[in Japanese]

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[in Japanese]

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  Due to the prevalence of examinations to detect hearing impairment in newborns and 3–year-old children, recent focus has been on deficits in various areas, including the educational system, in the diagnosis of hearing loss and subsequent intervention. We encountered a rare case of delayed diagnosis of congenital hearing loss. A 13–year-old girl was referred to our hospital with a complaint of hearing loss and delay in the development of speech and language. Her mother had been informed of a hearing impairment in her early childhood, but her homeroom teacher and mother had left it unattended. Because the patient tended to show symptoms of inattention and hyperactivity/impulsivity, she attended a special support class at her elementary school. After we pointed out the difficulty in study due to her suspected hearing impairment, her mother purchased a hearing aid with a resultant drop in inattention. We consider that problems caused by complex relationships between home and social environment will be very difficult to solve in the future.

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  A prototypical screening test aimed at the early identification of children having difficulties reading and writing hiragana, Japanese characters, was conducted and tested for accuracy. It was composed of the following 5 thematic categories: accuracy of writing strokes; language representation of simple graphic forms; ability to copy these forms; phoneme parsing; and phoneme abstraction.
  Participants comprised 161 children who started school between 2009 and 2012 and took the screening test. Children defined as having reading difficulties were those who, in spite of at least 6 months of practice, could not read words written in hiragana. Children who were unable to write the hiragana characters representing the basic 46 sounds, despite having writing practice at a stage when they could read hiragana to some extent, were defined as having writing difficulties. Excluded from the study were those cases in which judgment was a concern. The accuracy of the screening test was verified by comparing the 116 and 95 cases showing no reading or writing difficulties, respectively, with the 24 and 23 cases showing reading and writing difficulties, respectively.
  Our findings suggested that phoneme abstraction tasks in the screening test were useful for identifying children who had reading difficulties. In actual clinical practice, we believe that this screening test has practical value as a confirmation method for those cases in which reading difficulties are suspected based on confused articulation and other indicators. On the other hand, few of the tasks included in the screening test for writing difficulties proved to be useful.

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  Penicillin-based antibiotics are contraindicated for infectious mononucleosis because they may trigger rashes. By contrast, with acute bacterial pharyngitis and tonsillitis, where the main causative organism is Streptococcus pyogenes, penicillin-based drugs are considered the first line of treatment. We report a case of pediatric infectious mononucleosis with concurrent group A streptococcal infection. The patient was a 7-year-old girl who presented with the chief complaints of pharyngeal pain and pyrexia. At the time of the initial examination, she had white moss and reddening on the palatine tonsil and epipharynx, and she tested positive in rapid diagnosis for group A streptococcal infection. Because a lymphocyte-dominant increase in white blood cells was revealed by an automated blood cell counter, we performed EB virus antibody and liver function tests and administered cefditoren pivoxil. Bacterial testing detected S. pyogenes 3+ in the palatine tonsil and epipharynx. Because blood tests revealed decreased hepatic function, atypical lymphocytes, and EB virus infection, the patient was diagnosed with infectious mononucleosis. She defervesced on the third day. When selecting an antibiotic for acute pharyngitis and tonsillitis in patients who test positive in a rapid diagnosis for group A streptococcal infection, it is necessary to check the differential white blood cell count.

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  Many studies on passive smoking as a risk factor have demonstrated that passive smoking is a serious risk factor for the onset of otitis media and prolonged otitis media in childhood. However, the association between passive smoking and otitis media in Japan has not been reported. Therefore I examined the association between passive smoking and otitis media. I sent a questionnaire regarding passive smoking and otitis media to 825 first grade school students in my area, I questioned parents of 310 first-time infant patients to determine whether or not they were exposed to passive smoking, and I asked 649 children diagnosed with otitis media in my clinic whether or not they were exposed to passive smoking. These results were studied by logistic regression analysis. Exposure to passive smoking was associated with prolonged otitis media. Moreover, exposure to passive smoking by the father and other males is more significantly related to prolonged otitis media than smoking by the mother.

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  Since the publication of clinical practice guidelines for acute otitis media and acute rhinosinusitis for children in Japan, more clinicians have begun to prescribe the limited kinds of antibiotics. It is necessary to pay attention to changes in susceptibilities of these important agents. We studied the susceptibilities of the recommended antibiotics for strains of Streptococcus pnumoniae and Haemophilus influenzae that were obtained from the nasopharynx of pediatric patients treated at Nemuro Municipal Hospital between 2003 and 2011. No change was observed in minimum inhibitory concentrations (MICs) of ampicillin (ABPC), amoxicillin (AMPC), cefditren (CDTR), cefcapen (CFPN), and cefteram (CFTM) for the strains of S. pneumoniae. Increases in MIC₅₀ to the strains of H. influenzae were observed from 1 to 4 μg/mL and ≤0.12 to 1 μg/mL in AMPC and CFPN, respectively. The increase in the MIC₅₀ value for AMPC may be related to the increasing isolation rates of non-susceptible strains of H. influenzae. CDTR showed no remarkable changes in susceptibility during the study period and maintained the lowest MIC for H. influenzae although it was the most frequently prescribed antimicrobial agent among cephalosporins for children.

