A hearing checkup is conducted at the three-year-old health examination. However, there are some cases where hearing loss is overlooked until the school entry health checkup. In this study, we investigated three hearing-impaired children whose hearing loss was not identified until school age. They were of also, they had been identified as suffering from intellectual disabilities and were suspected of having Attention-Deficit/Hyperactivity Disorder (AD/HD) and Autism Spectrum Disorder (ASD) in two cases. Important to note is that none of the children underwent in-depth hearing evaluation. We examined their hearing levels and provided hearing aids or cochlear implants where applicable. We also provided behavioral and speech-language therapy. Prior to hearing assistance and behavioral therapy, accurate hearing and developmental/intelligence tests were impossible. However, post intervention, problem behavior was reduced, and we were able to get accurate results for the hearing and developmental/intelligence tests. Finally, we found that two of the three children did not suffer from intellectual disabilities, ASD or AD/HD. Third child continue to display signs of previous diagnoses despite hearing intervention. In cases where individuals display signs of language delay or hearing loss during medical checks, an in-depth hearing evaluation should be conducted by a hearing professional as soon as is practicable.

We have been enlightening teachers and parents of the children in kindergartens/nursery schools in Mie Prefecture on foreign bodies in the airways mainly through lectures. To provide continuous and effective education, we prepared an edifying picture book, “Tsubukkochan,” in November 2017. To examine the efficacy of enlightenment through the use of the picture book, we distributed this picture book to 79 national and public kindergartens, in cooperation with Mie Prefecture, and administered a survey questionnaire to the teachers after they read the picture book (collection rate: 94.9%). The kindergartens that held an event to scatter roasted soybeans to drive demons away on the day before the calendric beginning of spring, before and immediately after distribution of the picture book, and planned to hold the event again the next year or later accounted for 85.3%, 69.3%. and 42.7%, respectively. The kindergartens in which the children ate lucky soybeans before and immediately after distribution of the picture book, and for which such an event was planned for the next year or later accounted for 52.0%, 49.2%, and 17.3%, respectively, showing a significant decrease. The kindergartens that provided instruction/countermeasures for children with respect to food intake, use of toys, etc. increased after distribution of the picture book. The kindergartens that did not perform enlightenment for parents and training for teachers tended to decrease significantly. A picture book is an effective enlightening tool to impressively demonstrate the high risk of a foreign body in the airway and the importance of the prevention of accidental ingestion.

Wideband tympanometry (WBT) is a new middle ear analysis technique that was developed to obtain information about pathological conditions of the tympanic membrane (TM) and middle ear across the wide frequency range, using absorbance measurements. The current study aimed to establish Japanese WBT normative data in infants and children and classify absorbance graphs into different types based on severity of otitis media with effusion (OEM), utilizing both WBT and an endoscopic examination of the TM. Normal Japanese infants and children (6 to 35 months) as well as those with OME with different severity were examined by Titan WBT (Interacoustics A/S) combined with an endoscopic examination of the TM. Total number of 116 ears were studied: normal (n=57 ears); retracted TM (n=23 ears), mild OME (n=10 ears), sever OME (n=22). Four ears were not classified. The results revealed relatively increased absorbance in the frequency range from 1000 Hz to 2000 Hz in Japanese normative data, compared to age-matched Caucasian normative data provided by the manufacture. The absorbance graphs were successfully classified into 4 types: normal (type 1); retracted TM (type 2); mild OME (type 3); severe OME (type 4). It was found that WBT could offer more information regarding TM and middle ear status, compared to conventional single-frequency tympanometry, due to the examination across the broader frequency range in WBT.

It is known that trachea-innominate artery fistula is one of the most fearful complications after tracheostomy and laryngotracheal separation. We report a case of trachea-innominate artery fistula in a 13-year-old girl with severe motor and intellectual disabilities: cerebral palsy, severe mental retardation, refractory epilepsy etc. Because of acute respiratory failure, she was emergently hospitalized, intubated and mechanically ventilated. Since extubation under such conditions was judged difficult, she first underwent tracheostomy and then, for the purpose of preventing an aspiration and improving respiratory status, laryngotracheal separation was performed. Approximately 2 months after the surgery, she experienced massive tracheal hemorrhage. The hemorrhage was temporarily controlled by hyperinflation of the tracheostomy tube balloon. Division of the innominate artery, ascending aorta-subclavian artery bypass, and restoration of the tracheal fistula were performed. Fortunately, her postoperative course was uneventful.