[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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[in Japanese]

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  Penicillins (PCs) are recommended as the first-line treatment for acute otitis media in children. However, the use of PCs is contraindicated in infectious mononucleosis owing to a high incidence of skin rash. I observed a case of severe acute otitis media complicated by infectious mononucleosis. The patient, a 14-month-old girl, presented with fever, nasal discharge, and irritability. The observed local findings were used to diagnose a case of right acute otitis media that was considered severe by the standards of the Clinical Practice Guidelines for Acute Otitis Media in Children 2013, as well as acute pharyngitis and tonsillitis. Because of an increase in the white blood cell count, particularly the lymphocyte count, tests to evaluate hepatic function and detect the presence of Epstein-Barr (EB) virus antibodies were conducted, and cefditoren pivoxil was administered. Streptococcus pneumoniae (3+) was detected in the accumulated middle ear fluid. Results of blood tests revealed decreased liver function, atypical lymphocytes, and EB virus infection, all of which were used to make a diagnosis of infectious mononucleosis. The patient's fever resolved after two days treatment. Differential leukocyte counts may be necessary when selecting antibiotics for severe acute otitis media accompanied by acute pharyngitis and tonsillitis.

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  It is known that phonological information processing has a significant influence on the development of the ability to read words. We report the case of a 6-year-old boy who had difficulty reading words written in Japanese syllabic symbols (kana) and who read syllable by syllable. While conducting initial examinations, we thought he had a delay in acquiring written language due to delayed language development. He was able to read individual kana aloud except for one particular kana, but he was only able to perform kana-by-kana reading and could not read whole words fluently. He also had difficulty understanding the meaning of words.
  Cognitive and spoken language development of the patient was evaluated by both intelligence tests and cognitive psychological tests. His performance IQ was within the normal range. However, his verbal IQ was in the lower boundary region, and his vocabulary was below the range for his age. Therefore, he was considered to have a specific language impairment. Cognitive development test results suggested that he had a phonological processing skills disability. Specifically, he had a mora segmentation problem, short-term verbal memory deficits, and reading disability due to a lack of vocabulary. We believe this led to his oral reading deficit.

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  The purpose of this study was to assess the air-bone (A–B) gap of infants by behavioral puretone audiometry. For six infants with hearing impairment (8–27 months of age), VRA (visual reinforcement audiometry) was used to assess minimum hearing thresholds of air/bone conduction across frequencies. The degree of the A–B gap was compared to subjective observations found by examinations by otoscopy, tympanometry, CT, MRI, genetic test and evoked potential test. In results, (1) an A–B gap was found in two infants with conductive/mixed hearing loss, (2) no A–B gap was found in two infants with moderate sensorineural hearing loss, and (3) bone-thresholds were unmeasurable (scaled out) in the other two infants with severe or profound hearing loss. (1)–(3) corresponded to other observations. The findings suggested that a cross-check by behavioral VRAs and subjective examinations is useful for differentiating types and degrees of A–B gap in infants.

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  The study includes 31 ears with acquired cholesteatoma (18 and 13 ears of male and female patients, respectively, ranging in age at surgery from 4 to 15 years old) that were treated with tympanoplasty in our department from April 2006 to March 2013. The patients were basically treated with the canal wall up tympanoplasty, and were treated with the planned staged tympanoplasty only when they showed stapes lesion. Fifteen (48%), 9 (29%), 5 (16%), and 2 (7%) of 31 ears were treated with WO ossiculoplasty, type I, type III, and type IV ossicular chain reconstruction, respectively. Eight (26%) of 31 ears showed persistence, and 6 of the 8 ears were treated with planned staged tympanoplasty but not with ossicular reconstruction at the first surgery, suggesting that progression of persistent recurrence could be regulated by staged tympanoplasty. Five (16%) out of 31 ears demonstrated recurrence. All these patients were 9 years old or younger, and the recurrence could be due to dysfunction of the Eustachian tube. Thus, careful consideration at surgery, attention to child-specific characteristics, long-term follow-up, and appropriate treatment are important.

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  Objectives: This study was designed to evaluate a surgical method of canal wall reconstruction (CWR) tympanomastoidectomy in the treatment of acquired pars flaccida-type cholesteatoma in children. Method: A retrospective review of acquired pars flaccida-type cholesteatoma in children from 2004 to 2010 was performed. Data included pre- and postoperative findings of the tympanic membrane and second-look surgery postoperative audiometry. Results: Thirteen ears with acquired pars flaccida-type cholesteatoma underwent surgery. Follow-up periods ranged from 3 to 9 years with a mean of 5.7 years. In one ear, of a patient with Down syndrome, the canal wall down method with mastoid obliteration was chosen, whereas in the other twelve ears, a second stage operation was planned. In the first operation, CWR tympanomastoidectomy using the temporal bony plate was performed. In these 12 ears, the recurrence rate was 80% in the group under 8 years old (five ears), whereas 28.6% in the group of 8 to 12 years old (seven ears). A pressure-equalizing tube was inserted postoperatively in five ears. Nine of 12 ears had improved stable aeration of the middle ear after the final ossiculoplasty. Postoperative air conduction hearing was within 30 dB in 7 ears, 31.7 dB in one ear, and 45 dB in one ear. We are still waiting for growth, especially the development of tube function, in the other three ears. Conclusions: In this study, patients younger than 8 years old had a higher risk of recurrence than the older group. Recurrence of cholesteatomas also seemed to be related to immature auditory tube function. In spite of the higher recurrence rate, if the patient's condition allows, it is better to wait for final ossiculoplasty until auditory tube function is mature because that would preserve the anatomy using CWR tympanomastoidectomy.

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