[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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[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 administered the Wechsler intelligence scales to 18 hearing-impaired children/adults aged ≥9 years with normal range performance intelligence (PIQ) levels who had received language training using the Kanazawa method from infancy until entering primary school and evaluated items that may affect verbal intelligence (VIQ). The VIQ scores ranged from 60–124, and the median was 92. Fourteen of 18 (77.7%) subjects were within normal VIQ range, and 16 of 18(88.9%) were administered the test orally. Evaluation of items that may affect the VIQ score (training initiation age, hearing level, or PIQ score) revealed no significant influence of any item, but speech intelligibility significant influenced the VIQ score. For hearing-impaired children to acquire normal speech, it is not necessary to have a high PIQ. We consider that the Kanazawa method using visual language forms such as written language and sign language during infancy may promote the development of verbal intelligence in hearing-impaired children/adults.

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  In general, the insertion of tympanic tubes or outpatient parenteral antimicrobial therapy (OPAT) are known to be effective treatments for otitis-prone children. Recently, juzen-taiho-to (JTT), an herbal medicine, was also reported as an effective treatment by improving patients' immune function. We administered JTT (0.15 g/kg BW/day for 3 months) to 25 children diagnosed as otitis-prone and determined the number of acute otitis media (AOM) episodes, changes of nasopharyngeal bacteria, and severity of each AOM episode. We found that JTT significantly decreased the frequency of AOM, from 1.8 times per month to 0.39 times per month (Wilcoxon signed rank test; p<0.0001). Ten children had no AOM episodes while taking JTT. A nasopharyngeal bacterial culture after JTT treatment did not show any change compared with that before the treatment. We found 75% of otitis-prone children had penicillin-resistant Streptococcus pneumoniae in their nasopharynx. The severity of AOM decreased in 40% of the otitis-prone children but did not change in some or became worse in other children after JTT treatment. We needed to repeat the JTT treatment in three children. The second administration was very effective in two children, but it was not effective in one; we gave him additional treatment (OPAT). We think the JTT is effective for the prevention of repeated otitis media episodes.

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  Laryngeal hemangioma of infancy is a life-threatening disease with airway obstruction. Previously, it was treated with steroids, vincristine, interferon-α, laser, tracheostomy, and open surgery, but responses were not satisfactory.
  We report two cases of laryngeal hemangioma of infancy successfully treated by a β-blocker (propranolol). Patient 1 was a three-month-old male with subglottic hemangioma. He demonstrated recurrent respiratory discomfort, but after propranolol administration was initiated, the hemangioma diminished immediately. Patient 2 was a 7-month-old female with a large supraglottic hemangioma. Due to wheezing and increasing size of the hemangioma, propranolol administration was initiated. After three months, the size of her hemangioma was well controlled and she had no symptoms.
  Léauté-Labrèze et al. first reported β-blocker therapy for hemangiomas of infancy in 2008, and additional reports have been published abroad since then. β-blocker therapy is effective for hemangiomas of infancy and superior to previous therapies in terms of its immediate effect with few side effects. We expect that it will become the standard therapy for laryngeal hemangioma of infancy.

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  We studied 15 cases of congenital cyst at the base of the tongue at Kanagawa Children's Medical Center from 1997 to 2010. The most frequent complaint (10 of 15 cases) was stridor. Nine cases were younger than 1 year old, and all of them exhibited stridor. Eleven cases were male, and four were female. In all cases, the outer part of the cyst wall was resected under direct laryngoscopy. The histopathological diagnosis of all cases was thyroglossal duct. Four cases relapsed and were resected again. Since then, they have not experienced further recurrence. Based on the results, resection of the outer part of the cyst wall under direct laryngoscopy is effective. When we examine patients who have difficulty breathing, a congenital cyst at the base of the tongue should be suspected.

