We report a case of congenital middle ear cholesteatoma in the anterior wall of the external auditory canal. The case was a boy who was followed for otitis media with effusion from 1 year old. When he was 6 years 7 months old, acquired cholesteatoma was found in his left tympanic membrane. Left tympanoplasty was carried out twice. At 8 years old, computed tomography revealed a mass lesion in the pneumatization of the anterior wall of the left external auditory canal. When he was 9 years 9 months old, tumor was found at the anterior wall of his left external auditory canal. The canal wall bone was destroyed at the tumor site. The tumor was resected. The pathological diagnosis was cholesteatoma. The cholesteatoma has not recurred.

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  Otitis media with effusion is very common in cleft palate cases. We studied 52 children who had undergone ventilation tube placement or tympanotomy at the same time as palatoplasty from 2006 to 2011. Fifteen children had bilateral lip and cleft palate, 22 had unilateral lip and cleft palate, 15 had cleft palate, and one had submucous cleft palate. Long-term ventilation tubes were placed in 25 children, while grommets were inserted in 26 children. Before surgery, 100 of 104 ears had effusion. After surgery, effusion was observed in 79 of 104 ears. Sixty-one ears had mucous effusion, and 18 had serous effusion. Therefore, routine ventilation tube placement is necessary in cleft palate cases. After ventilation tube insertion, tubes dropped out of 64 ears. Seven ears developed eardrum perforation, and otitis media recurred in 21 ears. There was no relationship between the types of ventilation tubes and duration of tube placement and the prognosis of otitis media.

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  Hamartoma is defined as a tumor-like malformation composed of a disordered mixture of mature tissues. It can develop at any site in the body, but few hamartomas in the oral area have been reported. We report a 4-month-old boy with a leiomyomatous hamartoma developing on the dorsum of the tongue. A lingual nodule was noticed during a medical examination at three months of age. The nodule was resected under general anesthesia and diagnosed as a leiomyomatous hamartoma. No post-operative complications were observed. Previous studies report cases in which resection of leiomyomatous hamartoma of the tongue was done; no relapses were reported. Considering that there is a case reporting enlargement of hamartoma in adulthood, long-term follow-up of the patient is required.

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  From among 24 children hospitalized and treated for respiratory syncytial virus (RSV) infection, we evaluated the ages, disease severity, clinical features, eardrum findings, bacteria type, medical treatment, and clinical course of the 18 that had acute otitis media. In the children with RSV infection, the rate of complications of otitis media was significantly higher in those younger than 2 years of age than in those aged 2 years or more. The age of the first visit of the patients with RSV infection-associated acute otitis media was from 0 month to 3 years 5 months, with the average age being 12.3 months and the median being 11.5 months. The severity of acute otitis media was mild in seven, moderate in three, and severe in eight children. Of all children, only two were cured of otitis media without antibiotics and myringotomy. The ear drum findings were worse on the next day in four children with mild or moderate otitis media, so that we increased treatment of three patients. One of these four patients experienced a recurrence even after treatment. Bacteria were detected in the epipharynx of 12 patients and in the middle ear fluid of one patient. There was no correlation between bacterial findings and severity or clinical course. RSV infections associated with bronchiolitis requiring total inpatient care are frequently found infants. Because otitis media, even if mild, may worsen quickly, careful observation on consecutive days in cooperation with pediatricians is necessary.

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  A case of rapidly progressive ossification of the cochlea after bacterial meningitis is reported. An eleven-month-old boy was referred to our hospital due to his loss of response to sound after suffering from meningitis at 8 months old. He did not respond to sound either by BOA or ABR at 105dB nHL. 3D reconstruction imaging with MRI suggested that the cochlea was completely occluded in his right inner ear. Possible progression to his left inner ear was suspected, and cochlear implant in his left ear was performed immediately. Ossification of the cochlea is frequently observed after meningitis. In cases with early and rapidly progressive ossification of the cochlea, repeated audiological evaluation and MRI imaging is indispensable in the follow-up after bacterial meningitis with very young infants.

