The circumference of the sphenoidal sinuses encloses important structures such as the base of the skull, optic nerve, and cavernous sinus. For this reason, spread of inflammation can cause severe symptoms in those structures. One sphenoiditis case presented several symptoms including raging headache, vomiting, and diplopia because antibiotic treatment had been insufficient, and finally an extradural abscess had formed. We performed endoscopic sinus surgery to open the sphenoid sinuses, and the symptoms were successfully resolved. It is concluded that extradural abscess was effectively treated by sinus drainage in this case.

View full abstract

We performed a questionnaire survey to determine the degree of awareness of the Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media in Children, its contents, and convenience of use. We analyzed the data and obtained the following results.
1. The Guideline was known by 95% of the otolaryngologists and 75% of the pediatricians surveyed, and had been used by 65% and 50%, respectively; the difference was not statistically significant. Of those not using the guideline,25% of both the otolaryngologists and pediatricians considered the Guideline unnecessary, while 50% and 25%, respectively, considered it time-consuming to use; a significant difference in the latter reason was observed between the two groups (p<0.05).
2. The scoring table of the Guideline was considered easy to use by about 50% of both the otolaryngologists and pediatricians but difficult to use by the remaining 50%. Both groups considered the guide to the types and doses of antimicrobial agents easy to use.
3. More than 50% of both the otolaryngologists and pediatricians did not change the dose of antimicrobial agents and the frequency of myringotomy on the basis of this Guideline; the difference between them was not significant. Most otolaryngologists and pediatricians consider the recommendations for increases in the dose of antimicrobial agents according to the severity of the disease shown by the Guideline useful; no significant difference was observed between the two groups (p<0.05).
4. When examinations in all situations were included, the frequency of bacteriological examination by otolaryngologists was significantly higher (p<0.05) than that by pediatricians.
5. The treatment algorithm was considered to be useful by about 70% of both otolaryngologists and pediatricians, with no significant difference.
6. The criteria for evaluation of antimicrobial agent efficacy did not significantly differ between the otolaryngologists and pediatricians. However, otolaryngologists tended to place importance on eardrum findings, while pediatricians placed importance on clinical symptoms.

View full abstract

Acute epiglottitis is rare in children in Japan, but recently the number of cases reported is increasing. Because pediatric acute epiglottitis can be lethal, quick diagnosis and airway management are indispensable for successful treatment of this disease. We report the case of a 4-year-old boy. His symptoms had gotten worse within half a day, and he was suffering from a sore throat and inspiratory wheeze when brought to our hospital. He had severe dyspnea and drool but did not have a barking cough. We performed laryngeal X-ray and laryngeal fiberscopy after admission and diagnosed his illness as acute epiglottitis. Endotracheal intubation was immediately performed to secure his airway, and intravenous administration of antibiotics and steroid was started. The level of laryngeal edema inducing the airway obstruction was ameliorated by drug therapy, and the patient was successfully extubated at 2 days and left our hospital 6 days later.Haemophilus influenzae was detected in his blood culture.

View full abstract

The frequency and efficacy of myringotomy for acute otitis media in children performed at our hospital following the “Medical Treatment Guidelines for Acute Otitis Media in Children” were investigated, and the following findings were obtained.
1) The frequency of myringotomy increased as the severity of acute otitis media increased, and myringotomy was performed in nearly 80% of severe cases. It was performed in all cases with a severity score of 19 points or higher or a clinical symptom score of 8 points, and more than 80% of cases with an eardrum score of 10 or greater.
2) In severe cases, as defined by the severity evaluation, the disease was ameliorated significantly earlier after myringotomy than without it in cases with an ear pain score of 2 and fever scores of 1and 2 on clinical symptom evaluation, a flare score of 2 and a bulge score of 4 and 8 on ear drum evaluation, and an otorrhea score of 0.
3) Early in the 10-day follow-up, the overall improvement rate was significantly higher after myringotomy than in non-myringotomy cases, but the difference was not significant in the final outcome.
4) Recurrence was noted in about 10% of cases judged moderate on severity grading with and without myringotomy, showing no significant difference. However, recurrence rates in severe cases were about 10% and 38% in cases with and without myringotomy, respectively, showing a significantly lower rate in myringotomy cases.

View full abstract

We used a scoring system based on the clinical symptoms of acute pediatric rhinosinusitis (rhinorrhea, postnasal drip, nasal obstruction, bad mood, and productive cough) and intranasal findings (mucopurulent rhinorrhea and/or postnasal drip, serous rhinorrhea and/or postnasal drip, swelling and reddening of nasal mucosa) to study a possible severity classification system. Subjects were 50 pediatric patients suffering from acute rhinosinusitis with mucopurulent rhinorrhea visiting our clinic from November 1 to 13,2007. Although antibiotics should not be used for mild cases of acute pediatric rhinosinusitis, children attending kindergarten or nurseries often required treatment with antibiotics. Many children with moderate cases of acute pediatric rhinosinusitis were improved [almost cured] by administration of the usual dose of antibiotics. Administration of a high dose of antibiotics from the beginning is considered desirable in severe cases. Classification of the severity using a scoring system allowed objective evaluation of the clinical course of acute pediatric rhinosinusitis. Moreover, the results support the view that group care is one risk factor for the development of acute pediatric rhinosinusitis.

