Down syndrome is reported to frequently involve comorbid hearing loss. Otitis media with effusion, a frequent comorbidity in children with Down syndrome, causes conductive hearing loss; is often intractable and bilateral requires hearing aids. When there is fluctuating hearing loss, we are often worried in the timing when to begin to wear hearing aids. For seven children aged for whom hearing aids were prescribed at our department, we examined the following items: timing of beginning to wear hearing aids, and the presence/absence and course of otitis media with effusion and linguistic development. Six of the seven children were afflicted with otitis media with effusion during the observation period; thus, conductive hearing loss associated with otitis media with effusion was strongly associated with hearing loss and the wearing conditions of hearing aids in children with Down syndrome. Children who began using a hearing aid at an early stage demonstrated favorable linguistic development. This may be connected to the result that early use of a hearing aid promotes linguistic development in children, whose hearing later improves. Most of otitis media serous were prolonged and repeated a recurrence.

Where there are bilateral otitis media serous that results in hearing loss, it appears that we should not hesitate about the introduction of wearing a hearing aid.

Surgical management of pediatric subglottic stenosis remains many challenging tasks to pediatric surgeons and otorhinolaryngologists. The children suffering from Myer-Cotton grade III and IV subglottic stenosis are put in the particularly difficult condition to be treated. The concept of partial cricotracheal resection with primary thyrotracheal anastomosis (PCTR) is to resect the cicatricial stenotic segment of the airway completely and to achieve a fully mucosalized reconstruction using thyrotracheal anastomosis. However, operative techniques and postoperative cares in PCTR for small infants are complicated, PCTR for severe subglottic stenosis in pediatric patients has been reported to have a high decannulation rate.

We performed PCTR in 5 patients with severe subglottic stenosis in children (one with congenital, and the other acquired) as a primary procedure. The silicone T-tube was temporarily used to maintain the airway expanded after surgery. We could successfully decannulate in all patients after surgery.

PCTR with T-tube stenting is one of effective and safe definitive procedures for the patients with severe subglottic stenosis in children.

Fatal accidents due to suffocation caused by foreign substances in the airways of children and accidents due to tracheal/bronchial foreign bodies occur approx. 20 and 100 or more times per year, respectively. To prevent such accidents, it is important to enlighten parents and caregivers of children. To date, the author has primarily been engaged in enlightening kindergarten teachers. In this study, we administered a questionnaire survey to 144 principals of national and public kindergartens in Mie Prefecture with respect to their awareness of foreign substances in the airway, countermeasures taken in their kindergartens, and the willingness of teachers to enlighten such accidents. Although the principals had abundant knowledge about accidents caused by foreign substances in airways, their attention and instructions for foods, such as school meals and box lunches, in kindergarten were less adequate than those for toys. It was found that bean-throwing/eating is performed in the Setsubun ceremony (the day before the beginning of spring) in most kindergartens. Although virtually no kindergartens have enlightened the parents to date, many principles suggested that it would be proper to promote such enlightenment at the health check-up, hospital, and kindergarten, in this order. In the future, I will continue with such activities so that teachers of kindergarten, children and their parents will be more aware of the prevention of accidents caused by foreign substances in an airway.

Objective: Subannular tube insertion is a surgical treatment for refractory otitis media with effusion, atelectatic tympanic membrane, and adhesive otitis media. We evaluated the clinical course and the efficacy of the procedure for cases in which subannular tube insertion was performed in our department.

Patients: This study included 11 patients (13 ears) aged 6–13 years who underwent surgery from December 2012 to December 2015.

Results: The tube remained in situ in one ear, and was naturally extruded or removed in 12 ears within the same period. The tubes remained in place for an average of 14 months. The improvement in the air bone gap was 13.9 dB (range –1.6 to 30 db). There were four cases of postoperative infection and no cases of permanent perforation following extrusion or removal of the tube.

Conclusions: Subannular tube insertion has a low risk of permanent perforation, and is well indicated in atelectatic tympanic membrane because the outcomes were good without reinsertion after extrusion or removal. However, most cases with adhesive otitis media required reinsertion and tympanoplasty. Therefore, the indication of subannular tube insertion should be carefully considered in these cases.

First branchial cleft anomalies present with lesions from the ear canal to the lower jaw. We report 3 cases of first branchial cleft anomalies requiring surgical treatment. [Case 1] In a 14-month-old girl, an otolaryngologist detected a 6.6 mm mass in the right external auditory canal. Under the diagnosis of auditory canal cholesteatoma, surgery (TEES) was performed. After 10 months, swelling appeared in the right cervical region. The swelling progressed to form an abscess within a month, and was treated by incision of the neck. [Case 2] A 22-month-old girl had a 4 cm mass on the lower pinna and a small horizontal fistula leading toward the neck was detected by imaging. The mass was resected and incision of the neck was performed to treat the fistula. [Case 3] In a 115-month-old girl, an otolaryngologist identified a mass containing serous fluid in the right external auditory canal. In addition, a vertical fistulous tract was observed by MRI. Surgery to remove these lesions was performed via a retroauricular incision.

When first branchial cleft anomalies are suspected, such as in a patient with who has a cystic lesion, MRI should be considered for confirmation, even if the preoperative diagnosis is cholesteatoma. While surgical treatment is required, the fistulas are located close to the facial nerve and symptoms develop during childhood in many cases. We should perform surgery with particular care after full evaluation of the positional relationship between the lesion and the facial nerve with reference to the Belenky classification.

Among pediatric patients, severely disabled children often develop sinusitis due to tracheotomy or nasogastric intubation. We herein report a case in which a patient developed repeated paranasal sinus infection. Paranasal sinus seemed to expand due to congenital cerebral hypomyelination.

