Button batteries can rapidly cause damage on contact with moist tissue, and should therefore be removed without delay. We encountered a case in which a button lithium battery was accidentally trapped in the nasal cavity of a 4–year-old girl. We were unable to remove the foreign body with vigorous movement, and thus removed it under general anesthesia. The foreign body was removed six hours after becoming lodged in the nasal cavity. There were no complications, such as perforation of the nasal septum. Button lithium batteries have the potential to cause greater tissue damage than alkaline button batteries.

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  Osaka City General Hospital is an advanced medical institution with a specialty pediatric department within the general hospital. To understand the specialized role of the Department of Pediatric Otorhinolaryngology, we analyzed clinical statistics related to the number and types of patients, examinations, and operations utilizing the services of this department and the examinations and operations performed.
  In the outpatient department, patients undergoing thorough examination for hearing loss accounted for 80% of all patients seen. The administration of pediatric hearing tests, such as play audiometry, COR, and ABR, is increasing due to the expansion of the auditory screening programs for newborns. Thus, the importance of an audiologist in the hearing habilitation of patients is increasing.
  With regard to pediatric operations, patients generally tend to visit pediatric specialty hospitals for pre and postoperative management and anesthesia services; hence, the numbers of inpatients and operations are increasing. In terms of operative procedures, the overwhelming majority are adenotomy, tonsillectomy, and tympanic ventilation tube placement. Because many cases involve airway management in pediatric patients with serious complications who need artificial respiration, the number of tracheotomies and laryngotracheal separations performed is also increasing.

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  In 2001, Nagao et al. proposed the designation ‘sialolipoma’ to establish and characterize a new category of benign lipomatous tumor occurring in the salivary gland. Histologically, the tumors are characterized by a well circumscribed mass composed of glandular tissue and mature adipose elements. The amount of fatty tissue in all tumors arising in the parotid gland is 90% or more. Unlike lipomas, sialolipoma always have normal glandular tissue. To our knowledge, 13 sialolipomas of the parotid gland have been reported in the literature, and three of these tumors were pediatric cases, regarded as congenital. We hereby present the fourth congenital case of sialolipoma in the parotid gland. A one and a half year old female was referred to our department with a right parotid mass that had been present since birth. The mass was painless and had been gradually growing. MRI was useful for diagnosis. We resected the mass preserving facial nerve. No recurrence was seen in any cases after surgical resection, including our case. Therefore, surgical resection is appropriate treatment for this tumor not only in adults but also children.

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  “Neutropenia” generally indicates a blood pathology in which the concentration of neutrophils in the peripheral blood is lower than 1500/mm³. Kostmann syndrome is a rare congenital severe neutropenia and is characterized by recurrent bacterial infections, fever, skin infection, gingivitis and early life-threatening infections. We report a 6–year-old girl with Kostmann syndrome who suffered from neck infection and swelling in the epiglottis without pain. She needed a daily dose of antibiotics to prevent infection. She visited to our hospital complaining of a cough. Four days after the visit, she started to experience fever and hoarseness, and one week after the visit, she returned with a right submandibular mass. Computed tomography revealed a low attenuation mass in the right parapharyngeal space without ring enhancement. A fexible laryngoscope study revealed swelling in the epiglottis and right arytenoid cartilag. Based on these findings the patient was diagnosed with a deep neck infection, and intravenous administration of antibiotics (meropenem), steroid and G–CSF (granulocyte colony-stimulating factor) was started immediately, following which a gradual improvement insymptoms was observed. However, swelling in the epiglottis remained unchanged.

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  We reported the case of 5-year-old boy initially suspected of having retropharyngeal abscess due to fever, cervical lymph node swelling, and CT imaging. The confirmed diagnosis of Kawasaki disease was made by magnetic resonance imaging with contrast agent. Kawasaki disease should be considered in older children who have a retropharyngeal abscess on CT scan in addition to fever, cervical lymphadenopathy, and especially when antibiotics have no effect on the clinical symptoms. In addition, magnetic resonance imagings with a contrast agent should be performed.

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  Acute otitis media is one of the most common infectious diseases in children. In some severe repeat cases, treatment is difficult. We clinically studied 51 cases (86 ears) of acute otitis media (age 2 monthes–14 years) treated from November 2008 to May 2009. According to the classification of the Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media in Children, 34 ears were mild, 24 ears were moderate, and 28 ears were severe. Of these cases, 52.9% were 0 or 1–year-old infants, 56.9% of the chief complaint was high fever. 88.2% had nasal symptoms, 31.4% had other inflammatory disease such as bronchitis, pneumonia, and tonsillitis. Twenty children required hospitalization. An otolaryngologist is indispensable for successful treatment of acute otitis media in child.

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  Some cases of respiratory disorder in infants may be caused by tumors in the throat. We report on the case of an infant with a respiratory disorder that had neurofibroma in the left parapharyngeal space. His first symptom was snoring, and after one month he had developed fever and inspiratory stridor. A tumor in the left parapharyngeal space was detected by enhanced MRI and CT. We were able to excise the tumor through the mouth. This case was diagnosed as isolated neurofibroma, but cautious follow-up is necessary because of the possibility of pathological changes leading the infant's condition to fulfill the diagnostic criteria of neurofibromatosis type 1.

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  The relationship betwee congenital hearing loss and delay in gross motor development in early infancy have been considered previously. With the development of systems for newborn hearing screening, the needs for early training programs for deaf infants and their parents is increasing. At the Saitama Children's Medical Center, pediatric neurologists examine them and assess their developmental stages. Our objective was to demonstrate the characteristics of infants with a single factor in genesis of deafness.
  We conducted a retrospective developmental review of the nine infant cases with hearing loss due to GJB2 mutations. Perinatal complications, congenital cytomegalovirus infection, and obvious inner ear malformation were excluded. We reviewed the course of gross motor development during the first eighteen months of life. All infants were able to control their head position in the first five months and walk alone in the first eighteen months. The ages of sitting up without support were all different. Their postural control of sitting up and gait in early stages were unstable due to hypotonia of trunkal muscles.

