Background: Choanal atresia (CA) is a congenital obstruction of the posterior nasal apertures. Patients with bilateral CA often require surgical treatment in the early neonatal period because of neonatal respiratory distress and suckling difficulty. However, surgery in this period requires high risk management during and after the operation. The transnasal approach and stent placement are often chosen in infant patients. The most common complication is restenosis/reobstruction after nasal stent removal. We evaluated the timing of the surgical approach, duration of nasal stent placement and the stent size in patients with CA.

Methods: A retrospective review of 19 patients with CA was performed. Seven patients had unilateral atresia and 12 had bilateral atresia. These patients comprised 10 males and 9 females.

Results: The mean duration of stenting was 8.4 weeks in patients with unilateral CA and 13.4 weeks in those with bilateral CA. Two patients with unilateral CA and four with bilateral CA successfully maintained an open stent, and the mean duration of stenting among these patients was 11.5 weeks. Seven patients developed restenosis after stent removal, and three patients developed reobstruction, and their mean stenting durations were 12.4 weeks.

Discussion: We maintain a nasal stent after surgery for a longer period of time in patients with bilateral than unilateral CA because of their more severe respiratory distress and suckling difficulty. However, the duration of stenting and success rates are not proportional between the two groups of patients.

We evaluated the postoperative results in five children (age at surgery ranging from 6 to 15 years) with partial deafness showing ski-sloping or high-frequency hearing loss audiograms who underwent electric acoustic stimulation (EAS) surgery. Low-frequency residual hearing was preserved in all five children after surgery. The patients’ preoperative aided thresholds with hearing aid were not sufficient at higher frequencies. After surgery, however, aided thresholds with EAS became less than 45 dB at both low and high frequencies. In four cases with continuously worn hearing aid, the scores of monosyllable speech perception improved from 0%–55% preoperatively with hearing aid and 35%–55% preoperatively unaided hearing to 70%–95% at 12 months after surgery. In one case where the hearing aid was not worn, the scores of monosyllable speech perception improved from 55% preoperatively unaided hearing to 90% at 12 months after surgery. With regard to sound quality questionnaire answers from their parents, scores in all items improved, and the total scores improved from poor to moderate or good. We conclude that EAS is a useful treatment in children with profound high-frequency hearing loss.

Otitis media with effusion in palatal clefts has a high recurrence rate, and it is often necessary to inset a tympanic membrane ventilation tube during childhood. In the present study, we examined the subsequent course of ventilation tube placement performed in 144 ears of 73 patients. Out of these 73 patients, two (3%) received surgery in a single ear, whereas 71 (97%) received surgery in both ears. The mean total indwelling period of ventilation tube placement in the 144 ears was 43.5 months. Ventilation tube surgery was performed once in 116 (80%) ears, twice in 26 (18%) ears, and thrice in 2 (2%) ears. The recurrence rate following ventilation tube placement was compared in terms of cleft palate type, gender differences, and complications; however, no obvious significant differences were observed. Treatment of otitis media with effusion of a cleft palate is refractory, and various causes are cited in the literature, including the development of mastoid air cell, surgical methods for cleft palate and sinusitis, and allergic rhinitis. We believe that further examination by long-term follow-up is necessary to further increase the number of cases in the future.

A few cases of mixed infection by adenovirus (Adv) and Group A β-hemolytic streptococcus (Group A hemolytic streptococcus) in oropharynx have reported. I recently experienced two cases of mixed infection by Adv and Group A hemolytic streptococcus in epipharinx observed from endoscope. Patient 1 was a 2-year-old male infant brought to the hospital with the chief complaint of fever. Nasopharyngoscopy revealed white spots on the pharyngeal tonsils. Test for rapid diagnosis of Adv using the white spot specimens was found to be positive, and bacteriological examination revealed the presence of Group A hemolytic streptococcus. The patient recovered after a 10-day course of amoxicillin (AMPC). Patient 2 was a 5-year-old male child with chief complaints of fever and headache. Nasopharyngoscopy revealed purulent postnasal drip. Test for rapid diagnosis of Group A hemolytic streptococcus using the purulent postnasal drip specimens was found to be positive, and AMPC was initiated. The patient was re-examined after two days as the fever had not subsided. Since it was the epidemic season for Adv infections in the medical district under which this hospital falls, test for rapid diagnosis of Adv using a nasopharyngeal swab was performed, which was found to be positive. The fever abated on the fourth day of the illness. Therefore, even in patients showing no inflammation of the oropharynx associated with Adv infection, it is important to perform thorough investigations for the presence of other infections concomitant with nasopharyngeal bacterial infections.