The patient was a 13-year old girl with severe physical and mental disorder who had been diagnosed with seizure attack and dystonia from 7 months of age. Head MRI revealed hypomyelination with atrophy of the basal ganglia and cerebellum. At 13 years, she experienced recurrent fever. Head CT images revealed prominent bilateral paranasal sinus enlargement, mucosal hypertrophy and liquid retention and acute sinusitis was diagnosed.

Although these abnormal findings initially improved with antibacterial treatment, an exacerbation occurred. Due to a lack of improvement, endoscopic paranasal sinus surgery was performed. Although liquid retention remained after surgery, the frequency of infection significantly decreased with the oral administration of a small amount of macrolide antibiotics and expectorants. In infants with a history of central nervous system disorder, it is possible that the sinus cavities may expand due to brain atrophy and that the condition could become difficult to treat.

Otolaryngologists rarely encounter dizziness in children; however, central dizziness is more common in children than in adults. Therefore, its careful evaluation in children is necessary.

Here, we report the case of a 5-year-old girl who visited the pediatric department of our hospital on developing gait disturbance and dizziness after experiencing cold symptoms for 2 weeks. Gaze nystagmus symptoms were also noted. She received a diagnosis of mycoplasma infection-induced acute cerebellar ataxia and was immediately hospitalized.

She was referred to our otolaryngology department to undergo balance assessment on the 3^rd day. The patient’s nystagmus and dizziness had already disappeared, and her hearing ability was intact. However, she could not maintain a standing position and was unable to undergo any other balance tests on that day.

Intravenous steroid treatment was started from the 6^th day. The patient’s gait disturbance alleviated gradually, and she could undergo electronystagmography on the 8^th day and stabilometric analyses on the 15^th day.

Gaze or non-gaze nystagmus was not obvious; however, the results of the eye-tracking test (ETT) were poor. The result of stabilometry for the first time was poor study because she could not keep her balance to the last. The patient could walk without assistance and was discharged on the 15^th day.

A few months after the onset, the patient could run easily. On conducting open- and closed-eye stabilometric analyses, total trace length and circumference area were found to be improved, and the ETT showed improved perpendicular eye speed.

The neuro-otological examination was not effective for diagnostic testing; however, it was useful for establishing an objective index of the recovery process and estimating treatment effects.

We report the case of a four-year-old boy who was diagnosed as having a nasopharyngeal tumor during the treatment of otitis media with effusion. He was referred to our institution with nasopharyngeal cystic tumor found by MRI. Polysomnography showed Apnea-Hypoxia Index of 4.0/h, indicating the patient had mild obstructive sleep apnea. The patient underwent tumorectomy and bilateral tonsillectomy under general anesthesia. The tumor was located medial of right internal carotid artery and reached to superior pole of tonsil along right torus tubarius. A yellowish white viscous fluid leaked out when the tumor was removed, and it turned out to be a cyst. Pathology leads the diagnosis of branchiogenic cyst. It was further classified as Bailey type IV in the 2nd branchial cleft cyst according to the site of lesion. After the one-year clinical follow-up, there was no tumor recurrence.

In infants, oral injuries caused by chopstick or toothbrush are frequently observed at overturning. Several cases in which the objects penetrated deeply to reach the cranium or cervical spinal cord and in turn causing difficulties in accessing the remaining pieces of the foreign bodies have been reported. Some reports have described that blunt injuries caused by foreign bodies that did not penetrate led to emphysema or deep neck infection. Cases of tardive obstruction of the internal carotid artery have also been reported. Therefore, informed consent and careful observation are clinically significant in oral injury cases.

In this case report, we present two pediatric cases of oral injuries caused by chopsticks penetrating deeply to the head and neck and review the current literature regarding this type of cases. In one case, a foreign body reached in front of the clivus under the nasopharynx membrane and caused retropharyngeal cellulitis; the object was removed via the endoscopic transnasal approach. In the other case, a foreign body was located in the carotid space, which caused emphysema; the object was removed via external dissection. Both patients were discharged without any complications.

Laser cauterization of flaccid arytenoid mucosa is reported to be an effective surgical method for treating arytenoid type laryngomalacia. However, postoperative complications such as supraglottic strictures due to adhesions in the arytenoid region, as well as granulations have been reported. We describe 2 patients with acquired arytenoid type laryngomalacia, in whom cauterization of flaccid arytenoid mucosa and plication of both sides of the cauterized areas were performed. Preventative treatment was also provided to reduce the risk of granulations and adhesions in the arytenoid region. The first case involved a 2-year, 9-month-old girl who was originally healthy but had anoxic encephalopathy due to status epilepticus. She began receiving nasogastric intubation for nutritional support. Inspiratory stridor was observed 2 months after onset, and she was diagnosed as having arytenoid type laryngomalacia. A significant decrease of SpO2 was not observed, but due to the child’s severely labored breathing and the family’s wishes, a surgical treatment plan was chosen. The second case involved a 1-year, 3-month-old boy later diagnosed as having Joubert syndrome. When the child was hospitalized to undergo polydactyly surgery, inspiratory stridor and decreased peripheral oxygen saturation (SpO2) were observed, and he was diagnosed as having arytenoid type laryngomalacia. As his condition required oxygenation, a surgical treatment plan was deemed the best course of action. In both cases, the children’s respiratory conditions improved postoperatively. No relapses were observed. These cases indicate that modification of plication operations is effective in preventing the granulations that result in relapse, particularly in patients in whom nasogastric intubation will likely continue.