Tracheotomy is an important technique in the treatment of recurrent pneumonia among handicapped children. It has long been difficult for children to be free from cannulation, but recent progress of technology made it easier to close the tracheotomy site. If children can be free from a tracheotomy tube, their ADL will greatly improve, and the load on their families will be reduced. In our hospital, we are trying to close the tracheotomy site by one month of hospitalization and gradual downsizing of the tubes. We obtained a good result in cases, whose tracheotomy was fresh, or who received a tracheotomy after trauma, or whose cough reflex was well preserved. However, it is important to stop the procedure once there is any sign of possible danger. It is also important to conduct this procedure when the patient is in the best condition.
Some children with sinusitis who may have complications related to the disease may not be easily recovered. We describe some cases with nasosinusitis who manifested related complications simultaneously. Sinusitis-related complications appear to be dependent on the development of the nasosinus. Phlegmon in the sinus of the face, such as the ophthalmic fossa may develop from the nasosinusitis at a younger age. In an older child, the rate of intracranial complications such as epidural abscess appears to be increased. Patients with nasosinusitis should be carefully observed if he/she is affected by severe complications such as an intra-cranial abscess.
Recently, emerging penicillin-resistant Streptococcus pneumoniae (PRSP) in children has become a serious problem. Here, we investigated the incidence and drug sensitivity of Streptococcus pneumoniae isolated from upper respiratory specimens obtained from children in our hospital for four years. We found the peak ages of PRSP-positive patients was one and four years of age. The number of patients who were positive for resistant strains (PRSP + PISP) was increased. Only LVFX, VCM, and REP showed 100% sensitivity against PRSP. It is important to consider whether the isolated PRSP is a“real”pathogen for diseases, and to use proper antibiotics to avoid the prevalence of multi-drug resistant PRSP.
We report an 11-month-old male infant. He was found to have bilateral sensorineural hearing loss on newborn hearing screening. At 9 months of age he developed infantile spasms and was diagnosed as cytomegalovirus (CMV) infection and persistent bilateral hearing loss on auditory brainstem response (ABR). We attempted immunoglobulin therapy for 3 days and gancyclovir therapy for 14 days. After antiviral therapy, urinary excretion of CMV-DNA measured by PCR assay disappeared, and on ABR recordings improvement in the acoustic threshold and reduction of peak latencies were remarkable. Due to severe developmental delay and anticonvulsant therapy, his auditory behavior was hard to investigate.
An eight-year-old girl with 18q-syndrome suffering bilateral conductive hearing loss was reported. At the age of 3 years, a delay in speech development was pointed out. On examination, bilateral external ear canal stenosis and moderate conductive hearing loss were found. She wore a hearing aid, in the right ear. In order to improve her hearing, surgery to enlarge the stenotic canals was performed on both ears, and type II tympanoplasty was also performed on the right side. After the surgery, the hearing of both of her ears (25 dB on the right,11 dB on the left) improved and she no longer needs to wear hearing aids.
Cochlear implantation was performed on a 3-year-old patient with congenital cytomegalovirus (CMV) infection whose initial ABR showed wave V at 105 dB in both ears, but later showed no response at the age of 2 years. After cochlear implantation, she was easily distracted during fitting and rehabilitation, and her response to sounds was inconsistent. Because of her progressive hearing loss, she underwent cochlear implant surgery at the age of three years. Two years after switching-on the cochlear implant, she obtained demonstrable benefit from it, showing improvements in language and hearing. In the case of deterioration of hearing, cochlear implantation can be of great benefit to those with congenital CMV infection at the individual developmental stage if additional problems are thoroughly evaluated and the parents are well informed about the potential linguistic outcomes.
In order to explore a desirable communication mode to recommend to the parents of a young hearing-impaired child, the actual communication modes used by deaf parents as well as the method of language education which they themselves had received in their school days were investigated. The participants in this study were 24 deaf parents including four who were born to deaf parents and twenty who were brought up by hearing parents. The results obtained from the present study were as follows: 1) All of the 24 deaf parents received language education by the auditory-oral method when they were at school, while the use of sign language was forbidden even at home. 2) However, the present communication with members of their family depends on sign language or total communication including auditory-oral communication as well as signed Japanese and manual codes of Japanese. Their communication with hearing people depends on a sign language interpreter or writing in addition to oral communication. 3) According to their statement, they stealthily learned sign language from their classmates or seniors at schools for the deaf, or took a course of sign language of their own accord after finishing their compulsory education. 4) On the basis of their own experiences of school education, all of the deaf parents emphasized the necessity of manual communication modes in addition to the auditory-oral method at school education.
Lung sounds are more easily heard in children, compared to adults. Recent advances in acoustic and computer technologies have made it possible to record and analyze normal and adventitious breath sounds. Increasing knowledge of the mechanisms of sound generation or sound transmission and the lung sound characteristics associated with changes in airway configuration is adding value to the art of auscultation. Our recent research on normal breath sound intensity and frequency distribution in asthmatic children revealed a significant association between lung function and acoustic parameters of lung sounds. Application of these new research techniques to the investigation of upper respiratory sounds might be useful in the field of pediatric otorhinolaryngology.