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  Laryngeal papilloma is the most common benign laryngeal neoplasm, but for otorhinolaryngologists it continues to be frustrating disease to treat. Laryngeal papilloma is a chronic disease with a variable course most commonly caused by human papillomavirus types 6 and 11. Vaporization using carbon dioxide laser, which is a bloodless procedure, has been considered the standard treatment in Japan. Recently in the US, the microdebrider (53%) has supplanted the carbon dioxide laser (42%) as the preferred means of surgically removing papilloma from the larynx in children. We used a laryngeal microdebrider to safely and precisely resect multiple laryngeal papillomatous lesions in a three-year-old boy. No recurrence was observed. This instrument can be useful to remove laryngeal papillomas.

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  Lysosomal storage diseases are caused by the lack of an enzyme in the cells that normally eliminates or breaks down other substances. Respiratory problems are frequently encountered by patients with lysosomal storage diseases.
  From 1990 to 2009, we treated 24 patients (17 male, 7 female): 8 with mucopolysaccharide storage disease, 6 with Gaucher disease, 5 with mucolipidosis II (I–cell disease), and 5 with other conditions.
  Adenotonsillectomies were performed for airway management in three cases of Hunter syndrome. One patient had surgery at the age of three years, three years before diagnosis of the disease. The other two patients had surgery after the diagnosis of the disease. The patients who underwent adenotonsillectomy suffered from upper airway obstructions after the adenotonsillectomies, and two of the three cases required tracheostomies.
  Seven of 24 (12.5%) required tracheostomies or laryngotracheal separation: 2 with Hunter syndrome, 2 with Gaucher disease, 2 with I–cell disease, and one with GM–2 gangliosidosis. The age at the time of surgery ranged from 9 months old to 19 years old (average 8.3 years). Of these cases, only one surgery took place before the diagnosis; the others took place an average of five years after diagnosis of the disease. Highly thickened skin, submucosal tissue, and tracheal wand, which are typical findings for mucopolysaccharide storage disease, were observed in one patient with Hunter syndrome at the time of operation. Complications after tracheostomy such as tracheal stenosis and granular formation in the trachea were observed in only two cases of Hunter syndrome.
  We concluded that the management and treatment for airway problems associated with lysosomal storage diseases should be considered case-by-case because of the wide variations in the clinical course.

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  In this study, we investigated the clinical characteristics of vertigo and disequilibrium in children who visited the Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, over the last 14 years. The study group consisted of 61 children (35 girls, 26 boys) aged 15 years or less. The proportion of patients increased with age, and patients older than 13 years accounted for 50% of the study population. The predominant diagnoses were orthostatic dysregulation in 22 cases (36.1%), psychogenic vertigo in 6 cases (9.8%), and Ménière's disease in 4 cases (6.6%). Diseases involving the central nervous system were common in children less than 6 years old, whereas those having a peripheral origin were common in patients more than 13 years. The common concomitant symptoms with vertigo were those involving the autonomic nervous system (44.3%) and the cochlea (32.8%). Audiometry, ABR evaluation, posturography, the Schellong test, and the optokinetic nystagmus test were performed readily and frequently demonstrated abnormal findings; therefore these are the most helpful diagnostic tests in children.

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  We set out to assess the attainment of and problems associated with home medical care in six months after performance of pediatric tracheostomy at our hospital over the last six years. Most of the patients were toddlers. Twenty-three of the 47 patients who underwent tracheostomy and were followed for over six months achieved home care, but 24 of the patients did not. Excluding 6 deaths, 8 patients (20%) were unable to return home even after one year. Patients who needed mechanical ventilation after tracheostomy and those who required emergency tracheostomy were less likely to attain home care. In 42% of the patients, home care was not possible because of nursing problems. It is not only important to establish a home medical care system, but also to discuss home care with patients and their parents before performing tracheostomy.

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  We examined the effects of early speech intervention for stuttering in 57 children after speech training for more than 3 months. The average age of the onset of stuttering was 3 years and 3 months, while that of the first visit for medical consultation was 5 year and 1 month. In addition to improvement of communication environments at home, we trained stuttering children using direct speech methods. Indeed, we started speech training for 46% of children within a year after the onset of stuttering. As a result, only 11% of stuttering children were cured. In addition, the minimum grade of stuttering was achieved in 88% of the 25 children in whom the very early intervention was started within 1 year after the onset of stuttering, in 75% of the 11 children with an intervention within 1–2 years after the onset of stuttering, 55% of 10 children with the standard intervention of 2–4 years after the onset, and 14% of 7 children with a intervention after more than 4 years after the onset. It was suggested that the earlier the speech training started, the better the outcome achieved.

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  Tonsillectomy is one of the most common surgeries performed in the pediatric age group, but the decision to prescribe antibiotics post-tonsillectomy still remains controversial. A retrospective study was undertaken to assess the effect of different management policies following tonsillectomy in children in our hospitals. We compared two groups of children; Group A (N=72), on oral antibiotics for 1 week post tonsillectomy, and Group B (N=68), on intravenous cefazolin only 30 minites before incision. The post operative recovery was assessed by the following parameters: fever, analgesic requirement, day of return to a normal diet, pharyngeal bleeding, and other complications. No significant differences were demonstrated between groups A and B for any of these measures. These results suggest that there is no justification for the routine use of postoperative antibiotics.

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