[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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  We report an infantile case of orbital complications due to acute sinusitis. A 3-year-old previously healthy boy presented with fever, moist cough, purulent nasal discharge and periorbital swelling and proptosis on the right side. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a medial subperiosteal orbital abscess and destruction of part of the medial wall of the orbital bone. The patient was treated with intravenous antibiotics (ceftriaxone) for two days, but the periorbital swelling and proptosis persisted. We performed endoscopic sinus surgery (ethmoidectomy and maxillectomy) and drained the subperiosteal abscess through bony dehiscence without removal of the entire lamina papyracea. Intraoperative cultures yielded no organisms. Swelling and proptosis were resolved, and the patient was discharged on postoperative day 6. Follow-up CT showed repair of the medial wall of the orbit and clear paranasal sinuses. In general, medical treatment for sinusitis with orbital complications is more effective for children than for adolescents. This case demonstrated that prompt surgical treatment is necessary for sinusitis with orbital complications when conservative therapy is not effective.

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  PFAPA is a non-hereditary autoinflammatory syndrome characterized by periodic episodes of high fever, aphthous stomatitis, pharyngitis, and cervical adenitis. It usually manifests in early childhood, especially before 5 years of age, and lasts several years. Its etiology is unknown, but some recent reports suggest a dysregulation of the immune response with continuous pro-inflammatory cytokine activation. We describe a case of periodic fever with few symptoms such as aphthous stomatitis. Thus, diagnosis of the disease was difficult. PFAPA was diagnosed from comprehensive examinations including clinical findings, cytokine profiling, and gene analysis. The episodes of periodic fevers persisted for several years, so tonsillectomy was performed and resulted in marked clinical improvement. In cases of periodic fevers with pharyngitis and cervical adenitis, PFAPA needs to be considered in the differential diagnosis. The management of PFAPA syndrome in children was initially entrusted to pediatricians alone, but now otolaryngologists should be trained to recognize PFAPA syndrome and should consider tonsillectomy, depending on patient's medical conditions.

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  The Clinical Practice Guidelines for Acute Otitis Media in Children was published by the Japan Otological Society, Japan Society for Pediatric Otorhinolaryngology, and Japan Society for Infectious Diseases in Otolaryngology in 2006 indicate the basic position of these societies on the treatment of otitis media. The Clinical Practice Guidelines was used to classify the severity of acute otitis media (AOM) in 217 pediatric outpatients under 4 years old who were diagnosed with simple AOM at this hospital and then used to treat those patients. The Clinical Practice Guidelines was used to coordinate treatment with two otorhinolaryngology clinics in this city. Criteria for referral to Otorhinolaryngology were tympanic membrane findings indicative of moderate to severe AOM; being under 1 year of age (not all patients); a markedly lower tympanic membrane score following primary, secondary, and tertiary treatment; relapsing AOM during treatment; and protracted AOM lasting 3 weeks or longer. During referral, the patient's severity score, AOM severity, treatment, course of illness, and results of a nasopharyngeal culture were noted on the patient's chart. As a result of using The Clinical Practice Guidelines, the referral rate was 36.8% and the myringotomy rate was 22.1%. Use of The Clinical Practice Guidelines allowed pediatricians in this Department to adopt the same basic policy on treatment as otolaryngologists and facilitated coordination between these specialists. In the future, pediatricians also should increase their use of The Clinical Practice Guidelines and coordinate closely with otolaryngologists.

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  We measured velopharyngeal competence during articulation in 382 children with cleft palate from 1992 to 2006 using the rhinomanometer MPR–3100 manufactured by Nihon Kohden Co., Ltd. with software program NI–301 designed by our department and Nihon Kohden. To determine the most suitable method, we compared the maximum nasal airflow leaking during articulation of “a”, “ʃ” and “n” of two groups, which included 8 cases with pharyngeal flap construction and 12 cases without operation. The maximum airflow leaking from the nostril during articulation in the flap construction operation group was significantly greater than that in the group without operation. We considered that measurement of airflow leakage from the nostril during articulation might be a useful modality to assess the indication for pharyngeal flap construction surgery in children with velopharyngeal incompetence.