Vocal fold paralysis is relatively rare in the pediatric population, and there are few instances of surgical intervention for glottic insufficiency in children. As a result, the pediatric literature on this condition is scarce.

We performed autologous fat injection laryngoplasty for a 9-year-old boy who experienced unilateral vocal fold paralysis. The patient developed dysphonia and aspiration following cardiac surgery at age 3 years. His condition remained unchanged for over 5 years. The left vocal cord was immobile at the paramedian position, and had atrophied. The GRBAS scale was G2R1B2A1S0, and the maximum phonation time (MPT) was 4 seconds.

We obtained a block of autologous fat from the lower abdomen by incision, and divided it into smaller sections. The particles of fat were injected into the left vocal fold by endolaryngeal microsurgery.

After the injection, the patient’s vocal quality improved to G1R1B1A0S0, and the MPT to 8 seconds. The frequency of aspiration also decreased significantly.

Autologous fat injection laryngoplasty is preferable for pediatric unilateral vocal fold paralysis because laryngeal frame surgery can interrupt normal laryngeal growth in puberty. Following this procedure, the patient should be monitored closely for possible airway obstruction. Long-term follow up is also required due to possible fat absorption and the effect of laryngeal growth in puberty.

LCH is a rare and proliferative disease of monoclonal cells and mainly occurs during childhood. Its clinical manifestations are highly variable, extending from very benign forms to a disseminated, aggressive disease that causes significant mortality. It manifests as an incurable otitis externa or mastoiditis in rare cases. A four-month-old girl was presented refractory otitis externa, an excisional biopsy from the ear canal mass provided that the diagnosis as LCH. Because of its highly variable clinical manifestation, it is sometimes difficult to diagnose LCH. Therefore, when a pediatric patient presents with refractory otitis externa or mastoiditis, otorhinolaryngologists should perform a biopsy of the ear. Late symptoms occur in 70% of LCH patients. A commonly ocurring late symptom is diabetes insipidus, and the second most common is hearing loss. Therefore, long-term follow-up is recommended in LCH patients.

Herpetic gingivostomatitis and pharyngolaryngitis are the most common clinical manifestations of primary herpes simplex virus (HSV) infection. Herpetic gingivostomatitis is characterized by the presence of multiple ulcer and stomatitis of the oral mucosa and frequently accompany swelling gingiva. Herpetic pharyngolaryngitis is characterized by the presence of multiple painful ulcer and stomatitis of the pharynx and larynx with the high fever and the poor state.

Detections of serum HSV antibodies are useful for the diagnosis of HSV infection. But it takes a week until serum anti HSV-IgM change to positive. So, for the accurate diagnosis of primary HSV infection, clinicians must wait for a week to check serum anti HSV-IgM. By taking care on this point, we diagnosed 5 pediatric patients as primary HSV infection.

Here we report 5 pediatric cases of HSV infection, 4 cases of gingivostomatitis and 1 case of pharyngolaryngitis. Nasopharyngolaryngo endoscope was useful in diagnosis of herpetic pharyngolaryngitis. The patients were 1 male and 4 females, aged from 2–17 years old. All patients had fever over 38 degrees centigrade, 4 patients complaint of sore throat and 3 patients had difficulty in oral intake. All patients were treated with acyclovir or valaciclovir and 1 patient with anti-biotics due to secondary bacterial infection. 2 patients were treated ambulatory and 3 patients were treated in the hospital. All patients recovered with no sequelae.

Most airway foreign bodies occur in children younger than 3 years of age. Early diagnosis is important to avoid respiratory problems and exacerbation of inflammatory responses that result from phagocytosis of the foreign material. We managed a patient with an airway foreign body that had not been diagnosed or treated for more than 8 months.

A 3-year-old girl with trisomy 21 and asthma was admitted to the pediatric department of our institution after presenting with wheezing and dyspnea. Approximately 8 months ago, she was taken to a nearby clinic for wheezing and hoarseness, and had received treatment for an asthma attack. As the respiratory symptoms worsened after hospitalization, she was referred to the Department of Otolaryngology for upper airway evaluation. A laryngeal fiberscopy revealed a foreign body situated between the vocal folds. The foreign body was a star-shaped spangle and was removed under general anesthesia. The respiratory symptoms immediately resolved after the procedure. Early diagnosis of airway foreign bodies is difficult in children, especially in those with mental retardation, as it is not easy to understand their complaints.

This case highlights the importance of considering an airway foreign body in the differential diagnosis in patients with prolonged wheezing. Accordingly, a computed tomography scan or fiberscopic examination should be considered for such patients.