We present the first clinical report of pediatric acute maxillary sinusitis detected Chlamydophila pneumoniae (C. pneumoniae) from maxillary sinus fluid. Acute rhinosinusitis is a common complication of upper respiratory tract inflammation in children. However, causative microorganisms remain unclear. We performed puncture and irrigation of maxillary sinus for investigation and treatment in 36 children (ages 5–14 years) with severe or persistent acute rhinosinusitis and detected respiratory bacteria in the sinus fluid using PCR. C. pneumoniae was detected in 4 cases (11%). The four cases were aged 8–10 years and composed of three boys and a girl. Among the cases, only C. pneumoniae was detected from 3 cases without fever, while C. pneumoniae and H. infuenzae were detected from one case with fever. There is a possibility that C. pneumoniae is one of causative bacteria of acute rhinosinusitis in children. The data suggest that C. pneumoniae, which accounts for about 10% of severe or persistent pediatric acute rhinosinusitis, is found frequently in patients aged 8–10 years and causes fever rarely unless the patient is coinfected by other microorganisms. Penicillins and cephalosporins, which are antibiotics commonly used for treatment of acute rhinosinusitis in children, are ineffective against C. pneumoniae. In treatment of acute rhinosinusitis in children, we need to consider that C. pneumoniae is a possible causative bacterium in persistent acute rhinosinusitis especially unresponsive to penicillin and cephalosporins.

Ectopic sinonasal teeth sometimes cause nasal obstruction, nasal bleeding, nasal discomfort, dysosmia, facial pain and headache. But in pediatrics cases, 40% of patients are asymptomatic. We report 9 years-old female case of ectopic nasal tooth without any symptom. A white mass was found in her nasal cavity by medical examination, but she was asymptomatic. Computed tomography showed a tooth-like mass in the bottom of her nasal cavity. Although she was asymptomatic, we determined surgery for the diagnosis of ectopic tooth and to avoid future infections and other complications. We removed the mass intranasally using endoscopy. The removal was easy and there was no complication after the surgery. The mass was canine-like shaped and pathologically diagnosed as tooth. Many reports suggest surgery to ectopic nasal teeth. But to asymptomatic cases, we must consider about its risk and benefits and must give informed consent before determination.

Microtia is often accompanied by congenital aural atresia (CAA). A cholesteatoma can occur with CAA without the atretic plate; thus, if CAA with otalgia or ear cellulitis is present, an infection related to a cholesteatoma should be considered. We report herein two cases of unilateral CAA with a cholesteatoma requiring external auditory canal reconstruction. Case 1, a 10-year-old, male patient with Grade 2 right microtia, presented right CAA without the atretic plate (Jahrsdoerfer scale 8) on computed tomography (CT) at age 3 years. Hearing in the right ear was 80 dB on an auditory brainstem response (ABR) test while the unaffected side was normal. The patient did not require a hearing aid and was followed up yearly. He later presented otalgia and bloody otorrhea, and CT revealed an extensive abscess in the right external auditory canal. After cholesteatoma debridement and external auditory canal reconstruction, his hearing improved. The external ear canal is currently open without lateral healing. Case 2, a 3-year-old, female patient with Grade 3 left microtia, presented left CAA without the atretic plate (Jahrsdoerfer scale 7) on CT at age 1 year. Left ear hearing was 50 dB on an ABR test. She presented with otalgia and bloody otorrhea, and CT revealed an extensive abscess in the left external auditory canal. After cholesteatoma debridement and external auditory canal reconstruction, her hearing improved. As in case one, the external ear canal is open without lateral healing. These cases demonstrate that a cholesteatoma may co-occur with CAA without the atretic plate. Although auricular reconstruction is commonly performed at age 10 years when sufficient costal cartilage is available for the procedure, the present cases suggest that screening for a cholesteatoma and surgery may be considered in younger patients.

Functional hearing loss is hearing loss in which there is a discrepancy between the pure tone audiometry threshold and not only other hearing test results but also normal voice discrimination. This report presents the course of six children with migraine and vestibular migraine who showed hearing abnormalities that were thought to be functional hearing loss. The children visited an ear-nose-throat clinic between March 2019 and July 2020. The main complaints at the first visit were poor hearing or difficulty hearing. In addition, migraine-related symptoms were obtained during an interview. Their mean hearing level at that time ranged from 32.5 to 62.5 dB (method of quartering). However, their ability to engage in daily conversation was normal. Observation with an infrared charge-coupled device camera showed abnormal movements of the eye and eyelid, which were thought to be caused by a migraine or vestibular migraine. Treatment using Kampo medicines, which are though to improve the water metabolism, was administered. As a result, most of the hearing loss improved to a level less than 25 dB within 3 months, but it took another 4 to 12 months to bring the migraine and vestibular migraine under control. Since the treatment of these migraines may have improved the functional hearing loss, it was thought that migraine and functional hearing loss might be related to each other.