The school health committee of the Oto-Rhino-laryngological society of Japan conducted questionnaire surveys to investigate medical care and reasonable accommodations at school, and involvement of school otorhinolaryngologist to the students with tracheostomy in July, 2017. We carried out the survey to 56 school otorhinolaryngologist and 20 school boards of ordinance-designated cities and Setagaya-ku.

Seven out of 56 (13%) school otorhinolaryngologists are in charge of ordinary schools where students with tracheostomy are attended. Only two school otorhinolaryngologists are registered as cooperating medical doctors for the students with tracheostomy. Thirty-seven school otorhinolaryngologists said they thought they would be able to register as cooperating medical doctors for the schools. Others thought that it would be hard to become a cooperative medical doctor, because of busy schedules and lack of experience or knowledge.

In 9 of 21 investigating cities, there were some students with tracheostomy in the ordinary classes. In 14 cities, some students with tracheostomy belonged to the special support class in the ordinary school. There were some requests from school boards, for example providing medical instruction at the school where student with medical care belonged to, and participation in the school committee for medical care students.

Objectives: We investigated vestibular function and gross motor development as well as the presence of cochlear malformation and auditory function in five children with aplasia of the semicircular canals.

Subjects: The subjects comprised five children with congenital hearing-impairment, in whom temporal bone imaging revealed aplasia of the bilateral semicircular canals. CHARGE syndrome was diagnosed in four of the five patients.

Methods: 1. Evaluation of vestibular semicircular canal function: Damped rotational chair test. 2. Evaluation of gross motor development: The ages at acquisition of head control and independent walking were used as indicators of motor development. 3. Evaluation of middle ear and inner ear morphology by temporal bone CT. 4. Auditory evaluation.

Results: 1. The results of damped rotational chair test revealed that all five subjects had no response, and decreased function of the vestibular semicircular canals was diagnosed. 2. The mean age of acquisition of head control was 10.2±7.9 months, and the mean age of acquisition of independent walking was 30.5±13.4 months. 3. Temporal bone CT findings showed that normal cochlear morphology in two ears, cochlear hypoplasia type I (CH-type I) in two ears, CH-type III in four ears, and CH-type IV in two ears. 4. Regarding hearing ability, three subjects had moderate bilateral hearing loss, and two had severe bilateral hearing deafness. All five subjects wore hearing aids. Cochlear implant surgery was not performed in any subject.

Conclusion: 1. All five subjects with aplasia of the semicircular canals showed severe deterioration of vestibular semicircular canal function, and acquisition of head control and independent walking was significantly delayed. 2. Auditory evaluation of five subjects revealed moderate to severe hearing impairment. Temporal bone CT findings revealed that there were cases with cochlea malformations ranged from normal to CH-type I-IV.

Generally, removal of the submandibular gland has been performed to treat submandibular hilar stones or stones in the deep portion of the Wharton duct. Minimally invasive surgery, such as sialendoscopic or transoral surgery, has recently been adopted. Because the salivary stones of children are relatively small and there is a strong demand for minimally invasive surgery from parents, there is a good indication for minimally invasive surgery in children. Sialendoscopic surgery does not require an incision or carry the risk of nerve paralysis, but salivary stones >5 mm in size are difficult to extract if not decimated by laser. Many stones are difficult to extract, such as cases in which it is difficult to secure a field of view or when the salivary stone cannot be grasped with a basket forceps. With transoral surgery, if it is possible to palpate stones at the bottom of the mouth, it is possible to remove the stones at the transition and deep parts; however, with this method, small stones which cannot be palpated cannot be removed and there is a risk of lingual nerve paralysis. For this reason, a combined approach involving sialendoscopic and transoral surgery has been reported. First, surgery is carried out using a sialendoscope, and in cases in which it is impossible to extract stones, a surgical procedure is continued with transoral surgery. Therefore, we examined the merits and disadvantages of the surgical procedure, the selection of the procedure, and the post-operative course for each minimally invasive surgical procedure for deep submandibular and transitional salivary glands of children and young adults treated in our hospital.

In the present study, we investigated the articulatory acquisition in three-year-old children who received municipal medical check-up from 2011 to 2016. The percentage of three-year-old children with articulatory errors gradually increased from 59.5% in 2011 to 84.1% in 2016. Although articulation of /k/ and /ɡ/ is believed to be acquired around the age of 3-year-6-month, 52.3% an 23.9% of three-year-old children enrolled in 2016 could not properly pronounce /k/ and /ɡ/, respectively. Because 24.3% and 5.4% of three-year-old children enrolled in 2011 had articulatory errors of /k/ and /ɡ/, respectively, it is suggested that the articulatory acquisition was delayed in Japanese children recently. The delayed articulatory acquisition may be related to insufficient exercise and poor communication with the adults around one in the childhood.

We herein describe the course and management of four patients in whom congenital rubella syndrome (CRS) appeared during the 2012–2013 rubella epidemic. All the patients had various presentations including cataract, congenital heart disease, development delay, and severe and progressive hearing loss. The patients’ hearing assessment was difficult due to the presence of multiple concurrent conditions. The present study underscored the importance of continuing audiometric testing by incorporating objective tests and of weighing the need for a method of communication or the use of a hearing aid in patients with overlapping conditions. Appropriate management of each condition in the present cases resulted in gradual progress in the patients’ development. An ongoing management plan which includes infection control measures is necessary to prepare pediatric patients with CRS to enter school and make a smooth transition to a nearby care and education institution.