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  Evaluation of language development is critical for hearing impaired children. Forty-four children in pre- and elementary school with hearing impairment worse than 70 dB HL were included in this study. The Assessment of Language Development for Japanese Children (ALADJIN), including productive/receptive and vocabulary/syntax tests, was conducted and compared in a nationwide survey. Most children who showed better Japanese language development were enrolled in a mainstream elementary school. However, some children attending a school for the deaf showed better language ability in the upper grades than their age-matched peers in the nationwide survey. Personally optimized education conditions for hearing impaired children would be effective against early language delay.

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  Between January 2005 and April 2011, we found retropharyngeal low-density areas on CT findings in four (3.8%) of 106 patients with Kawasaki disease at Shiga University of Medical Science Hospital. The ages of four patients were 1, 5, 6, and 11 years (average 5.6 years). Their initial symptoms were high fever and cervical lymphadenitis. Antibiotics were not effective, but treatment with γ-globulin and aspirin was effective, and the retropharyngeal low-density area disappeared without surgical intervention. The presence of a retropharyngeal low-density area without ring enhancement on contrast-enhanced CT may help in the early diagnosis of Kawasaki disease.

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  The Joint United Nations Programme on HIV/AIDS (USAIDS) reports that an estimated 370,000 children contracted HIV during the perinatal and breastfeeding period in 2009. In Japan, there are 51 documented cases of mother-to-child transmission of HIV. We saw a 5-year-old boy who was introduced for recurrent otitis media with vertical HIV transmission. He was categorized as A2 by the U.S. Centers for Disease Control and Prevention (CDC) classification system, so Highly Active Anti-Retroviral Therapy (HAART) was introduced. During the observation period, the frequency of recurrent otitis media was significantly reduced, coincidentally with a decrease in HIV–RNA copy number due to HAART.
  A relatively higher prevalence of otitis media in HIV–infected children than in normal children was reported, and an article published recently reported that the use of HAART was associated with a reduction in the prevalence of chronic otitis media. In our case, the frequency of recurrent otitis media was significantly reduced after initiation of HAART. Our experience strongly suggests that HAART can prevent the recurrence of otitis media. Finally, from our experience, we hope that physicians will consider the possibility of mother-to-child transmission of HIV in cases of severe recurrent otitis media in childhood.

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  The mucopolysaccharidoses are a group of rare, genetically transmitted metabolic disorders affecting children in early life. These are potentially life-threatening disorders that almost invariably involve the auditory apparatus and upper respiratory tract; therefore, an otolaryngologist is frequently involved in the treatment of patients with these disorders. The first case is that of a patient diagnosed with Sanfilippo syndrome at the age of seven years. At the age of 13 years, the patient suffered repeated bouts of deglutition pneumonia. Laryngotracheal separation surgery was performed, which resulted in an improvement in the recurrent deglutition pneumonia. The second case was that of a patient diagnosed with Hunter syndrome at the age of five years. The patient had undergone tonsillectomy and adenoidectomy at the age of three years to treat sleep apnea. However, the sleep apnea recurred along with repeated bouts of deglutition pneumonia at the age of 18 years, and laryngotracheal separation surgery was eventually performed. One year later, the underlying disease resulted in the proliferation of granulation tissue in the trachea along with flattening of the tracheal wall.

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  I surveyed current rates of drug-resistant bacteria in 522 pediatric patients with acute rhinosinusitis who visited Tomiyama Clinic from January 2009 to December 2010 and presented with Streptococcus pneumoniae or Haemophilus influenzae in purulent nasal discharge. There were 166 strains (62%) of drug-resistant S. pneumoniae (DRSP) among 266 strains of S. pneumoniae, while 326 strains (74%) of ampicillin (ABPC)-resistant H. influenzae were found among 442 strains of H. influenzae. The 0–2-year-old group was found to have high detection rates of DRSP and ABPC–resistant H. influenzae. Furthermore, a relationship between day care and DRSP or ABPC–resistant H. influenza was established in the group younger than 3 years because these bacteria were more frequently observed among patients in day care than those not. Amoxicillin (AMPC) was found to be more effective than cefditoren (CDTR) for penicillin-sensitive S. pneumoniae, while CDTR was more effective than AMPC for penicillin-resistant S. pneumoniae. CDTR worked well for β–lactamase negative ampicillin-sensitive H. influenzae and ABPC–resistant H. influenzae.

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