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  Enlarged vestibular aqueduct (EVA) is one of the most common congenital inner ear malformations. Vertigo may accompany fluctuating hearing loss, but its evaluation is usually difficult because many of the patients are very young. We report the results of vestibular function of two cases of bilateral EVA with vertigo in children.
  Case 1: A 7-year-old boy with a bilateral congenital hearing loss was referred to our hospital because of repeated episodes of vertigo. He had worn hearing aids bilaterally since he was 3 months old. At the age of four, he first complained of vertigo suddenly. Pure tone audiometry revealed hearing deterioration in the right ear, and intravenous administration of corticosteroid was commenced immediately. Similar attacks were repeated twice after this first episode. Temporal bone computed tomography (CT) imaging detected bilateral EVA. Compound heterozygous mutations in SLC26A4, H723R, IVS7–2G>A, were later identified. Electronystagmography (ENG), which was taken after he recovered from vertigo, showed elimination of bilateral caloric responses.
  Case 2: An 8-year-old boy with a progressive hearing loss was referred to our hospital for episodic vertigo. He suddenly had difficulty in conversation at the age of four and had received corticosteroid therapy. Brain magnetic resonance imaging (MRI) did not demonstrate any abnormalities in the brain parenchyma. Auditory brainstem response (ABR) revealed bilateral hearing loss, and he began to wear a hearing aid in his right ear. He had another attack with deterioration of hearing in his left ear, and intervenous corticosteroid therapy was administrated. The temporal bone CT imaging revealed bilateral EVA. ENG with no vertigo showed decreased right caloric response.

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  To date, only the operator has viewed the operative field during the removal of pediatric bronchial foreign bodies. We experienced two cases of bronchial foreign bodies in which the foreign bodies were displayed on a screen during removal using a pediatric bronchoscope. Case 1 was a 21-month-old boy. A foreign body was detected in the left bronchus one and a half month after an episode of peanut aspiration. Bronchoscopy was performed using a rigid pediatric Karl Storz bronchoscope with the patient under general anesthesia in the operating room. The peanut was successfully removed by the pediatric bronchoscope. Case 2 was a 29-month-old boy. A foreign body was detected in the left bronchus three days after an episode of peanut aspiration. The peanut was removed using a pediatric bronchoscope equipped with a telescope. The operator can remove foreign bodies while watching a screen, which can also be observed by anesthesiologists, young doctors, and medical students. Because of these merits, pediatric bronchoscopy is considered a very useful method.

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  Recently, due to the prevalence of detection of hearing loss in 3-year-old children and newborns, hearing screening has focused on gaps between various areas in the diagnosis of hearing loss and subsequent intervention, including the educational system. We experienced a case of delayed diagnosis of congenital hearing loss. A 12-year-old girl visited our outpatient clinic with a complaint of hearing loss. Her parents had noticed a hearing deficit since her early childhood, but the medical practitioner in her town asked them to observe her. At the end of elementary school, her homeroom teacher pointed out a difficulty in study due to her suspected hearing loss. A certain distortion of articulation suggested that her hearing loss could be congenital. However, significant linguistic delays are not observed on various tests. She seemed to benefit from a small number of neighbors, her educational environment, and relationships with friends. When she changes her environment due to higher education and a move, we consider that support to solve problems caused by hearing loss will be necessary in the near future.

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  We retrospectively reviewed histories of 30 children (aged five months to 13 years) who had undergone computed tomography (CT) for evaluation of unilateral sensorineural hearing loss from January 2009 to December 2009 at Chiba Children's Hospital. Inner ears, vestibular aqueducts, internal auditory canals, and cochlea nerve canals were evaluated by CT scans with 0.6 mm axial sections and coronal reconstructions.
  Thirteen children were first diagnosed by newborn hearing screening (NHS), and six were first diagnosed by a school hearing examination. The male to female ratio was 3:2. Seventeen out of the 30 cases (57%) had some abnormalities visible on the CT image. Cochlear nerve canal stenosis was seen in 13 patients; in four of them, this was associated with internal auditory canal stenosis. Two children with enlarged vestibular aqueducts were identified; one of them had a bilateral enlarged vestibular aqueduct. Only one child with unilateral cochleovestibular malformation was identified. Eleven of 13 children (85%) diagnosed by NHS showed abnormal findings, which is a high percentage compared with the other children in the review. There were no complications among them except for one 21-trisomy and a very-low-birth-weight baby.
  On the basis of these findings, we think some malformations are detectable with CT imaging in most cases of congenital unilateral hearing loss. CT should be performed in cases of pediatric unilateral sensorineural hearing loss to predict the course of a child's hearing and to determine the best follow up.

