Understanding the causes and risks of postoperative bleeding can greatly facilitate effective counseling of patients on their postoperative course. We discussed herein 1469 cases of tonsillectomy performed at Tokyo Metropolitan Children’s Medical Center between May 2010 and March 2019 and analyzed postoperative hemorrhages, gender, age, time-to-bleeding, degree of adhesion, trigger, and bleeding episode. There were 24 cases of postoperative hemorrhage (1.63%), and four patients required second general anesthesia to stop the bleeding. The present study found no significant difference in hemorrhage rates in terms of gender or age. Most bleeding occurred on postoperative Day 7. Determining whether postoperative bleeding is more likely due to the degree of adhesion during surgery is difficult. In the present study, 58.3% of patients experienced bleeding during sleep, and 41.7% of patients experienced throat pain before bleeding onset. There was no relationship between exercise and postoperative bleeding. If postoperative pain worsens, patients may be given softer food to lessen the risk of postoperative bleeding.

Periodic health check-up for infants is effective to enlighten the awareness of accidents caused by foreign bodies in the airways of infants. We administered a questionnaire survey to 110 public health nurses in public health centers in 29 cities/towns in Mie Prefecture and 29 representatives of individual public health centers in the cities/towns, who were engaged in health check-ups, regarding their knowledge of airway foreign bodies, actual enlightenment upon health check-ups, and demands for enlightenment. In survey A, with the public health nurses, it was suggested that they had sufficient knowledge about airway foreign bodies, but confused substances with causal foreign bodies of accidental ingestion. The rates of enlightenment upon health check-ups were low for suffocation (58.2%) and accidents caused by dried beans (34.5%). In survey B, with the representatives of public health centers in individual cities/towns, the representatives responded with higher rates of enlightenment about suffocation (69.0%) and accidents caused by dried beans (51.7%) than those in survey A, suggesting there were differences in the actual learning situations. It was found that public health nurses rarely had the opportunities to learn about airway foreign bodies (6.9%) and hoped to have a new enlightenment tool. The knowledge and enlightenment methods should be standardized among public health centers/public health nurses, and new enlightenment tools should be prepared to address this discrepancy.

Children with acute otitis media (AOM) were enrolled at an otolaryngology clinic between July 2017 and June 2018. The association between the severity of AOM, treatments, and clinical outcomes was evaluated. Two hundred twenty-four children (119 boys and 105 girls, aged 0 to 14) were enrolled. The severity of AOM was classified by the Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media in Children in Japan, 2018. By diagnosis of severity at the first visit to the clinic, 178 cases (79%) were classified as mild, 37 cases (17%) moderate, and 9 cases (4%) severe. Of the 178 mild cases, 19 (11%) had already been prescribed antibiotics by the previous physician, and 13 (7%) were prescribed antibiotics by our clinic. There were 146 (82%) cases that were followed up without prescription of antibiotics. Six patients (4%) who were observed without antibiotics were administered antibiotics at the second visit. Among 178 mild cases, 156 cases (88%) were cured. The results from this survey suggest that determining the severity of pediatric AOM at an otolaryngology based on the Clinical Practice Guidelines may reduce the administration of antibacterial drugs.

With sublingual immunotherapy, the therapeutic method should be properly understood and continued long-term, but with pediatric patients this needs to be done by patients and parents together. We conducted a group administration trial of the initial dose of sublingual immunotherapy early during summer vacation in children who wanted sublingual immunotherapy. We assumed that if the first dose was given during summer vacation, home observation for side effects during the early period would be easier, and the parent and child could establish the habit of taking the medicine every day. Multidisciplinary team used group instruction to efficiently and adequately instruct many pediatric patients simultaneously. This approach was highly rated on a questionnaire given to parents, with 78% responding that the group instruction was “Good” or “Fairly good.” In children who received their first dose of sublingual immunotherapy for mite allergy as a group in 2018, the continuation rate was high, similar to that of children who started the same therapy individually. Initial group administration of sublingual immunotherapy for children using a multidisciplinary approach is thought to be an efficient and effective method.

Japanese adults who stutter (AWS) may acquire a certificate of mental disability to increase their employment opportunities, however, the delivery of such a certificate to a child who stutters (CWS) is very rare in Japan.

We herein report child who obtained a certificate of mental disability approved by Japanese government based on a diagnosis of stuttering.

A 4-year old boy who stutters was referred to our outpatient ear, nose, and throat (ENT) clinic. His mother complained that people around him, especially in his kindergarten, did not recognize his stuttering, and asked us how to inform them of his “disability” due to stuttering.

We created a medical certificate explaining that he was a CWS and his speech condition deserved to be considered a “disability”. An application for the certificate of mental disability was made by his parents, and thereafter it was approved by the government office.

After the boy received certificate of mental disability due to his stuttering, the teachers and staff at the kindergarten came to recognize and be more considerate of his speech condition.

By drafting medical certificates, medical doctors can play a role in helping patients obtain such certificates that can lead to various support opportunities, not only for adults who stutter, but also children who stutter.

Orbital complication due to rhinosinusitis is induced by inflammation in the rhinosinus. In some cases with orbital complication, congenital or acquired defect of the orbital wall is sometimes seen. The current study reports an infant case of subperiosteal orbital abscess with a partial defect of the floor of the orbit. The operative, and pre- and post-operative findings of the case are reported herein. The case was an eight-month-old female, and introduced to the department of ophthalmology of our hospital due to swelling of the eyelid and exophthalmous. Although no visual loss was seen, subperiosteal orbital abscess was seen in enhanced CT and MRI. Then she was introduced to our department. She underwent an emergent endoscopic rhinosinus surgery on the same day. Patent lateral nasal window was made through the inferior nasal meatus, and drainage from the maxillary sinus and subperiosteal orbital abscess was performed. An inflammatory response has been suppressed by antibiotic treatment, and she left our hospital seven days after surgery. A partial defect of the floor of the orbit was thought to be a plausible cause of subperiosteal orbital abscess.

Langerhans cell histiocytosis (LCH) is a disease in which Langerhans cells proliferate and cause tissue damage. Herein, we report our experience with a case in which it was difficult to treat refractory bilateral otitis externa, and subsequently, LCH was diagnosed based on biopsy findings of the mastoid antrum. The patient was a 1-year-old boy in whom the diagnosis was not possible by biopsy from the external auditory canal on an outpatient basis; however, a definitive diagnosis of LCH was possible by biopsy of the mastoid antrum. The reason why a biopsy from the external auditory canal was not helpful in the diagnosis of LCH is possibly explained by the fact that necrotic tissues (a secondary change of LCH occurring in the temporal bone) were used as biopsy specimen. Because many necrotic tissues were also found in the biopsy specimen of the mastoid antrum, immunostaining of the tumorous tissue was difficult. LCH must be considered in cases of refractory otitis externa. During biopsy, samples must be collected directly from the lesions and submitted for immunostaining.