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  We report a diffuse sclerosing variant of thyroid papillary carcinoma with non-recurrent laryngeal nerve. A 12-year-old girl with anterior neck swelling and hoarseness was referred to our hospital. Flexible fiberscopy revealed that the vocal cord was fixed on the left side. On ultrasonogram, numerous minute calcifications were seen with diffuse swelling of the thyroid gland without forming nodules. Computed tomography (CT) and magnetic resonance imaging showed a retro-esophageal right subclavian artery arising from the dorsal part of the aortic arch, which preoperatively reminded us of a non-recurrent laryngeal nerve on the right side. Chest CT revealed a small lung metastasis. Based on all the imaging results, a diffuse sclerosing variant of papillary carcinoma was strongly suspected. Fine needle aspiration confirmed a diagnosis of papillary carcinoma.
  Total thyroidectomy with bilateral neck dissection was performed. During the operation, we recognized the right-side non-recurrent laryngeal nerve, which derives from the main vagal nerve trunk. After surgery, the right-side vocal cord movement was normal, indicating that the right-side non-recurrent laryngeal nerve was not damaged. Damage to the right-side non-recurrent laryngeal nerve would have caused bilateral vocal cord paralysis, and a tracheotomy would have been unavoidable. Fortunately, the patient required no airway intervention and was able to maintain a good quality of life afterwards.
  Although a non-recurrent laryngeal nerve is rare, head and neck surgeons must be aware of non-recurrent laryngeal nerves resulting from anomalous embryonic development of the aortic arches.

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  A 16-year-old man whose cheek had been swollen for two months was referred to our department. A 30-mm tumor was found in the right maxillary sinus, and the second trigeminal branch exhibited decreased perception. Imaging studies confirmed tumor involvement, along with some calcification. The maximum SUV value by PET was 7.6. The pathological diagnosis on biopsy was osteosarcoma. A right maxillary excision was conducted under general anesthesia. The final post-operative pathology diagnosis was juvenile trabecular ossifying fibroma (JTOF). The tumor margin was clear. Juvenile ossifying fibroma can be divided into two pathological categories: juvenile psammomatoid ossifying fibroma (JPOF), and JTOF, as in this case. JTOF generally occurs in the maxillary bone and during the teen years. Aggressive proliferation is generally limited, but often relapses. Therefore, the best policy is to treat it as a malignant growth.

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  We conducted a questionnaire survey of 37 children with allergic rhinitis treated with KTP laser between 2005 and 2009. Twenty-two patients answered the questionnaire. The improvement rates of nasal obstruction, number of times they blew their nose, sneezing, and interference in daily life were 81.8%, 63.6%, 72.7%, and 72.7%, respectively. Eighteen patients considered that KTP laser surgery was effective, but 14 of 18 patients reported that the effective period was less than two years. Nine out of 22 patients reported more postoperative bleeding than they expected, and 12 of 22 patients claimed some concerns about the surgery preoperatively. We should try to prevent postoperative bleeding and preoperative anxiety of patients. Thus, KTP laser surgery is effective for pediatric patients with allergic rhinitis who are resistant to conservative treatment, but it does not have a long-term benefit. The questionnaire study was useful to achieve satisfactory results for patients.

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  Suppurative inflammation of the tongue is not common, and abscess formation is extremely rare. A 14-year-old girl with pain in the tongue, dysphagia, and difficulty in breathing was admitted to our hospital. The patient was treated using intravenous antibiotics administration and did not require any puncture or incision drainage.
  We reviewed the cases of lingual abscess in Japan after 1980. In most cases, lingual abscess develops in the body of the tongue, and the causes are unknown. The abscess was most frequently diagnosed by lancing or incision; however, in our case, enhanced computed tomography was useful as a non-invasive diagnostic technique. The principal treatment for lingual abscess is puncture or incision drainage; however, in a few cases, abscess was cured using only antibiotics. When puncture or incision is difficult to perform and there is no airway obstruction and no foreign particle in the abscess, it can be treated using intravenous antibiotics administration under careful respiratory monitoring. However, if the abscess does not improve within several days of antibiotic treatment, puncture or incision should be performed without hesitation.

