A 5-year-old boy presented a painful right cheek mass that had enlarged within a month. Magnetic resonance imaging demonstrated a 3.0×2.5×2.0 cm mass infiltrating the right orbit. A mass of the zygomatic bone was biopsied. Histological examination disclosed Langerhans cell histiocytosis (LCH). Chemotherapy was subsequently initiated to prevent central nervous system infiltration and vision sequelae. Complete remission was achieved and maintained for one year. Although there are several options of treatments for unifocal LCH including local excision, radiation therapy, local steroid injection, chemotherapy, and observation alone, chemotherapy was offered to avoid sequelae or extensive surgical resection or radiation.

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  This study evaluated the effects of maxillary protrusion on upper airway obstruction in three children by fluid-mechanical simulation. 3D images of the upper airway were constructed using a cone-beam CT scanner, and upper airway fluid-mechanical simulation (UAFS) was applied to each image at the resting peak tidal flow rate. UAFS was able to confirm that maxillary protrusion caused upper airway obstruction. Furthermore, it was recognized that the location of the obstruction could be identified as a characteristic of UAFS. This study suggests that UAFS is useful for diagnosis of upper airway obstruction.

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  The purpose of this study was to determine the number of newborns diagnosed with hearing loss at maternity hospitals by the Newborn Hearing Screening (NHS) Program in Osaka Prefecture, and the number of newborn babies who were introduced to the ENT Departments of 36 hospitals especially selected for this program in Osaka Prefecture from 2002–2006.
  We evaluated 10 items, of which 3 are discussed in this paper. The total number of babies seen in the referral hospitals increased from 134 cases in 2002 to 372 in 2006. Detection of hearing loss by the diagnostic examination clearly increased from 63 (47.0%) in 2002 to 194 (61.0%) in 2006, and 29 babies with profound hearing loss were identified among the 372 babies who were examined by the diagnostic hearing test in 2006. A comparison of the results of the screening test and that of the diagnostic hearing test shows a progressive increase in the agreement rate from 35.4% in 2002 to 63.5% in 2006. The above findings indicate that from the viewpoint of the otolaryngologist, the reliability of the Newborn Hearing Screening Program in Osaka Prefecture has improved.

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  In Japan, the morbidity of Japanese cedar pollinosis (JCP) in children has increased. Medical and parental care are important for patients with JCP, but it is difficult to recognize and manage the symptoms of JCP in young children because identification depends on the parents. We investigated the symptoms of pollinosis and home care for children with JCP using a questionnaire.
  Parents of 40 children with JCP (age 2–12 years/median 8 years, 23 boys and 17 girls) filled out questionnaire. The peak ages of onset and diagnosis of JCP were 3 years old. The children had not only nasal symptoms but also symptoms such as epistaxis, skin and eye symptoms, coughs, and sniffles. Most of the parents noticed that going outside in sunny and windy days exacerbated JCP symptoms. About half of the children had sleep disorder. Many parents recognized that JCP symptoms disturbed their children's school work. To avoid pollen exposure, 80% of the parents paid attention to pollen information and 60% of them had their children wear masks.
  Appropriate diagnosis, treatment, and education for home care is important to improve the quality of life of children with JCP.

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  Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss (SNHL) in children. A significant proportion of children with congenital CMV infection-related SNHL experience delayed onset of hearing loss and deterioration of hearing during early childhood. Thirteen children with congenital CMV infection as identified by newborn virology test or PCR test using Guthrie cards were retrospectively investigated, and periodic hearing tests using auditory brainstem response were performed. All patients enrolled in this study visited our neurology clinic for the first time with a chief complaint of microcephaly, seizure, and/or developmental delay. Of 13 patients, 10 had SNHL, at least 5 developed SNHL within the first year, and at least 2 were late progressive. Odds ratios were calculated, and the analysis revealed that predictors of SNHL were preterm delivery, intracerebral calcifications, and cortical dysplasia. Detection of congenital CMV infection in neurologically impaired children and follow-up study of hearing is needed because of a higher probability of progression and late-onset hearing loss.

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  Infants who undergo tracheotomy commonly experience postoperative complications such as infection, erosion, and hemorrhage around the stoma. Such skin complications are frequently resistant to treatment, requiring repeated gauze dressing and administration of antibiotic ointment. In order to prevent the occurrence of these complications, we examined the efficacy of spongy sanitary liners instead of conventional Y-cut gauze for dressing of the stoma. Eight patients who developed postoperative skin complication after tracheotomy at younger than 1 year old were dressed with a Y-cut sanitary liner. The efficacy of treatment and ease of handling were assessed using a questionnaire of the nursing staff who cared for the patients.
  The questionnaire revealed that the use of Y-cut sanitary liner was effective in keeping the stoma dry, while the handling and appearance of this method were negatively evaluated.

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  Diffusion tensor imaging (DTI) tractography was used to evaluate five children with hearing loss or impaired language development. Our first case involved a 5-year-old boy with unilateral hearing loss apparently due to callosal disconnect. The second case involved a 10-year-old girl with developmental Gerstmann syndrome. The third, fourth, and final cases involved 3 children who experienced difficulty acquiring the ability to read Japanese kana characters. Each image depicted on DTI tractography was compatible with the results of neuropsychological testing. Thus, DTI tractography is suitable for clinical use in pediatric audiology and logopedics. Because results from DTI tractography are unchanged even if the subject is sedated, DTI tractography offers advantages over functional magnetic resonance imaging for young children.