This report presents the case of a one-year-old boy who developed mediastinal emphysema following pharyngeal injury caused by a toothbrush.

Immediately after falling with a toothbrush in his mouth, there was no bleeding and the child was able to feed by mouth. However, he was brought to a general hospital as he gradually started to experience weakness. A laryngoscopy examination revealed blood adhering to the nasopharynx. As a computer tomography (CT) scan showed emphysema extending from the retropharyngeal space to the mediastinum, the child was transferred to our hospital. However the child was awake, alert and in no respiratory distress on arrival at our hospital, his condition gradually got worse. Out of concern for further worsening of general condition, emphysema enlargement and airway constriction caused by crying, emergency tracheal intubation was performed. Another laryngoscopy examination revealed posterior pharyngeal wall enlargement just below the adenoid and laryngeal edema rapidly progressed within minutes. Under sedation and artificial respiration, the child underwent conservative treatment and improvement of the pharyngeal edema was observed on the seventh day after the injury. The child was discharged on the 19^th day.

In children, there is a risk that a pharyngeal injury that seems mild may develop into a serious condition. Therefore, especially in mediastinal emphysema cases, preparation for rapid intubation management should be in place, in consideration of sudden worsening of respiratory status.

Intracranial complications of acute otitis media are rare. However, the mortality rates are high and it may lead to neurological sequelae, early diagnosis and appropriate treatments are important. Herein, we report a case of acute otitis media complicated with mastoiditis and sigmoid sinus thrombosis. The patient was an 11-year-old girl who came to our hospital complaining of headache and vomiting. The day before admission, she was diagnosed with acute otitis media and was prescribed oral antibiotics. On admission, she was conscious and clear with no fever, and had no signs of meningeal irritation. We diagnosed right otitis media and mastoiditis by computerized tomography and started administration of broad-spectrum antibiotics. Next day, MRI revealed right sigmoid sinus thrombosis, and we started anticoagulant therapy with heparin. We performed anticoagulant therapy for 7 days, and administered antibiotics for 14 days. She discharged with no neurological sequelae. The thrombus disappeared on MRI of day 26. In conclusion, although sigmoid sinus thrombosis is rare, it should be considered as a possible cause of severe headache or vomiting with acute otitis media. In addition, treatment with broad-spectrum antibiotics and anticoagulant therapy might be useful for children with sigmoid sinus thrombosis.

Pyriform sinus fistula is a congenital disease derived from the third or fourth branchial cleft. It often develops after childhood with recurrent thyroiditis. In neonatal onset, respiratory symptoms and neck swelling are the chief complaints. The general treatment is fistulectomy, but recent reports suggest cauterization with trichloroacetic acid, silver nitrate, laser, and radio knife. Cauterization is superior in esthetics and invasiveness. However, in Japan, there have been no reports of cauterization performed in neonates.

We report a case of pyriform sinus fistula in a neonate with dyspnea. No perinatal abnormalities were detected. Five days after birth, dyspnea and neck swelling appeared. Computed tomography revealed a 40-mm cyst with niveau. The trachea was evaginated by a cyst and required tracheal intubation. The neonate was treated with cauterization using silver nitrate. Although there was a relapse after feeding was resumed, no recurrence was observed after the second cauterization.

We consider cauterization as a treatment option for pyriform sinus fistula in neonates. The long-term prognosis is unknown, and further case reports are awaited.

Obstructive sleep apnea (OSA) in children can be exacerbated by upper respiratory tract infection. This report describes a pediatric case of OSA complicated by onset of infectious mononucleosis (IM) that led to marked exacerbation of respiratory disorder.

A 2-year old patient presented with a 6-month history of OSA symptoms. Physical examination at the first visit revealed severe adenoid hypertrophy and Brodsky grade 3 palatine tonsil hypertrophy. A simplified sleep test was performed 7 days after the initial visit, showing that the oxygen desaturation index with >3% drop in oxygen saturation was 23 and the lowest oxygen saturation was 80%, leading to a diagnosis of OSA due to adenoid and palatine tonsil hypertrophy. Treatment was started with nasal corticosteroid administration, while adenotonsillectomy was planned approximately 2 months later (around the age of 3 years), and this plan was explained to the patient’s guardian. Eight days after the first visit (the day after visiting our department), however, the patient had a fever of 39.4°C, pharyngeal pain, bilateral hen’s egg-sized parotid swelling, and wheezing while awake, and thus was referred and admitted to the pediatric department. On day 5 of the hospitalization, elevated Epstein-Barr virus viral-capsid antigen was found, leading to a diagnosis of IM complicating and aggravating OSA. Continuous positive airway pressure was attempted until day 5 of the hospitalization but the patient refused wearing the mask. Nasal high-flow therapy was thus started, leading to improvement in the respiratory condition. On day 22 of the hospitalization, adenotonsillectomy was performed. The postoperative course was favorable with improvement in OSA symptoms. In pediatric patients, onset of upper respiratory tract infection can promptly worsen OSA to be severe and necessitate immediate treatment. The keys to successful immediate treatment are close communication with the pediatrician and the anesthesiologist as well as prompt selection of appropriate treatment.