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  This study comprised 49 children with mumps deafness who came to our clinic at Iwate Medical University over the past 29 years. Of 49 cases, 37 were positively diagnosed with mumps deafness according to the criteria of the Acute Profound Deafness Committee (1987). These 37 cases were evaluated by sex, biaurality, age of onset, interval from parotid gland swelling to onset of hearing loss, vestibular symptoms, initial audiogram, treatment, and post-treatment audiogram. Twenty cases were male and 17 cases were female. Among them, 35 cases (95%) were unilateral and 2 cases (5%) were bilateral. The onset of hearing loss ranged from one day before parotid swelling to 16 days later, with the average being 6.6 days. Thirty two of 37 cases had severe or total hearing loss at the initial audiogram. In spite of treatment, no improvement was shown in their hearing except in one case. The number of patients with mumps deafness increased during mumps epidemics. The prognosis of mumps deafness is poor, as shown in our investigation. Vaccination is useful to prevent mumps deafness. Therefore, these results would seem to indicate that mumps deafness is preventable by routine, not optional, vaccination. It is very important to regularize vaccination against mumps, cooperate with pediatricians, and improve the quality of the mumps vaccine.

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  Congenital nasal airway stenosis without craniofacial malformation is one of the causes of airway obstruction in infants. From March 2002 through December 2009, there were five such cases at the National Center for Child Health and Development. Respiratory distress developed with nasal obstruction at birth in three cases, or was later associated with airway infection in four cases, feeding difficulty in three cases, and difficulty in inserting a nasogastric or suction catheter through nasal cavity in four cases. The diagnosis was confirmed by nasal endoscopy and sinus CT scan. Sinus CT scan revealed pyriform aperture stenosis in four cases and a peculiar nasal cavity stricture in one case. Three of the four cases with pyriform aperture stenosis required nasal stenting therapy due to severe respiratory distress. while the other cases with mild respiratory distress required conservative treatments such as alpha-stimulant nasal drop therapy.

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  We investigated children who passed the newborn hearing screening (NHS) test but were suspected of having hearing loss. Their actual status depends on the hearing threshold level, language development, and screener used. The hearing threshold level was classified as profound hearing loss, medium hearing loss, or psychogenic hearing loss, such as that caused by a father's violence. Profound and medium hearing loss were discovered relatively late, after the child should have acquired language. This suggests that early discovery of hearing loss and initiation of appropriate measures are essential for language acquisition. We examined the distribution of results due to screener differences (OAE/AABR) and found that strict management of hearing ability and appropriate guidance in language acquisition were effective in reducing the disparity. To discover hearing loss in children who passed the NHS, hearing should be reexamined during the medical and developmental evaluation at age 1.5. Understanding and cooperation between obstetricians who conduct NHS and persons engaged in the medical and developmental evaluation are necessary, and an ear, nose, and throat doctor who can supervise hearing loss and an ST are required.

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  An otologist has few opportunities to examine children with feeding and swallowing problems that do not require preventive surgery such as aspiration and tracheotomy, but the otologist does not play a small role in feeding and swallowing problems in children. Pediatricians, speech therapists, physiotherapists, teachers and parents who feel uneasy about development of a child's feeding and swallowing can consult an otologist for an assessment of the child's swallowing function. Videofluoroscopy (VF) is the gold standard for the assessment of dysphagia, but videofluoroscopic assessment of children, who often have bottle feeding disorder and no ability to communicate, is difficult. Taking a detailed history of the child is important to create the best conditions for VF. An accurate assessment of the swallowing function is necessary to solve children's feeding and swallowing problems. It is important to note that VF is not uniform.

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  Oral and pharyngeal trauma occurs often in children six years old and younger, and the toothbrush is one of the main causes. In 2010, five cases of trauma caused by a toothbrush, in which all patients were hospitalized and received intravenous antibiotics, were treated at out hospital. In three, abscesses formed and required drainage. In one case, the abscess in what was thought to be a pharyngeal constrictor muscle from the tonsillar fossa of an extracted palatine tonsil was drained. All five cases have been documented and reported.
  The result indicates a high rate of abscess formation along with toothbrush trauma. This phenomenon is thought to be caused by the external force transmitted directly by the toothbrush, without protection from the lips or teeth, which allows a deep pricking, when large quantities of oral bacteria such as Streptococcus milleri group bacteria are on the brush. It is therefore thought that toothbrush trauma causes abscesses in places where abscesses do not form naturally Furthermore, it is assumed that in cases of toothbrush trauma in which abscesses have not formed, the puncture would have been by the toothbrush handle and not the brush itself.

