL when tested by pure tone audiometry, was diagnosed as having psychogenic deafness with a normal ABR and DPOAE pattern. In the second case, a 7-year-old girl, who showed a hearing loss of 60 dB HL in the left ear, was introduced to our hospital with suspected left sudden deafness. She was diagnosed as having psychogenic deafness with normal ABR and DPOAE. In conclusion, DPOAE testing is useful for the rapid and reliable diagnosis of psychogenic deafness in children.
Hearing screening in healthy newborns was initiated in 1999,u sin g the ALGO 2e. The 1606 newborns were screened. A total of 1599 (99.5%) newborns passed,1579 (98%) at the first attempt and 20 (0.01%) by the third attempt. In addition,7 (0.05%) were referred at the final attempt,4 of whom were suspected of having bilateral hearing loss. All of the referred newborns underwent ABR until the age of 3 months, and the diagnosis of 6 of them was congenital hearing loss (bilateral: 4cases, unilateral: 2 cases). We concluded that ALGO 2e is helpful for the early detection of hearing loss from healthy newborns. It is necessary to establish a learning system for children with hearing impairment within a few years.
Congenital anosmia is usually diagnosed after childhood, because not many parents notice anosmia of their child, unlike deafness or blindness. Furthermore, pediatric olfactometry is not established like audiometry. We introduce here two cases of congenital anosima. Objective olfactometry by near infrared spectroscopy of the orbitfrontal cortex was performed in one case. Congenital anosima and pediatric olfactometry were also reviewed and discussed. It is desirable to establish guidelines of congenital anosima based on congenital hearing disturbance and pediatric audiometry.
We reported the clinical symptoms and method of discovery of 4 cases of thyroglossal duct cyst in the root of tongue, which is a relatively rare congenital cyst. In all cases, the symptoms developed in the neonate at about 1 month after birth, and the cyst was discovered in the neonatal phase and in the early infant stage. The symptoms noticed by family members and nursing personnel included cyanosis/shortness of breath, which appeared repeatedly at feeding or weeping, a weak cry, a hoarse voice, and low weight gain. In addition, all symptoms were accompanied by the symptoms of respiratory disorder, such as intermittent retracted respiration and stridor at inspiration. The cyst was discovered at hospitalization in all cases, and could be detected by tongue depression or by intraoral examination with a laryngscope. It was surgically removed rapidly.
This investigation was conducted by a questionnaire that was administered to the mothers of hearing-impaired children. A total of 68 completed and valid questionnaires were returned. The questions were about hearing-impaired risk factors in the neonatal period, development of gross motor skills and balance, development of speech and language, placement of hearing aids and speech training. Of all hearing-impaired children,54% showed one or more neonatal hearing-impaired risk factors. Head control, sitting, crawling and walking were delayed by one month or four months relative to children with normal hearing. Onset of canonical babbling, first words and the use of two words also showed a delay. Of all hearing-impaired children,81% used hearing aids and 84% received speech training. The results suggested that early identification of hearing impairment is needed for the development of speech and language in childhood.