[in Japanese]

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  To evaluate long term results of surgical outcomes of retrograde mastoidectomy when using soft-wall reconstruction of the canal wall in pediatric cholesteatoma by retrospective case review. A total of 25 ears underwent cholesteatoma removal surgery employing soft-wall reconstruction. Average follow-up time was 96.2 months. The incidence of residual and recurrent cholesteatoma, postoperative hearing results (Guidline for Reporting Hearing Results in Middle Ear and Mastoid Surgery, 2010), and the form of reconstructed external canal wall and tympanum were assessed. Residual cholesteatoma was detected in 5 (20%) while recurrent cholesteatoma was occurred in 1 (4%) out of 25 ears. Success rate of the hearing outcome was 96%. The long term forms of the external canal wall were almost favorable without pathological changes. The form looks changed depends on the eustachian tube function and the middle ear pressure. The feature of the unsatisfactory hearing cases was disease extension to the mastoid and the eustachian tube. Retrograde mastoidectomy with soft-wall reconstruction is an effective technique that can be used to lower the recurrence rate of cholesteatoma in the pediatric population and good hearing outcome. However it is possibly difficult to improve hearing that cholesteatoma extent to the mastoid and the eustachian tube because of potential eustachian tube dysfunction.

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  Backgraund: Growth failure has been reported as a common complication of obstructive sleep apnea syndrome (OSAS), but few studies have reported on the effect of adenotonsillectomy (AT) on subsequent physical growth in children with OSAS who are under 7 years old. Objectives: The aim of this study was to evaluate the effect of AT on physical growth in children under 7 years old. with OSAS. Our study included 19 children (13 boys and 6 girls). We diagnosed OSAS based on adenotonsillar hypertrophy and an apnea-hypopnea index (AHI) ≥5 with type 3 portable monitoring. After AT, anthropometric measurements were performed in children 3, 6, and 12 months following surgery. Results: After AT, AHI significantly decreased from 18.9±15.3 to 3.4±1.6 (P<0.01). Three months after AT, body mass index (BMI) percentiles significantly increased from 43.9±26.1 to 55.6±22.5 (P=0.023). Twelve months after AT, standard deviation scores for height significantly increased from −0.26±0.94 to 0.006±0.63 (P=0.022). Conclusions: After AT, body weight increased sooner than height in patients under 7 years old, with OSAS.

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  A deep neck abscess in children rarely progresses to the mediastinum or leads to respiratory obstruction unlike adult cases. However, in immunodeficient children, this type of abscess sometimes recurs and advances a difficult-to-manage stage. We describe the case of a 13-year old boy who first presented with a left submandibular abscess and one year later with a posterior pharyngeal abscess. During both episodes, his condition required emergency drainage under general anesthesia. Staphylococcus aureus was isolated from both abscesses. The patient had had mosquito bite hypersensitivity and elevated IgE levels (20,000–60,000 IU/mL) without atopic dermatitis since infancy. His signs and symptoms were not consistent with the diagnostic criteria for hyper IgE syndrome. He may have immunodeficiency of an unknown nature, and careful clinical monitoring for recurrent deep neck abscesses is required.

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  A 3-month-old male infant presented with nasal infantile hemangioma accompanied by repeated nasal bleeding. Although several treatments are administered to treat infantile hemangioma including steroids, interferon, vincristine sulfate, laser cauterization, and surgical extirpation, there have been no recommended safe therapeutic strategies. In addition, surgical treatments for nasal infantile hemangioma may include cosmetic problems. We treated this infant with 1 mg/kg/day of a β–blocker (propranolol), and increased the dosage to 2 mg/kg/day after 1 week, which has been maintained for 12 months so far. The infantile hemangioma has apparently reduced in size, with almost no episode of bleeding. Propranolol could be one of the first-line choices for treatment of nasal infantile hemangioma.

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  In order to select precisely the right antibacterial drug for treatment of pediatric acute rhinosinusitis, we must constantly monitor the frequency with which drug-resistant bacteria are detected. Bacterial tests of purulent nasal mucus were performed for ?? pediatric acute rhinosinusitis patients examined at my hospital between January 2012 and December 2013, and bacteriological examinations were then performed for the 1347 patients from whom Streptcoccus pneumoniae or Haemophilus influenzae was detected to compare the results with those of the 2009–2010 survey. As a result, drug-resistant S. pneumoniae (DRSP) showed significant decreases in 2012 and 2013 compared to the 2009–2010 survey, although no such difference was observed for ampicillin-resistant H. influenzae. It will be necessary to continue monitoring the detection frequency of DRSP.

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  Oral bacteria may cause other infections including aspiration pneumonitis and infective endocarditis as well as tooth caries and periodontal disease. We report a case of recurrent bacterial meningitis due to pericoronitis of the wisdom tooth. A 16-year-old boy diagnosed with bacterial meningitis was referred to our hospital because neoplastic disease was suspected. Computed tomography and magnetic resonance imaging both showed bone destruction mainly of the fossa pterygopalatina. Tissue biopsy using a navigation system revealed no malignant findings. Bacterial meningitis due to a G group streptococcus recurred during follow-up. The relationship between the wisdom tooth and recurrent bacterial meningitis was pointed out at a multidisciplinary conference. The wisdom tooth with pericoronitis was extracted. C-reactive protein (CRP) decreased and meningitis has not recurred since tooth extraction.