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  Infantile hemangiomas naturally decrease in size over time in most cases, but in some cases, they cause conditions, such as airway obstruction, that require treatment to prevent development of life-threatening conditions. Recently, propranolol therapy has been used as the first choice for the treatment of infantile hemangiomas because of its immediate effect and low rate of adverse effects. Only few reports showed failure of propranolol therapy in the treatment of infantile hemangiomas. The infants had either superficial tumors or large mixed sublingual tumors. Here, we report the failure of propranolol therapy in the treatment of a large sublingual infantile hemangioma. The tumor continued to increase in size and airway obstruction worsened even after propranolol therapy and administration of steroids. Therefore, intensive therapy was necessary to treat the hemangioma. The tumor was cured by administration of vincristine and steroids instead of propranolol. Therefore, infants with large sublingual hemangiomas require careful examination and administration of an alternative therapy if propranolol therapy proves to be ineffective.

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  Odontogenic myxoma is a relatively rare neoplasm that is usually seen in patients in their 20s to 30s. We report the case of 1-year-old boy who suffered odontogenic myxoma of the maxilla. Conservative surgery preserving the mucosa of the maxillary sinus was performed considering the function, cosmetic problems, and future growth of the facial bones. No recurrence has been observed for three years after the surgery, although careful outpatient follow up will be necessary from now on. To the best of our knowledge, this is the youngest case to undergo surgical treatment for this disease.

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  The purpose of this study was to investigate the development of auditory skills in infants with hearing loss. A developmental inventory was used to evaluate the longitudinal auditory skill development of 10 infants whose hearing levels ranged from 50 to 100 dBHL in the better ear. Infants started to use hearing aids from 3 to 10 months of age based on 2 cc SPL fitting. One infant received a cochlear implant at 2 years of age. The developmental inventory was composed of five stages (39 items) arranged according to the table of early auditory skill development (EASD) for special populations. The results showed that EASD scores rapidly improved to stage 3 before 12 months of age. Between 1 to 3 years of age, individual differences in longitudinal development were found between infants. Some infants caught up with the normal range in stage 4 and 5, and others showed slow improvement. The results suggested that the EASD inventory has utility for evaluating auditory developments in pre-verbal and early verbal stages.

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  Deep neck abscess is a critical disease and requires intensive treatment, especially in children. We here present three cases of children with deep neck abscesses in different sites: parapharyngeal, retropharyngeal, and parotid regions. Case 1: A 2-year-old boy presented with high fever and swelling and pain of the left neck. A parapharyngeal abscess was diagnosed by echographic, CT, and MRI examinations. A cervical incision and drainage was performed, and his postoperative course was unremarkable. Case 2: A 5-year-old boy had high fever, left neck pain, snoring, and drooling. CT findings showed an abscess in the left retropharyngeal region. He was successfully treated by transoral drainage and postoperative tracheal intubation for one day to avoid possible airway obstruction. Case 3: A 6-month-girl suffered from left neck swelling. On the tenth day after onset, she received a transcutaneous puncture, and thick purulent effusion was identified. Echographic, enhanced CT, and MRI examinations showed an abscess in the left parotid region. An external incision was made in the left neck, and the lesion was successfully drained. In children, deep neck abscesses occasionally show atypical symptoms leading to delayed diagnosis. For diagnosis, enhanced CT and/or MRI study and blood examination were indispensable. Early drainage and appropriate antibiotic treatments are thought to be vital. Airway management should also be considered, especially in pediatric cases.

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  An 18–month-old girl with an epidural abscess following acute otitis media treated by the transmastoid approach is reported. She had a history of high fever and running nose. Otoscopic findings showed right-sided acute otitis media. Laboratory results included a high C-reactive protein that suggested bacterial infection, so intravenous antibiotic therapy was started. The site of infection was found after six days by whole brain computed tomography (CT), which showed a right mastoid opacity associated with an epidural abscess in the posterior fossa. The abscess was drained immediately via mastoidectomy, and she recovered without any sequelae. This patient did not show any otological symptoms, such as otorrhea, otalgia, nor retroauricular swelling, which made it difficult to identify the otogenic intracranial infection. In an infant or child with fever of unknown origin, otogenic infections should be considered to allow early diagnosis and treatment. In some cases, surgical intervention should be performed without hesitation to achieve a better outcome.

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  To characterize the clinical course and treatment of acute facial nerve palsy (FNP) in cases up to two years of age, seven cases were reviewed retrospectively. The cases were referred to Saitama Children's Medical Center for neurological evaluation of acute FNP between January 2002 and December 2011. The mean age of onset was 1.3 years (1.0–1.8 years). Causes of FNP were infection (3) including acute otitis media and initial infection of herpes simplex, Bell's idiopathic palsy (3), and trauma (1). All patients in this study have recovered almost completely, and the recovery period was between one week and four months. One case had a relapse but was mostly recovered from symptoms after four months. Clinical evaluation of isolated facial movements of all cases was conducted using the Yanagihara grading system in the first week after onset, but it was inadequate. Therefore, appropriate methods for evaluation of FNP in children and infants are required.

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