View full abstract

Tracheoesophageal diversion for chronic aspiration was performed on ten children with a history of repeated pneumonia. The surgical procedure in all cases was tracheoesophageal anastomosis. We evaluated the disease in each case, the history of prior tracheotomy, swallowing ability, type of food that could be consumed, and postoperative complications. Seventy percent of subjects had brain damage due to hypoxia, and 40% of subjects had undergone prior tracheotomy. Aspiration ceased after surgery in all cases. Post-operative ingestion was related to improvement of primary disease, and 10% of the children were able to eat only orally with improvement of the general condition. However, oral ingestion does not necessarily become possible after tracheoesophageal diversion. No case was complicated by fistula. It is essential to fill the space between the trachea and esophagus with muscle or thyroid gland tissue. Tracheoesophageal diversion is thought to be effective and safe surgery for children.

View full abstract

In recent years, respiratory syncytial virus (RSV) has been reported as a major virus of the respiratory tract involved in the onset of acute otitis media (AOM). In April 2008, middle ear fluid (MEF) samples of 16 (80%) of the 20 children with AOM at a hospital were positive for RSV antigen with the RSV antigen rapid testing kit “check RSV. ” Five (31%) of the antigen-positive cases relapsed with purulent asymptomatic MEF, and 3 (15%) were antigen-positive at the time of relapse. Furthermore, one of these cases, which was examined for RSV antigen three times in one month, showed positive results in all three evaluations. fve of the antigen-positive cases relapsed and became intractable, and tympanostomy was performed in 4 cases. Bacteria were detected in 14antigen-positive cases, and although some cases improved quickly despite the presence of drugresistant bacteria, there were cases that were intractable despite the presence of drug-sensitive bacteria. Among the cases of AOM in which RSV was detectable in MEF, were observed; hence, examination of the effect of the virus in this disease is considered necessary.

View full abstract

Obstructive sleep apnea-hypopnea syndrome (OSAHS) in children is associated with complications such as snoring, mouth breathing, night terrors, and hyperactivity during sleep. Nocturnal enuresis and nocturia are less frequently recognized complications that also often occur. These conditions have atypical clinical presentations, and they often do not respond adequately to treatment. The patient was a 12-year-old boy who had grade III hypertrophy of the palatine tonsils. Although he had snored and experienced nocturnal apnea attacks since infancy, he was monitored without proper treatment, and had been having nocturnal enuresis on a daily basis. He was diagnosed with severe OSAHS based on an apnea-hypopnea index of 77.8 on polysomnography. Nocturnal enuresis rapidly resolved following the introduction of continuous positive airway pressure therapy, and subsequent bilateral tonsillectomy dramatically resolved both OSAHS and nocturnal enuresis.

View full abstract

Forty-one children who were first diagnosed with bilateral hearing impairment after the age of 4years were evaluated. Thirty-nine had mild-to-moderate hearing loss. There was no relationship between hearing level and age. Two had passed the Newborn Hearing Screening test. Problems during the regular health examination for 3-year-old children had been pointed out for 8. Eleven of 26school-age children had learning or behavior problems at school. Only 46.3% of parents recognized the language development disorder of their children. After the diagnosis, parents of 65.0% purchased a hearing aid. Parental recognition of their child's language development disorder affected adoption of the hearing aid.

View full abstract

We report on three pediatric cases of chronic sinusitis with headache for which medical interventions were not effective. These cases were diagnosed with chronic sinusitis using X-ray and magnetic resonance imaging. Sinus headache in children is frequently misdiagnosed because headache is associated with the common cold or seen as primary headache. Symptoms of chronic sinusitis disappeared after several times repeated irrigation of the maxillary antrum via the natural ostium using a Killian-Kubo cannula. This therapeutic method is not invasive for children, making iterative operations possible. We recommend that this no-longer-utilized method be reevaluated in the future for treatment of childhood sinusitis.

View full abstract

In this article, developments and current studies in pediatric otolaryngology at Children's Hospital of Philadelphia (CHOP) are reported. Comparison to the Japanese medical system is also discussed. The history of otolaryngology at CHOP and its progress to world renown in the specialty is briefly reviewed. The use of nurse practitioners and satellite hospitals has increased the ability to see more patients and rationalize the system. Current states of outpatient surgery at CHOP and activities of nurse practitioners are reported. The use of nurse practitioners and outpatient surgery is spreading in Japan as well, but many faculties are facing difficulties. Issues regarding differences in health insurance are discussed.

View full abstract