Some infants suffering from vocal cord paresis caused by the compression of cervical tumors such as cystic lymphangioma and congenital anomalies may manifest respiratory distress. Less-invasive examinations should be selected for the diagnosis of young patients in a poor general condition. Vocal cord paresis is generally diagnosed by laryngo-fiberscopy. Ultrasonography, which is another useful tool for the diagnosis of vocal cord paresis, can demonstrate the mobility of the vocal cord noninvasively. Observation of the vocal cords by ultrasonographic examination requires a certain level of technical skill. Despite this disadvantage, ultrasonography appears to be useful for the diagnosis of vocal cord paresis in infants in a poor general condition.
We report a recent experience of adenoidectomy and unilateral tonsillectomy for severe OSAS that saved the life of an infant who had been infected with acute upper respiratory inflammation from the age of 5 months. The adenoidectomy was performed with an XPS shaver to limit the amount of bleeding. Hemorrhaging was stopped by a Monopolar. An ultrasonic surgical system (SonoSurg) was used in the adeno-tonsillectomy. The respiratory condition of the patient was improved immediately after surgery. It is important not to consider the time for treatment, but to employ a minimally invasive approach for OSAS in a newborn baby or infant. The details of these procedures were reported.
The subjects, who were 5 years of age, consisted of 9 children with mild hearing Impairment at the level between 25 and 39 dB. Three of the patients had impaired language development and showed an articulation index (A. I. ). level of less than 75%. These three cases have used hearing aids and received language therapy even after they started to attend school. The study suggests that language development appears to be more related to the A. I. level than the hearing level. Use of hearing aids and educational intervention should be considered, based on an appropriate observation of language development in the patient.
Learning disability is the single most frequent complication of hearing impairment, occurring in up to 15% of all school-aged deaf children. Neuropsychological evaluations of these cases may contribute to further diagnosis of the additional handicaps and the identification of a suitable procedure for better intervention. A nine-year-old boy with mild hearing impairment was referred to our hospital because of his poor language development. His average pure tone audiometry was 35dBnHL in the right ear and 65 dBnHL in the left ear and audiological interventions with a hearing aid had already been started before the referral to our clinic. Although mild mental retardation was suggested by WISC-III, as FIQ65 (VIQ 65, VIQ71, and PIQ65), non-verbal intelligence examined by RCPM corresponded to the normal range. Verbal and non-verbal semantic disorder was considered by the results from ScTaw and SLTA. He was later diagnosed as having Asperger syndrome and his semantic problem concomitant with Asperger syndrome could be another cause of his additional language delay.
Accurate acoustic evaluation is necessary in order to start early rehabilitation of hearing-impaired children. It is difficult for these children to obtain an auditory behavior response owing to immaturity of the auditory pathway and undeveloped perception. We report the present circumstances and problems of acoustic evaluation of hearing-impaired children. Seven children, who had been diagnosed as having bilateral deafness by the auditory brain stem response (ABR) and hearing aids (HA), were evaluated in this study. Changes in auditory behavior were observed in six cases after starting to use an HA. In another case of a multiply handicapped child, we observed different auditory behavior after this child was able to use an HA regularly. The acoustic evaluation was performed by ABR, behavioral observation audiometry (BOA), conditional oriented reaction (COR) audiometry and from information about daily auditory behavior from the patients' families. Immediate behavioral changes were observed in the former 6 cases, but there were many individual differences between the cases. In the multiply handicapped case, hearing perception and ability to detect phonic sensation were developed by using an HA, and therefore, the COR of this patient revealed a decreased threshold level.
During the period from 1968 to 2000, more than 2000 young hearing-impaired children participated in my home training program. The present study was undertaken to confirm the validity of Yoshinaga-Itano's hypothesis that the period of early infancy is critical for language development in hearing-impaired children based on the outcomes of 12 illustrative cases selected from those who had previously participated in my home training program. These children were followed up for more than 15 years. They included two company employees who had graduated from universities, two medical students, a dentist, a pharmacologist, a molecular biologist, a writer of juvenile songs, a worker at an industrial home for the handicapped with cerebral palsy and mental retardation associated with severe hearing loss, a woman who selected to live with deafness, a deaf teacher for a school for the deaf and a deaf student of a professional school. These cases had attained a high proficiency of literacy, although they were older than one and half years when they participated in my home training program. The outcomes of these cases suggest that long-lasting parental support and school education are the most important factors for attaining a high level of language development rather than the age at which the hearing loss is detected. These findings do not support Yoshinaga-Itano's hypothesis. (This work was supported by a Grant for Child Health and Development (17C-3) from the Ministry of Health Labor and Welfare)
This paper reviews the diagnosis and treatment of foreign bodies in the tracheobronchial tree of children. From 1986 to 2005, sixty-four cases were treated in the Tohoku University Hospital. According to previous reports, children under the age of three years were the most common sufferers. The most freguently found foreign bodies were peanuts, but non-organic materials were also the cause in a few cases. For the diagnosis and examination of the sites of foreign bodies, the history of aspiration and coughing attacks, weakness of respiratory sounds, chest roentgenogram f indings, and also CT scans were found to be valuable. In all cases, i t was possible to remove the foreign bodies by ventilation bronchoscopy.