Innominate artery fistula is a rare but severe complication after tracheostomy or laryngotracheal separation. As rupture of the artery causes lethal bleeding, it is important to prevent bleeding by surgical ligation of the artery. In the present study, with the aim of safe management for a tracheal cannula we retrospectively reviewed the medical records of six patients with severe motor and intellectual disabilities (SMID) in whom innominate artery ligation was performed. We also evaluated the symptoms, fiberscopic findings of the trachea, and imaging findings. In one case, tracheoinnominate artery fistula was diagnosed and an emergency operation was performed. Prophylactic surgery was done in other cases. In all the cases, some findings such as erosion, ulceration, in the anterior wall of the trachea, and tracheal stenosis due to compression by the upper shift of the innominate artery were identified during fiberscopic examination. Postural changes, such as scoliosis or retroflexion of the head were also detected in all the patients. A small amount of precede bleeding was detected in three of the six cases. The median value of the Cobb angle was 61.0° in radiographs, and the diameter of the thorax was 18.7 mm, the anteroposterior distance of the trachea was 5.0 mm in the CT scan, which was correspond to risk factors reported in previous studies. The long duration of insertion of the tracheal cannula increases the risk of innominate artery fistula. Hence, physicians should frequently assess the inner lumen of the trachea by using fiberscope, order the CT scan, and decide the indication for innominate ligation surgery.

The indications for cartilage conduction (CC) hearing aids have not been clearly determined. In this study, we evaluated CC hearing aids using standard methods for air and bone conduction (AC and BC) hearing aids, after which we estimated the indications for CC hearing aids. The two evaluation methods were as follows: 1) the vibration emitted from the transducer was translated into sound and the output level was measured using a 2 cm³ copular (as with AC hearing aids), and 2) the vibration emitted from the transducer was evaluated using an artificial mastoid (as with BC hearing aids). In CC, the transmission pathway to the cochlea depends on ear structure. When the sound is transmitted via the eardrum, the output level should be evaluated using the AC method. In this case, CC hearing aids could provide adequate amplification for a mild to moderate hearing loss. Furthermore, CC hearing aids can be used in individuals with severe hearing loss when the audiogram shows loss of low to middle tones. In other ears, the output level should be evaluated using the BC method. Here, CC hearing aids can be effectively used in ears with normal BC thresholds.

We evaluated bacterial pathogens associated with pediatric conjunctivitis-otitis media syndrome and pediatric acute conjunctivitis without acute otitis media. Thirty-three cases of conjunctivitis-otitis media syndrome (age range 6–41 months, mean 16.2 months) and 120 cases of acute conjunctivitis (age range 1–36 months, mean 15.0 months) were studied. Of 33 bacterial cultures of conjunctival swabs taken from patients with conjunctivitis-otitis media syndrome, 27 (81.8%) yielded at least one pathogen, including Haemophilus influenzae (H. influenzae) in 25 patients (89.3%), Streptococcus pneumoniae (S. pneumoniae) in 3 patients (10.3%), and Moraxella catarrhalis (M. catarrhalis) in 1 patient (3.4%). Twenty-six of the 27 bacteria cultured from the conjunctival swabs matched those detected in the nasopharynx.

Of cultured samples from patients affected by acute conjunctivitis without acute otitis media, 64.7% (84/120) yielded at least one pathogen including H. influenzae in 64 patients (68.8%), S. pneumoniae in 16 patients (17.2%), M. catarrhalis in 5 patients (5.4%) and other bacteria in 8 patients (8.6%). We compared detection ratio of H. influenzae to S. pneumoniae in conjunctival swabs based on ages and found the detection rate of H. influenzae to increase with age.

In children with conjunctivitis-otitis media syndrome, H. influenzae was most frequently detected in conjunctiva and nasopharynx, making it the most significant pathogen in acute cases of the condition. H. influenzae was more common in younger children with acute conjunctivitis. We speculate this may be secondary to lysozymes with bacteriolytic effects against S. pneumoniae and but not against non-typable H. influenzae which lack capsules. In younger children with acute conjunctivitis, S. pneumoniae was detected more often in the conjunctival swabs. This may be due to a lower lysozyme concentration in infant tears as compared to elder children.