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  Retropharyngeal abscess (RPA) is a severe inflammation in small children that follows retropharyngeal lymphadenitis in the retropharyngeal space. We experienced a case in which the retropharyngeal abscess perforated the external auditory canal. The patient was 17-month-old girl with persistent fever. She underwent intravenous medical treatments, but no improvement was observed. The anterior wall of her right external auditory canal swelled on the fifth hospital day, and pus was extracted upon incision. Computed tomography of the head and neck revealed that the lesion had advanced to the upper parotid space through the secondary parapharyngeal space. Surgical incision of the abscess was carried out under general anesthesia on the same day. The postoperative course was good and no recurrence has been observed since.
  The bony part of external auditory canal in children is undeveloped, and the defect is known as the foramen of Huschke. It has been reported that inflammation of the external auditory canal spreads to the neck through this foramen. In this case, no inflammation had been found in the middle ear or parotid grand, and it was believed that the retropharyngeal abscess spread directly to the external auditory canal through this route.

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  Functional anarthria is an articulatory disorder caused by no organic disease, and is a rare condition in otolaryngology. We report a 6-year-old boy suffering from functional anarthria of only i line sound. The mother of the patient was aware of his slow language development when the boy was 2 years 8 months old. At the 3-year check-up, the delay in language development was pointed out. When he was 4 years 7 months old, he was diagnosed with functional anarthria of only the i line sound. Speech therapy at a couple of hospitals produced no improvement of the symptoms. Then he was sent to our department, and we also diagnosed with functional anarthria of only the i line sound. After four months treatment by speech therapists at our hospital and teaching his mother, his articulatory disorder completely disappeared. It is considered that appropriate speech therapy is important to improve this rare condition.

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  Revision/additional surgeries after cochlear implants are sometimes required because of device failure, hematoma, infections, and malinsertion/extrusion of electrodes. Younger implant age may also increase the incidence of additional ear surgery due to the immaturity of the Eustachean tubes. Since 1992, we have conducted 150 pediatric cochlear implants with three revisions (2.0%) or two additional surgeries (1.3%) required so far. All three revision cases were due to device failure, and ipsilateral explantation/reimplantation surgeries were conducted. The two additional cases included a case of ventilation tube malplacement and a case of myringoplasty. A case with implant failure after head trauma is reported here in detail.
  A 7-year-old girl who received cochlear implantation at the age of two visited our hospital because she didn't respond to sound after a head trauma. Her speech perception had been good until her head was struck by a swing in a park, and she came to our hospital four days later. An impedance check or NRT of the cochlear implant was impossible, and explantation and reimplantation of the same side cochlear implant was performed six weeks later. Insertion of the electrodes was extremely difficult because of inner ear malformation, but the right position of the electrode was finally confirmed by X-ray. Her speech perception and language development were good after the operation.

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  Polysomnography (PSG) is the gold standard for evaluating pediatric sleep disordered breathing. I report two pediatric cases diagnosed as central sleep apnea syndrome by PSG. Case 1 was a 10-year-old girl with witnessed snoring and apnea. She occasionally complained of headaches. Tonsil hypertrophy and adenoid hypertrophy were confirmed. Home cardiorespiratory monitoring showed one-hour continuous intermittent oxygen desaturation after the onset of sleep. Case 2 was an 11-year-old girl with recurrent snoring after an adenotonsillectomy at the age of four. She was obese and showed hypertrichosis. Home cardiorespiratory monitoring showed a high pulse rate and intermittent desaturation without a rising pulse rate. Obstructive sleep apnea syndrome was suspected in both cases, but PSG revealed that almost all respiratory events were central apnea. The total apnea hypopnea indices were 18.6/h in case 1 and 26.6/h in case 2. Because the cranial MRI indicated herniation of the cerebellar tonsils through the foramen magnum, Case 1 was diagnosed as a type I Chiari malformation. The parents of Case 2 refused further medical examination, and therefore the cause of the central apnea was unidentified.
  At the Pediatric Sleep Related Disorders Clinic, medical conditions associated with sleep-disordered breathing are occasionally not recognized. We should perform PSG for pediatric cases with a suspicion of specific medical condition and/or co-morbid disease. Moreover, in cases with atypical patterns in cardiorespiratory monitoring, careful examinations including PSG are required.