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  We report two siblings with the predominantly inattentive type of attention-deficit/hyperactivity disorder (ADHD) that were identified by the diagnosis of psychogenic hearing loss at adolescence. Case 1 was a 16-year-old female. She was diagnosed with sensorineural hearing loss at the age of 14, though a hearing aid was not useful. We diagnosed her hearing loss as psychogenic by further audiological examination using pure tone audiometry, speech audiometry, stapedial reflex, distortion product of otoacoustic emissions, auditory brainstem response, and auditory steady state response. case 2 was the 14-year-old sister of case 1. Her hearing loss had been unstable and a hearing aid was not useful, as in case 1. case 2 was also diagnosed with psychogenic hearing loss at our department. A detailed interview suggested impaired auditory perception and carelessness despite the normal intelligence of both siblings. Further examinations performed by a pediatric neurologist and clinical psychologist revealed the predominantly inattentive type of ADHD in both siblings. After medication and intervention for ADHD for a couple of months, their hearing loss was ameliorated. It was supposed that the sisters had ADHD primarily and that the psychogenic hearing loss occurred consequently. The psychogenic hearing loss was due to not only external factors but also internal ones. For the diagnosis of this disease, a cooperative approach with a specialist in pediatric neurology is recommended.

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  In this case study, we discuss approaches for early amplification in three infants or babies who had been identified by newborn hearing screening tests. All of them had a severe to profound bilateral hearing loss and began to wear hearing aids in both ears at 3 to 5 months old. (1) Baby-type hearing aids caused whistles by acoustic feedback, and wearers often pulled their aids off by turning their hands. Behind-the-ear-type aids also brought whistling problems. (2) Visual reinforcement audiometry using ER–3A insert earphones was useful for measuring minimum responsive thresholds across frequencies in each ear. For 8–to 10-months-old infants, VRA thresholds could be measured in aided/unaided ears. (3) Real-ear-to-coupler differences (RECD) were measured using a FONIX probe-tube microphone system connecting to 3A insert earphones and custom earmolds. RECD increased as the frequency increased. (4) To validate auditory behavioral developments in aided infants, a Japanese questionnaire to evaluate early auditory skill development in special populations was used. The results suggested that amplification before 6 months can provide benefits for early auditory development in aided infants.

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  Objective: To investigate the prevalence of otitis media (OM) among Chinese children and to profile the difference between the lower and higher socioeconomic strata of society.
  Methods: Two groups of children in Xi'an, China, were selected. Group A comprised children from three kindergartens and four primary schools in rural areas, and group B children from three kindergartens and two primary schools in urban areas. All children aged 2 to 7 years were examined by both otoscopy and tympanometry.
  Results: Data of 1,967 children (834 in group A and 1,133 in group B) were analyzed. The overall prevalence rates were 3.71% for otitis media with effusion (OME), 0.51% for chronic suppurative otitis media (CSOM) and 0.51% for acute otitis media (AOM). Forty-five children (5.40%) in group A and 28 (2.47%) in group B were diagnosed with OME, with a statistically significance difference between the groups (P<0.01). No statistical significance was found between the two groups in the prevalence of CSOM and AOM (P>0.05).
  Conclusions: OME is the most prevalent types of otitis media among children in the sampled population; children with lower socioeconomic status were found to have a higher prevalence of OME; and CSOM is not prevalent among children from 2 to 7 years of age in Xi'an.

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  Early detection of hearing loss in infants by newborn hearing screening (NHS) is necessary for early treatment. Undetected bilateral hearing loss in children delays speech, and language may not develop spontaneously. NHS was started 10 years ago in Japan. Of about one million newborns per year in Japan, 62% undergo NHS. In Ishikawa Prefecture, about 90% percent of newborns receive NHS, but no follow-up system after NHS was established. Recently, we created a new follow-up system, and all referred infants and their families receive support from a public health nurse. We introduce the Ishikawa program of follow-up after NHS.

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