Trisomy 18 Syndrome is an autosomal disorder found in 1 in 3,500 to 8,500 babies in Japan. They present with hearing loss in addition to the merger of multiple system abnormalities, such as the heart, digestive tract, and kidney. In this study, we evaluated the effect of hearing aids on seven children with hearing loss due to this disease. The type of hearing loss showed conductive or mixed hearing loss. We examined the history up until the first use of hearing aids, the hearing aid compatibility examination as well as the questionnaire from family members. The ages hearing aids were introduced ranged from 10 months to 4 years old. CT examinations were performed in 4 cases, which showed constriction of the ear canal and conjunctival malformation. Two types of hearing aid models were used namely bone conduction hearing aids, in 4 cases, and air conduction hearing aids, in 3 cases. The questionnaire from families showed that about 70% of the cases had some response to human voices or other sounds. And more than half of these cases, the family members felt there were positive effects in regards to children wearing hearing aids. Trisomy 18 children have significant cognitive developmental delay. However, among them, there are also reports where body language and emotional reactions are the main form of communication. Under such circumstances, it is thought to enhance communication with their families when hard-of-hearing babies wear a hearing aid. Therefore, once it is clear that a child has a hearing disability, we can encourage them to use a hearing aid and it will improve the child`s growth and development.

This study evaluated data from 44 children with Down syndrome who visited Osaka university hospital department of otorhinolaryngology from January 2008 to December 2018. We evaluated hearing thresholds, progress and interventions. 94% (42/44) had mild or more hearing loss. Hearing aids were introduced in 17 of 20 patients with bilateral moderate or more hearing loss. Three patients were performed cochlear implantation eventually. In 5 cases, it was finally judged that hearing aids was unnecessary, and they stopped wearing hearing aids. Of the children who passed the newborn hearing screening (NHS), 31% (5/16) had bilateral moderate or more hearing loss. Therefore, all children with Down syndrome should be evaluated for hearing in the otolaryngology department, even if they passed the NHS. And if necessary, hearing aids should be introduced without hesitation. It is necessary to keep regular follow-up, keeping in mind that hearing threshold may fluctuate.

We encountered a case of facial palsy in a 6-month-old infant. In Japan, the Yanagihara method is generally used for the evaluation of facial palsy. However, evaluation of facial palsy in infants by this method is difficult because of their non-compliance toward instructions. Therefore, the patient’s condition was assessed using the 10 points of triage method, which is reportedly useful to evaluate facial palsy in infants. In this method, the outcome measures are limited to three items—“wrinkling forehead,” “strong eye closure,” and “showing one’s teeth as if enunciating the sound, ‘ii!’ ” The difference between the speeds of the right and left motions can be easily captured by repeating the same motions multiple times if children are old enough to comply with instructions. However, because infants can hardly follow instructions to repeat the same motions, the difference between the speeds of the right ang left motions must be measured at a single motion correctly. Thus, naked eye observation alone often cannot capture the difference. To overcome this problem, video recording of the movements that mimic muscles and subsequent slow-motion examination of the movements by replaying the video was found useful.

Thyroglossal duct cyst carcinoma (TGDC) is rarely seen in children and it rarely recurs. We report here a case of recurrent TGDC in a child. A 12-year-old boy presented with a complaint of neck swelling. We suspected TGDC following the results of some examinations and performed surgery (thyroid lobectomy, Sistrunk operation, and right neck dissection surgery). Pathological findings revealed a papillary carcinoma without any carcinoma of the thyroid. At the age of 13 years, the patient developed a recurrent lymph node swelling, and he underwent a neck dissection surgery. At the age of 21 years, he further developed another swelling in the left lobe of the thyroid, and he underwent left thyroid lobectomy. In this paper, we discuss the initial treatment, subsequent treatment, and pathological interpretations of the left lobe of the thyroid.

Sever laryngomalacia required surgical management; supraglottoplasty. Supraglottoplasty using laser is reportedly effective treatment for laryngomalacia with redundant arytenoid mucosa. However we don’t have a special laser tubes for infants and children. Therefore, we can’t use a laser to avoid a respiratory burn. We performed the supraglottoplasty with one of the cold instruments, microscissors, under the general anesthesia using a conventional plastic tube.

We observed the supraglottis after oral intubation. The supraglottoplasty is performed focusing on removal of the redundant arytenoid mucosa and on divide of the aryepiglottic folds. There is little bleeding during operation, and it is easy to stop bleeding. We didn’t observe the laryngeal edema at the postoperatively 1^st day, and we did the extubation.

We think that the supraglottoplasty is successfully performed using the only microscissors.