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  Recently, tympanostomy tubes have been advocated for the prevention of recurrent episodes of acute otitis media concomitant with middle ear effusion, but there are only a few reports on their efficacy for intractable or recurrent otitis media in children and none on the Feuerstein split tube (FST). Thirty-five children (a total of 90 ears) under 2 years of age with intractable or recurrent otitis media underwent FST placement in our hospital between April 2008 and March 2010, and were followed until the tube extruded spontaneously. The mean patient age at tube placement was 12.1 months. The average period of tube retention was 121.4 days (maximum, 678 days; minimum, 3 days). In 48 ears (53%), the tube was retained for more than 3 months. Perforation of the tympanic membrane by FST that lasted for more than 6 months developed in 1.1% (1 ear), obstruction of the tube was observed in 1.1% (1 ear), severe retraction of the tympanic membrane after extrusion of the tube was observed in 2.2% (2 ears), and the tubes extruded with purulent otorrhea in 7.8% (7 ears). The mean number of antimicrobial administration days per month of 13.6 before operation was markedly decreased to 3.3 postoperatively. FST insertion is useful for treatment of intractable or recurrent otitis media in children and has complication rates comparable to those reported for short-acting tubes.

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  We conducted a retrospective study of 101 (83 males, 18 females) children aged from 1 to 7 years (mean: 3.6 years) with speech-language problems in early childhood. The patients were screened for hearing acuity during their first visit to the authors' institutions from 2005 to 2009. We analyzed their present status, developmental quotient (DQ), and categorical diagnosis of mental development. Ninety-two patients (91%) had a developmental or neuropsychiatric diagnosis: 51 (50%) had autism spectrum disorder, 39 (39%) had mental retardation (MR), and 2 (2%) had attention deficit-hyperactivity disorder. Thirty-one cases (31%) visited our institutes for the first time after the age of 4 years. Of these 31 children, at least 10 cases had been found to be normally developed by physicians at the health checkup for 3-year-old children. In this group, five cases were diagnosed with MR other than borderline based on the intelligence tests (Tanaka-Binet or WPPSI). However, the average DQ of the five patients was 84 (range: 79?91). Physicians should pay attention to behavioral problems in children with speech-language problems as well as their speech status.

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  The major causes of airway obstruction in children with sleep apnea are palatine tonsil hypertrophy and adenoid hypertrophy. Pediatricians may hesitate to treat sleep apnea aggressively in infants with an underlying disease due to other complicating factors. We recently performed conservative airway management for a nine-month-old infant with multiple deformities who suffered from sleep apnea. Her parent's chief complaints were apnea attacks during sleep and stridor while awake. At the age of six months, magnetic resonance imaging of the head detected decreased oxygen saturation during sleep. Otorhinolaryngological findings included bilateral low-set ears, bilateral ear canal stenosis, and mild adenoid hypertrophy. Radiography and computed tomography revealed narrowing of the upper pharynx. An ambulatory sleep monitoring device showed a marked decrease in oxygen concentration, with an oxygen desaturation index of 50 events per hour and a lowest oxygen saturation level of 53%. Based on these findings, the cause of sleep apnea in this case was judged to be narrowing of the upper and middle pharynx due to hypoplasia of the medial face bones. A nasal airway tube inserted into her nose administered oxygen at 0.2 L/min only while she was asleep and prevented sleep apnea and decreased oxygen concentration. She was discharged and currently wears a nasal continuous positive airway pressure mask under oxygen inhalation. No decrease in her oxygen concentration at night has been observed since then, and she has had a favorable clinical course.

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  The severity of acute rhinosinusitis of 132 children was classified according to the Japan Rhinologic Society's Clinical Practice Guidelines for Acute Rhinosinusitis (2010 edition), and maxillary sinus ultrasonography was performed. Many cases in all severity classifications were negative on ultrasonography, and these cases often recovered within a week. Even when the severity of symptoms and nasal examination were the same, the cases classified as severe on ultrasonography diagnosis tended to require longer treatment. In addition, cases that were negative on ultrasonography at the time of diagnosis but subsequently began to test positive also required long treatment. This suggests that a more accurate diagnosis of rhinosinusitis can be made by performing imaging in addition to symptoms and nasal examination. Ultrasonography, which is minimally invasive and can be repeated, is therefore thought to be useful in the diagnosis in pediatric rhinosinusitis.

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