Ingestion or insertion of a foreign body by pediatric patients is a problem frequently encountered at the Ear, Nose, and Throat Department. In this study, we examined the cases of 276 patients aged <16 years who consulted our department between January 2006 and December 2011 for foreign bodies in the external auditory canal, nasal cavity, pharynx, larynx, trachea, or esophagus. Foreign bodies in the external auditory canal were most commonly found in children aged <8 years. Biotic and nonbiotic foreign bodies were found in 7% and 93% of children, respectively, with plastic BB bullets, beads, and stones accounting for 62% of the bodies found in the external auditory canal. Foreign bodies in the nasal cavity were most commonly found in children aged <6 years. A great variety was observed in the foreign bodies found in the nasal cavity, with beads, toys, and plastic BB bullets accounting for 55% of the foreign bodies found in the nasal cavity. Children who had foreign bodies in the pharynx were aged <10 years in 93.8% of cases, and it was particularly common in children aged <2 years. Bones, most often from fish in the order of horse mackerel, eel, and salmon, accounted for 95% of the foreign bodies found in the pharynx. Foreign bodies were found in the trachea and esophagus of 80% of children aged <2 years. Although there tended to be fewer cases involving peanuts, the results indicated that the majority of foreign bodies found in the trachea and esophagus were beans, as expected. To prevent complaints or events of foreign body ingestion, it is important to continue educating parents and caretakers about appropriate measures.

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  A boy aged 2 years and 3 months, who had received 7-valent pneumococcal conjugate vaccine (PCV) four times, underwent adenoidectomy and bilateral tonsillectomy under general anesthesia because of snoring and apnea. As the perioperative antimicrobial agent, ampicillin was injected intravenously immediately before and 10 hours after the operation. The boy developed fever with a temperature of 40℃ on post-operative day (POD) 1 and convulsions on POD 2. Pneumococcus was isolated from the blood and spinal fluid. The patient was diagnosed with bacterial meningitis caused by pneumococcus. Intensive care was required during the acute stage, but he recovered without any sequela. Pneumococcus isolated from the spinal fluid was identified as genotypic penicillin-resistant Streptococcus pneumoniae (gPRSP) of serotype 35B (non-PCV7 and non-PCV13 serotype). Although the occurrence of meningitis after such surgery is extremely rare, bacteremia is frequently observed. To prevent the progression of bacteremia to meningitis, it is desirable to complete the PCV vaccinations before surgery. In addition, postoperative meningitis similar to that observed in our patient might be caused by non-vaccine S. pneumoniae serotypes and other bacteria. Hence, administration of perioperative antimicrobial agents may be necessary to prevent bacteremia.

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  Study of the unstimulated salivary flow rates of 566 children were reported. The unstimulated whole saliva was collected by a spitting method with each child spitting into a plastic cup for 5 minutes at rest. The procedure was carried out in their school hall in the afternoon.
  Object persons were from 4 sites, 96kindergartner (5 to 6 years of age), 72 in the 2^nd grade in school, 143 in the 3^rd one, 61 in the 4^th one, 114 in the 6^th one and 80 in the 8^th one.
  Results: The average whole salivary flow rates were 0.43 (in milliliters per minute) for kindergartners, 0.74 for the 2^nd graders, 0.72 for the 3^rd ones, 0.71 for the 4^th ones, 0.70 for the 6^th ones, and 0.66 for the 8^th ones respectory. As one's grade advanced, they showed a decreasing tendency in the flow rates except in the cases of kindergartners. It was suggested that the kindergartner could not spit accurately into each plastic cup in some cases on site.
  Considering the salivary flow rates of the children without the kindergartners by gender, significant differences were found. The mean whole flow in boys was 0l707, though the one in girls was 0.620. So, a statistically significant difference was seen between the ones of both (p<0.001). Compared to adults, children produced saliva over twice times as much as adults did.

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  Behçet's disease is a systemic disease characterized by lesions of mucosa, dermis, and eye lesions. Although Behçet's disease generally presents in adults, we report a rare case of an incomplete form of Behçet's disease in a 13–year-old boy. The patient, who had a history of recurrent cervical lymphadenitis when he was 5 and 10 years old, had cervical lymphadenitis, oral ulcers, genital ulcers, and digestive symptoms, leading to the diagnosis of an incomplete form of Behçet's disease. It is important to collaborate with other departments, focusing on suspected diseases hidden under repeated infections.

