Pediatric Otorhinolaryngology Japan

PFAPA syndrome is a non-hereditary auto-inflammatory syndrome characterized by periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis. It manifests in early childhood, generally prior to the age of 5 years. The etiology of PFAPA syndrome is unknown. Antibiotics are not effective, and the therapeutic strategies have not been established yet. However, corticosteroid, cimetidine, and tonsillectomy are suggested to be effective. We treated five cases with PFAPA syndrome at the Department of Otorhinolaryngology of Kanagawa Children's Medical Center from 2008 to 2011. Only one case was treated with corticosteroid and cimetidine. Nevertheless, the symptoms of all five cases persisted, and all cases underwent tonsillectomy. After tonsillectomy, their symptoms were reduced remarkably. We recommend that tonsillectomy should be considered when conservative treatment is not effective.

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Otogenic intracranial complications are rare. We present a 5-year-old boy with acute otitis media due to mucoid type Streptococcus pneumoniae, which caused an epidural abscess. He complained of left otalgia and postauricular swelling. CT showed an expanding abscess at the posterior fossa and subcutaneous. Mastoidectomy and craniotomy were performed, and the abscess was drained. Subsequently we administered carbapenem and penicillin. The patient recovered uneventfully. We considered that drainage and appropriate administration of antibacterial agents are very useful for treatment of acute otitis media due to mucoid type Streptococcus pneumoniae with epidural abscess.

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Retropharyngeal abscess is usually seen in children under 3 years of age. Sudden exacerbation of this disease may occur, leading to a serious condition. We present the case of a 2-month-old girl with retropharyngeal abscess due to MRSA. She was evaluated by a pediatrician for transient abnormal myelopoiesis. After treatment for cervical lymphadenopathy, she exhibited poor sucking and respiratory obstruction. Computed tomography of the head and neck revealed an expanding abscess in the retropharyngeal space. The abscess was surgically incised under general anesthesia by an intraoral approach. After surgery, we performed fenestration for recurrence. The postoperative course was good, and no recurrence has been observed since. Transient abnormal myelopoiesis resolves itself, so a causal relationship is not obvious.

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During the period between 2005 and 2011, 13 patients (4 male and 9 female) with severe motor and intellectual disabilities underwent surgical intervention to prevent intractable aspiration. We evaluated the surgical results and postoperative conditions of these patients. The average age was 10 years and 10 months, with an age range from 1 year and 11 months to 20 years and 11 months. Laryngotracheal separation (LTS) was performed in 8 patients, total laryngectomy in 3 patients, tracheoesophageal anastomosis (TEA) in 1 patient, and laryngeal closure in 1 patient. The average duration of surgery was 124 minutes for LTS or TEA (9 patients) and 148 minutes for total laryngectomy (3 patients). There was no significant difference between the two groups. The average blood loss during LTS or TEA was less than that for total laryngectomy. Postoperative complications were tracheocutaneous fistula in one patient, narrowing of the tracheostomy site in one patient, and a tracheo-innominate artery fistula that caused fatal bleeding in one patient. Tracheocutaneous fistula was treated conservatively, and the fistula was successfully closed. Additional surgery was performed to enlarge the tracheal stoma in the patient with narrowing of the tracheostomy site. Unfortunately, the patient with the tracheo-innominate artery fistula died. Scores of incidences of aspiration pneumonia reflect the frequency of occurrence. Aspiration pneumonia scores after surgery were significantly better than the scores before surgery, indicating that surgical therapy for severe motor and intellectual disabilities with intractable aspiration is effective. Surgical management for intractable aspiration should be performed at appropriate times, considering the underlying disease and age.

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