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  A two-year-old girl was manifesting otorrhea, conjunctival chalazion and skin induration. She had not been diagnosed for a year, however, a biopsy from granuloma-like mass in the ear canal provided pathological definitive diagnosis as Langerhans cell histiocytosis (LCH). Further investigation revealed a pulmonary cyst in the right lung field and lytic lesion in the left temporal bone, suggesting that the type of the LCH was multiple system without risk organ. Chemotherapy according to the Japan LCH Study Group protocol led all of her LCH localization to total remission. CT scan of the temporal bone showed bone remineralization but the incus had disappeared. Thus, conductive hearing loss remained after the treatment. LCH is a rare and multifocal disease, more frequent in children and its prognosis worsens according to younger age. The initial clinical presentation could be only repetitive otitis with otorrhea. The present case suggested that a biopsy should be performed in the presence of a mass in the ear canal at the early stage, and long-term follow up with audiometry is necessary so as not to overlook hearing loss in children with LCH involving temporal bone.

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  Infantile hemangioma is the most common benign tumor of infancy and naturally regresses gradually in most cases. However, some atypical hemangiomas may become life-threatening and require immediate initiation of treatment. They used to be treated with laser, surgery, arterial embolization, radiation, vincristine, interferon-alpha, and/or steroids, which comprise some adverse effects. Propranolol, a non-selective beta-blocker, has been recognized as a first-line treatment of infantile hemangioma. It is non-invasive treatment with fewer adverse effects. We report successful treatment of a very large infantile neck hemangioma, which caused swelling of the epiglottis, with oral propranolol. The patient was a female infant with a neck hemangioma. Because the tumor progressed so rapidly that it compressed her airway, we performed a tracheostomy 21 days after birth. Oral propranolol was initiated on day 26 after birth, and we increased its dose from 1 mg to 3 mg. The tumor began to decrease in a few days. The hemangioma gradually shrank until it almost totally disappeared. Oral propranolol was continued for 6 months. No relapse has been observed.

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  Cornelia de Lange syndrome is a congenital disease that was first described by the Dutch pediatrician Cornelia de Lange. This syndrome is a multiple malformation disorder characterized by specific facial features, abnormalities of the limbs, mental retardation, and growth delay. It is also known to involve hearing impairment, but reports are scarce. We report the case of a 1-month-old infant suffering from this syndrome who was suspected of having a moderate hearing loss. His hearing has improved during the follow-up examination. When he was 4 years and 1 month old, his auditory brain stem response showed a normal threshold and latencies on both sides. Otolaryngological and audiological examinations are important in the treatment and prognoses of children with this syndrome who have sensorineural or conductive hearing loss.

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  We surveyed the current situation and methods used, as well as the status of educational institutions regarding medical check-ups, with the aim of increasing the level of interest toward the medical examination of spoken language in Niigata Prefecture and for increasing the implementation of such examinations at the time of medical check-ups. We administered a questionnaire survey to 20 members of the school health committee and found that 65% of them performed speech and language disability screening, and that 15% of them used picture boards. One member advised that his school performed medical examinations using a method of screening for speech and language disorders as part of the school health program. He asked the students to vocalize the phrase, “The name is XX,” and tested them using a picture board. The results revealed that the health examinations lasted approximately 10 seconds longer when a picture board was used, than when it was not used. The rate of detection of speech disabilities using this method was 1.3%, which was higher than the rate seen in Niigata City until that time.
  As a countermeasure taken in Niigata Prefecture, if a speech disability is detected during a medical examination, the subjects attend speech therapy training, as required, in a resource classroom. Some subjects may also require detailed examination at higher-level medical institutions. Going forward, we hope to work together with the school health committee, in particular, to increase our knowledge of spoken language abnormalities, and make further efforts to establish and increase usage of speech and language screening in Niigata Prefecture.

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【Rationale】The School Health and Security Law defines sound and language disorders as otorhinolaryngological disorders. However, checkups for these disorders have never performed sufficiently up to the present in Shizuoka Prefecture.
【Methods】This survey was carried out to disclose the present status and awareness of school doctors, because we need to expand these checkups for children. The questionnaires were delivered to 261 members of the Oto-Rhino-Laryngological Society of Japan in this prefecture.
【Results】We obtained 105 responses out of 261. 60% of them performed sound examinations including hoarseness and rhinolalia. This was a lower percentage than was expected despite its simple procedure. Furthermore, only 37% of them examined language disorders including articulation disorder and stammer. Although otorhinolaryngologists understand its importance to get involved in these communication disorders, they do not conduct these checkups satisfactorily at present.
【Conclusions】It is necessary to make details of these checkups known to school doctors and build up closer connections between boards of education and hospitals or rehabilitation institutes where children with these disorders will be treated. It is also important for otorhinolaryngologists to play leading roles in these communication disorders and perform these checkups regularly for school children.

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  We report a case of congenital chondrocutaneous branchial remnant. A 13-month-old infant had a lesion in the left neck since birth that gradually increased in size. We performed complete surgical excision, and there has been no recurrence during follow-up. The branchial cartilage is associated with the development of structures such as ossicles, hyoid, thyroid cartilage, and cricoid cartilage, but may on rare occasion remain in an external cervical subcutaneous site. This congenital lesion was first described in 1858. Various nomenclatures have been applied to this lesion but the term ‘cervical chondrocutaneous branchial remnants’ have recently been the most commonly used. It seems that it is necessary to standardize a Japanese name for this lesion. The clinical characteristics of cervical chondrocutaneous branchial remnants are: 1) male predominance, 2) presence at birth, 3) location in the middle or lower third of the neck anterior to the sternocleidomastoid muscle, and 4) similarity of the overlying skin to the surrounding neck skin and painlessness of the lesion, with neither inflammation nor discharge. Also, because this lesion is often associated with other malformations, attention is necessary regarding potential complications, although no other malformations were apparent in our case.

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