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  Congenital choanal atresia is a congenital malformation of the posterior portion of the nasal cavity. Transnasal, transpalatal, transseptal, and transantral surgical approaches for repair of choanal atresia have been described. Before endoscopy was developed, the transnasal approach had the disadvantage of limited vision, and an inadequate surgical procedure resulted in re-stenosis. Recently, the endoscopic transnasal approach has become the method of choice for the repair of choanal atresia because it provides excellent exposure of operating field and enables creation of a large opening of the choana. However, re-stenosis sometimes occurs due to inadequate resection of the vomer.
  We report a case of a congenital choanal atresia in which operation, with adequate removal of vomer, was successful. An 8–year-old female had suffered from nasal obstruction and nasal discharge of the left side and sometimes from snoring and sleep apnea since she was a neonate. Computed tomography and endoscopic studies showed choanal atresia on the left side. CT showed that the atretic plate was membranous. Under general anesthesia, we repaired the choanal atresia using endoscopy. The atretic plate was removed and the vomer was resected to widen the choana. We also used an intranasal stent for a month. After the endoscopic repair, her clinical symptoms improved and she was followed for a year without any problem including re-stenosis. In the endoscopic repair of choanal atresia, resection of the vomer increases the chance of success.

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  Although infant obstructive respiratory failure is mainly caused by adenoid and/or tonsillar hypertrophy, the criterion for surgical treatment for infant obstructive sleep apnea has not been determined. In this study, we analyzed the clinical symptoms before and after surgical procedures on patients less than one year old. All patients who underwent surgery had severe desaturation. Especially under 6 months old, these patients tended to exhibit multiple severe clinical symptoms such as wheezing, retractive breathing, or suckling disorder. The desaturation index as well as clinical symptoms related to respiratory failure were improved after adenoidectomy and/or tonsillectomy in all patients. Based on these results, surgical treatment for infants should be recommended when the patient has severe respiratory failure even if the patient is still under one year old.

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  Dysgraphia and dyscalculia are early symptoms of developmental Gerstmann's syndrome (DGS) and can progress to a severe learning disability. In this paper, we report the case of a boy with DGS who was followed from age 4 to 9. At his first visit to our clinic, his vocabulary was poor and he could not draw a man. After receiving speech therapy, his vocabulary increased to a range of subjects, and he could read short sentences correctly. However, he was not able to write some hiragana characters, even characters in his own name. In addition, he could not count five objects. Immediately after beginning elementary school, he encountered many difficulties in learning. However, the school teachers did not recognize that he had DGS until he was 9 years old. The draw-a-man test is important for the early diagnosis of DGS and for demonstrating the condition to teachers.

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  We studied 10 ears of 10 patients with congenital middle ear cholesteatoma who underwent surgery between January 2004 and December 2011. The clinical study included seven boys and three girls, all children were under 3years old. Eight cholesteatomas were located in the anterosuperior quadrant (ASQ), and five of them were less than 3 mm. These were surgically removed using the myringotomy procedure. In the remaining two cases, cholesteatomas in the ASQ were larger than 3 mm and removed using the tympanoplasty procedure with preservation of the ossicular chain. It has been observed that in cases under the age of two, most congenital middle ear cholesteatomas are located in the ASQ. We chose less-invasive operative techniques in order to preserve the ossicular chain in these cases. In order to preserve the ossicular chain, early detection and treatment are absolutely mandatory.

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  We examined the resultant tracheostoma closure of 12 patients whose tracheostomy tubes were removed in our hospital and determined that closure of a tracheostoma was possible. The underlying diseases were neonatal respiratory distress syndrome in six patients (five were low-birth-weight neonates (less than 1,000 g)), congenital subglottic stenosis in one, difficulty in extubation after heart surgery in one, idiopathic interstitial pneumonia in one, traffic trauma-related consciousness disorder in two, and craniosynostosis in one. Because the infantile airway is narrow, the subglottic region was evaluated by bronchoscopy, and, subsequently, tracheostomy tubes were changed to smaller ones. After confirming the absence of respiratory abnormalities, the tracheostomy tube was removed. Bronchoscopy revealed stenosis of the subglottic cavity in seven of the 12 patients. In four patients, surgery for subglottic stenosis was performed. The interval between tracheotomy and removal of a tracheostomy tube was particularly prolonged in patients who underwent surgery involving laryngeal operations.

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  Congenital cerebral hypomyelination is characterized by hypomyelination of the cerebral white matter. Recently, various diseases were identified and classified into a new category. The authors report three cases of different types: Pelizaeus-Merzbacher disease, 18q- syndrome, and 4H syndrome (hypomyelination, hypodontia, and hypogonadotropic hypogonadism). All had different causes, and clinical course and ABR findings were affected by each genetic abnormality.

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