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  From April 2005, we followed 13 children with speech and language delays. Audiometric and developmental tests and evaluation of articulation were performed for all cases. Bilateral hearing loss was found in 2 cases, and hearing aids were fitted. Otitis media with effusion was found in 5 cases. The other 3 cases had functional dyslalia. During speech therapy, articulation, speech, and language improved in 7 cases, but not in 6. In these 6 cases, more general developmental disorder was noted, and therapeutic education at a special institute was required. Because the causes of speech and language delays vary, we must evaluate all aspects including articulation and psychomotor development as well as hearing.

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  We previously extracted bronchial foreign bodies by using only optical forceps and a rigid bronchoscope. However, this procedure may damage the trachea, is time consuming, and requires several physicians at the same time. After we located a bronchial foreign body using a flexible fiberscope and extracted it by using a video-endoscope with a suction channel, we introduced a modified method of extracting the bronchial foreign body using a combination of a video-endoscope with a suction channel and the rigid bronchoscope. By using the video-endoscope with a suction channel, we are able to reduce some risks during the procedure. The rigid bronchoscope should be prepared in case the foreign body is a hard particle or if it moves into the trachea.

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  Both distortion product otoacoustic emission (DPOAE) and automated auditory brainstem response (AABR) are widely used to screen newborn hearing. AABR is considered to have high accuracy and give very few false-negative errors (sensitivity of nearly 100%), but theoretically both tests may fail to identify congenital hearing loss. A small number of hearing-impaired infants may be missed because they have low-frequency hearing loss, and auditory neuropathy cannot be detected by DPOAE screening. We investigated the profiles of false negatives in these screening procedures. Thirteen cases passing DPOAE screening had serious hearing loss: 9 with auditory neuropathy, 2 with cochlear nerve deficiency, 1 with a brainstem disorder, and 1 with moderate hearing loss. Three cases passing AABR screening had serious hearing loss: 1 with unilateral profound hearing loss and 2 with inner ear anomaly (Mondini dysplasia). The false-negative error in newborn hearing screening must be kept to a minimum because it may be associated with delayed development and socioeconomic consequences. If only one ear fails the initial screening test, an audiologic assessment of both ears is recommended. ABR screening is preferred for infants admitted to the NICU who are at risk of neural hearing loss.

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  Of 31 children with cholesteatoma treated between 1996 and 2007, 7 cases of adhesive cholesteatoma (pars tensa type cholesteatoma) were operated on at Konan Hospital. The average age was 7.4 years, ranging from 6 to 12 years, with 6 boys and 1 girl. Atelectasis of the other ear was revealed in 4 cases, and a tube was inserted in 3 cases. A 6-year-old boy who had severe atelectasis of both ears needed tympanoplasty for the right and subsequent tube insertion 3 times. The left ear needed tube insertion 10 times.
  We believe sniffing and poor mastoid pneumatization are risk factors of recurrence, so careful follow-up is necessary even with placement of tympanostomy tubes.

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  A retrospective study was performed of 7 infants with deep neck space abscess admitted to the Tenshi Hospital from April 2003 through December 2008. Patients ranged in age from 1 month to 3 years. The most common presenting signs and symptoms were neck swelling and fever. Four patients with retropharyngeal abscess had poor oral intake. Contrast-enhanced computed tomography scans were obtained in all patients, and an abscess was identified by a low-density core and rim enhancement. Magnetic resonance imaging (MRI) was performed in three patients. T2-weighted MRI scans demonstrated the abscesses as high signal intensity masses. The most common regions of deep neck abscess were retropharyngeal (n=4), posterior triangle (n=4), and parapharyngeal spaces (n=3). Four patients had abscesses in more than one fascial space. All patients received intravenous antibiotics and underwent surgical intervention. Two patients underwent only needle aspiration by the cervical approach, and 5 patients underwent incision and drainage: 1 external drainage by the cervical approach, 2 transoral drainage, and 2 combined. Purulent material was identified in all patients. The most frequently cultured pathogens were Staphylococcus aureus (n=3) and group A streptococcus (n=2).

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  A 4-year-old boy was hospitalized with fever, vomiting, and convulsions. His sputum and nasal culture showed Streptococcus pneumoniae. He was diagnosed with purulent meningitis, and treatment with intravenous antibiotics panipenem-betamipron, cefotaxime sodium, dexamethasone, glycerol, and the anticonvulsants diazepam and phenobarbital was started. Although his general condition and consciousness improved, he didn't speak at all. Magnetic resonance imaging demonstrated a high intensity area in the frontal and temporal lobes on diffuse imaging. After 2 weeks treatment, speech was completely recovered without sequelae.

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  Among traumas, tracheobronchial injuries are rare and typically occur as the result of blunt thoracic injury. Immediate or potentially life-threatening thoracic injuries are uncommon, but must be identified and treated quickly. Tracheobronchial rupture is caused by direct trauma to the anterior neck, traction forces when the head is thrown suddenly backward, and increasing the pressure in the bronchi enough to cause rupture. In the case of blunt neck injury, we otorhinolaryngologists usually see the patient first; therefore, we must have the knowledge to treat complicated chest injury with blunt neck injury.
  We report a case of tracheobronchial injury due to blunt neck injury in a 4-year-old boy.

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