[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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[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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 To clarify presentations, organisms, locations, and surgical approaches to neck abscesses in children, a retrospective chart review was conducted. The records of 10 children (5 males and 5 females, ranging in age from 3 months to 14 years old, mean age 5 years and 3 months) with neck abscesses during the period between January 2006 and December 2014 at Nara Medical University Hospital were retrospectively.
 Signs and symptoms commonly reported were fever (8 cases), neck swelling (7 cases), odynophagia (3 cases), dysphagia (2 cases), neck pain (1 case), decreased range of neck motion (1 case), and decreased oral intake (1 case). The most common organism cultured from the discharge was Staphylococcus aureus (4 cases), followed by Streptococcus pyogenes (2 cases). Four cases were reported to have no growth after incubation. All the patients had a computed tomography (CT) scan with intravenous contrast-enhancement. Abscesses were located in the posterior cervical space in 7 cases, retropharyngeal space in 4 cases, anterior cervical space in 2 cases, and parapharyngeal space in one case. All the patients received intravenous antibiotics and surgical drainage. Intraoral drainage was performed on all patients with abscess in the retropharyngeal space (4 cases) under general anesthesia. The other six cases underwent external drainage. Five of six cases were operated on under local anesthesia. No patient required two surgical procedures or tracheotomy. There was no mortality in this series of patients.
 Early diagnosis with the help of contrast-enhanced CT scan and prompt surgical drainage are essential to treat neck abscesses in children. Drainage under local anesthesia led to prompt recovery.

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 The transition in operative procedures in 23 pediatric patients with congenital cholesteatoma (CC) who were primarily operated on in the five years before this study was investigated, and the surgical strategy for treatment of the disease is discussed.
 Among operative procedures, microscopic endoscope-assisted ear surgery was primarily performed in most cases from 2009 to 2011. We selected transcanal tympanoplasty, transcanal atticotomy, or canal wall up tympanoplasty according to the extent of the cholesteatoma; however, no trend toward a particular surgical method was observed. On the other hand, the rate of transcanal endoscopic ear surgery (TEES) has been gradually increasing since 2013 and accounted for 80% of all surgeries in 2014. Early diagnosis of CC is now possible because of the development of diagnostic tools such as the high-vision endoscope attached to a monitor. Using Potsic's staging system to determine the CC stage, we categorized more than 50% of CC cases as Stage Ⅰ or Ⅱ. Therefore, the surgical procedure was limited to the tympanic cavity, and an increase in the proportion of en-bloc resections for cholesteatoma was observed. However, cases in which cholesteatoma extends to the attic or mastoid cavity require mastoidectomy with preservation of the posterior wall of the external ear canal. The surgical method should be selected in accordance with the status and extent of the cholesteatoma.

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 A five-year-old boy who had been diagnosed as bilateral peanut-shell microtia and low-set ears visited our out-patient ENT clinic complaining of right otalgia, fever up to 39℃, and difficulty in opening his mouth. His first manifestation was right meatal stenosis with otorrhea and debris, demonstrating the potential existence of a cholesteatoma in the external auditory canal. A CT scan of the temporal bone revealed an extensive abscess in the right external and middle ear. He also had left meatal stenosis, but it was not accompanied with otorrhea or debris. After intensive conservative treatment of the right ear and medication for 10 days, a CT scan revealed that inflammation had almost disappeared in the right external and middle ear. After discharge from the hospital, conservative management for cholesteatoma of the external auditory canal was continued. When he was 12 years old, reconstruction of the auricle and external auditory canal was performed. The definitive diagnosis of cholesteatoma of the external auditory canal was not made at an early phase due to the difficulty of otologic observations with severe meatal stenosis. It is rare that cholesteatoma-related inflammation leads to extensive abscess in the external and middle ear in children with microtia accompanied by meatal stenosis. The present case suggested that, in microtia cases accompanied by meatal stenosis but not meatal atresia, ENT doctors need to pay attention to the potential for cholesteatoma when otorrhea, debris, or abscess is present.

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 A 10-month-old boy presented with chief complaints of fever (39℃) and nasal discharge during his initial visit. Purulent nasal discharge was found in the middle meatus, and pus and adhesions were found in the nasopharynx. A rapid diagnostic test for group A β-hemolytic streptococcus (group A hemolytic streptococcus) performed on the nasopharyngeal samples showed positive findings. Based on these findings, group A hemolytic streptococcal infection was suspected, and the patient was treated with clavulanic acid/amoxicillin (1:14) (CVA/AMPC [1:14]). After oral administration for 3 days, the fever still persisted, and the patient underwent a re-examination. Bacteriological tests conducted on the purulent nasal discharge and pus from the nasopharynx during the initial visit showed presence of group A hemolytic streptococcus. The minimum inhibitory concentration of AMPC was 8 μg/mL. The leukocyte count was 33,300/μL (granulocytes: 58.3%), which indicated leukocytosis with a predominance of granulocytes; therefore, the condition was diagnosed as acute nasopharyngitis caused by group A streptococcus resistant to penicillin (PCs). Ceftriaxone was administered by intravenous drip infusion for 2 days, and the fever declined. Thereafter, tebipenem pivoxil was administered for 7 days, and the patient cured. The results of the drug susceptibility tests indicated that the group A hemolytic streptococcus detected was resistant to PCs, but since no genetic analysis was performed, the bacterium could not be identified. In the future, caution should be exercised during drug susceptibility testing of group A hemolytic streptococci.

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 The vascular pathology was observed using an electronic endoscope with normal light and narrow band imaging (NBI) in 77 patients with pediatric epistaxis aged 15 years or younger who visited the outpatient clinic of our department over the past 6 years, and the characteristics of the frequent development sites and 6 types of vascular morphology classification were clarified. The development site was located near the mucocutaneous junction of the anteroinferior nasal septum and near Kiesselbach's area in more than 95%. The vascular morphology was the linear type in 39 patients (50.6%), reticular type in 34 (44.2%), granular type in 2 (2.6%), punctate type in 1 (1.3%), and aneurysmal type in 1 (1.3%). The recessed type was not observed in any patient, and all cases were venous hemorrhage. Based on the frequent development site of pediatric epistaxis and its vascular pathology, the thumb press maneuver (TPM): pressing the nasal ala to the median nasal septum with the thumb on the affected side while opening the palm and setting the other fingers at the contralateral mandibular angle and pinching the held region, is rational and effective to achieve hemostasis for the initial treatment of pediatric epistaxis.

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