The present study was undertaken to investigate the actual conditions of communication in school children and students with various degrees of hearing loss in their daily life.
The participants of this study were 43 boys and 43 girls aged six to twenty years who visited our clinic during July and August,2006. They were receiving education at regular primary, middle and high schools as well as schools for the deaf or other educational institutions, including colleges and universities.
Their actual conditions of communication were analyzed in terms of communication modes and difficulty in communication with hearing people. The results obtained were as follows:
1) The average hearing losses of their better ear ranged from 23 dB to over 100 dB.
2) Nineteen of the 86 children were attending schools for the deaf where manual communication was permitted in addition to oral communication, while the remaining 67 were receiving education at ordinary schools, colleges or universities with normal-hearing peers.
3) Twenty-two of the 86 participants were unaware of difficulty in oral communication with or without hearing aids in their school life, but the remaining 64 complained of difficulty in oral communication to a greater or lesser degree. Some of the latter cases were suffering from isolation or emotional distress caused by difficulty in communication among normal-hearing peers. Eventually they shifted to schools for the deaf, where they were no longer isolated nor experienced a sense of alienation.
These findings suggest that for hearing-impaired children, generally speaking, communication disorders due to hearing loss may be inevitable when among normal-hearing peers. Therefore, more attention should be paid to introducing manual communication modes into communication with hearing-impaired children.

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We evaluated the usefulness of intravenous antimicrobial therapy for the treatment of infantile intractable recurrent middle otitis in the outpatient department, and obtained the following results:
1. Continuous intravenous therapy with 60 mg/kg/day ceftriaxone (CTRX) in the outpatient department resolved infantile intractable recurrent middle otitis in all patients in a 3-day period. This result was obtained even though previously, a combination of an indwelling tympanic ventilation tube and oral administration of antimicrobial drugs had been ineffective in these patients.
2. This intravenous antimicrobial therapy in the outpatient department was considered useful for the treatment of infantile intractable recurrent middle otitis.
3. However, since CTRX administration to children once per day is not an approved indication, it is necessary to evaluate its usefulness in a large population to expand the indications.
4. Since continuous 3day intravenous therapy in the outpatient department is often difficult for otorhinolaryngologists to perform in infants in whom intractable recurrent middle otitis is common, close cooperation with pediatricians is important.

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were evaluated on an interdisciplinary basis and treated by pediatricians and otorhinolaryngologists. Pediatric diagnoses included asthma and cough-variant asthma, bronchitis, psychogenic cough, and whooping cough in 40.6%,15.6%,6.3%, and 3.1% of cases, respectively. Otorhinolaryngological diagnoses include sinusitis and nasal allergy in 50.0% and 43.8% of cases, respectively. Co-morbid upper and lower airway illness was identified in 43.8% of the patients. Appropriate interdisciplinary treatment for a month resulted in significant improvement in more than 80% of the children.
The results of this study underscore the importance of taking an interdisciplinary approach to treating chronic respiratory symptoms in children that can arise from either the upper or lower airway.

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We attempted to surgically extract a facial giant tumor that had progressed in the skull base because sclerosing therapy had been ineffective. We were able to radically resect the tumor macroscopically. After the operation, cerebrospinal fluid leakage was not seen, and other serious complications were not generated. However, due to bone defect and transformation of the face, we were not able to close the tracheotomy site. Furthermore, the pathological diagnosis was an immature teratoma, which is classified as a malignant tumor. There will be a danger of recurrence in the future.

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Vocal cord dysfunction (VCD) is characterized by the paradoxical adduction of the vocal cords during inspiration, which causes inspiratory stridor and airway obstruction. It has been reported that a definitive diagnosis of VCD is established from the laryngoscopic findings. Although laryngoscopic examination is widely performed by otolaryngologists in Japan, there have been few reports of VCD in Japanese patients. We report here a 2-year-old female patient who presented with dyspnea, and was subsequently diagnosed as VCD. Laryngoscopic findings showed abnormal adduction of the vocal cords during inspiration. It is important for otolaryngolosists to gain experience in the definitive diagnosis of VCD.

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Sinus infections remain very common. Recently, complications of sinus infection have greatly decreased with progress in antibiotic treatment. Acute infection of the sinuses, however, can sometimes causes serious orbital and intracranial complications. We treated 4 pediatric cases of sinusitis with orbital complications. In 3 of these cases, orbital cellulitis was diagnosed on computed tomography (CT) and successfully managed using intravenous antibiotics alone. In the remaining case, CT failed to detect subperiosteal abscess of the orbit, but magnetic resonance imaging provided evidence of the need for surgical drainage. Some reports have recommended individual non-surgical management of subperiosteal abscess of the orbit. Indications, timing and approach for surgical drainage remain contentious.

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We evaluated methods of diagnosing sleep apnea syndrome (SAS) in children. Measurement by polysomnography and esophageal manometry are the current gold standard techniques for obstructive sleep disturbance. However, the placement of an esophageal catheter and other sensors are uncomfortable, especially in children. The pulse transit time (PTT) is thought to function as a noninvasive marker of negative pleural pressure and subcortical arousal. PTT with PSG is useful for distinguishing between obstructive apnea and central apnea. There are significant correlations between the Apnea-Hypopnea index in hypno PTT^TM and PSG. The arousal index in hypno PTT^TM was not less sensitive than the EEG arousal index in our four cases. The sleep parameters using PTT were improved before and after adeno-tonsillectomy; moreover hypno PTT^TM is simple and useful for the detection of sleep apnea syndrome. It is thought that PTT allows a quantitative estimation of the inspiratory effort in SAS with children.

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To discuss the pathogen, treatment and length of hospital stay of children with acute mastoiditis, we reviewed the cases of 19 children who were hospitalized between 1991 and 2005 at Chiba Children's Hospital. Eighteen of the children were under 4 years of age and one child was 11 years of age. Among these patients,6 children were under 12 months of age and 61% of the infant patients were under 24 months of age. S. pneumoniae was isolated from middle ear discharge or subperiost abscess in 15 of the children, GAS from one child and MRSA from the 11-year-old child. No pathogen was detected in samples obtained from the other 2 children. Of the 15 children with S. pneumoniae, PRSP and PISP were each isolated from 7 children, respectively.
Though our current first choice of antibiotics is ABPC, our earlier first choice was the intravenous administration of PAPM/BP against PRSP. However, due to concerns that PAPM/BP would be less effective against S. pneumoniae, it was replaced by ABPC, which has been proved to be truly effective. The average length of hospital stay of the 17 children, excluding 2 children, was 7.2 days. Of the 2 exclusions, one had a subperiost abscess and the other had problems with her family about leaving hospital; both stayed in hospital for 13 days. All the patients were cured without mastoidectomy.

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Patients with Cornelia de Lange syndrome have multiple congenital malformations, such as the typical facial appearance including down-turned mouth, convergent eyebrows and curly eyelashes, and abnormalities of the limbs, as well as mental retardation. Otorhinolaryngologic abnormalities, including hearing loss and cleft palate, are well known. Cornelia de Lange syndrome occurs in approximately 1 of every 20,000 live births. Nasal polyps in Cornelia de Lange syndrome have never been reported, but 3 our 10 cases with Cornelia de Lange syndrome had nasal polyps. Nasal polyps are rarely found in children, hence,30% is a high incidence. Accordingly, based on our findings, Cornelia de Lange syndrome may be associated with a high incidence of nasal polyp.

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