Primary ciliary dyskinesia (PCD) is a syndrome that is primarily inherited in an autosomal recessive manner. The PICADAR score is a prediction score developed in Europe for all ages. Because the causative genes of this disease differ depending on the race, and the pathological conditions differ between adults and children, we aimed to devise a predictive scoring system for PCD in Japanese pediatric patients. A retrospective study was conducted on patients under 18 years of age who were referred to our outpatient clinic at our hospital and we divided them into a group diagnosed with PCD and a group not diagnosed with PCD. Multivariate analysis was performed for items that showed significant differences in univariate analysis. As a result, four items were found to be significant: tachypnea, cough, and pneumonia during the neonatal period, situs inversus or situs ambiguous, rhinitis that persisted throughout the year, and abnormal findings in the eardrum. We proposed a new prediction score as Hongo score using the above four items.

Pediatric patients with a tracheostomy may develop scoliosis, altering the shape of the trachea. This change can make tracheal cannula management challenging, eventually requiring the use of adjustable length cannulas and custom cannulas. The aim of this study was to identify the factors predicting the requirement for custom cannulas. We compared two groups of cases that received adjustable-length cannulas: 12 cases in which the variable-length cannula alone was sufficient (adjustable length group), and three cases in which a custom cannula was necessary (custom group). CT of the trachea revealed significantly greater tracheal tortuosity and a significantly smaller tracheal cross-sectional area in the custom group. Although there was no significant difference in curvature, it was higher in the custom group. The formulation of indices that combine cross-sectional area with curvature, as well as cross-sectional area with tortuosity, indicated the necessity for a custom cannula when the cross-sectional area was below 85 mm², and either curvature was higher than 0.45 m⁻¹ or tortuosity was higher than 1.04.

To investigate the effects of the COVID-19 pandemic on the number of surgeries performed in the field of pediatric otorhinolaryngology, we reviewed the medical records of pediatric patients who underwent ENT surgery under general anesthesia from 2019 to 2023, and investigated the association between the monthly trends in the total number of patients and new COVID-19-infections in Osaka Prefecture, followed by the annual trend of the number of patients receiving each surgical procedure. The monthly total number of patients showed an abrupt decline immediately after the first declaration of a state of emergency in Japan, followed by repeated decreases after each of the subsequent three declarations. Regarding the annual trend in the number of patients, the total number showed an abrupt fall in 2020, followed by a gradual decrease from 2020 to 2022, then a subsequent slight increase in 2023. Regarding each surgical procedures, the numbers of patients undergoing adenotomy, tonsillectomy, and tympanostomy tube insertion progressively decreased from 2019 to 2022. In 2023, both adenotomy and tonsillectomy showed a recovery to baseline, whereas tympanic tube insertion showed only a slight increase. In particular, the performance of tympanic tube insertion without adenotomy showed a further decrease even in 2023, while the co-performance of tube insertion and adenotomy showed a recovery to baseline. In contrast, tympanoplasty and tracheotomy showed a poor change during the five years. In conclusion, the annual trends in the number of patients receiving surgeries over a 5-year period that included the COVID-19 pandemic, the presence or absence of an abrupt fall in 2020, and the presence or absence of a subsequent recovery in 2023, differed according to the surgical procedure, which can be attributed to not only the status of patient visits to medical institutes, but also to the incidence rate of diseases as an indication for surgery.

Translaryngeal tracheal intubation (tracheal intubation) is widely used because it is the most reliable method of airway management, however, tracheal intubation can cause damage to the laryngopharynx and trachea; the mucosal erosive, laryngeal edema, and ulcerative changes. Among of them, laryngeal edema, especially, is a factor in airway narrowing after extubation, which may require reintubation. The subjects were among cases in which surgery was performed at the Department of Otorhinolaryngology, Plastic Surgery, or Pediatric Surgery at the Kyorin University Hospital during the 6 years from 2017, or cases in which airway management by tracheal intubation was performed at the Department of pediatric. Patients had undergone laryngeal flexible endoscopy within 24 hours immediately after extubation. The patients were 10 boys (15 times) and 13 girls (18 times), for a total of 23 patients, and the ages at the time of tracheal intubation were 0 to 11 years old. Laryngeal endoscopic examination was observed the diverse findings after extubation, such as follows; postglottic granulation, subglottic swelling, swelling of the false vocal cords, vocal fold swelling/redness, mucosal erosion, wound swelling/white crusts, postglottic swelling, epiglottis/arytenoid/epiglottic edematous, and unilateral vocal fold paralysis, and there were also cases with no findings. In particular, severe laryngeal damage occurred in cases where the pharynx and larynx were severely invasive, and in children as well as adults, severe laryngeal damage occurred after intubation for 5 days or more.

The auditory brainstem response (ABR)/auditory steady-state response (ASSR) is used to measure hearing levels in infants. However, to perform stable tests, the infant should be put to sleep using a sedation. There are no drugs without side effects or sedation without risks; hence, care must be provided to avoid respiratory depression and cardiac arrest. We studied 251 cases of infants who were sedated using oral triclofos sodium and underwent outpatient examinations. Respiratory depression occurred in 42 patients (16.7%), of which >50% occurred within 15 min of falling asleep, suggesting that upper airway patency was affected,and approximately 10% occurred after ≥30 min. Therefore, measures must be conducted considering the risk of transitioning to deep sedation until the end of the examination. Information should be shared,considering the background of respiratory depression, with the awareness that there is no risk-free sedation.

Although it would be beneficial to examine cartilage conduction hearing aids separately for adults and children, as the indications, reasons for purchase, and prices are different, there are few reports of single hearing aids in children.

In this study, we conducted a review of 68 cases of children under the age of 20 who had been fitted with a cartilage conduction hearing aid. Our objective was to examine the continuation rate, the clinical characteristics of the continuation and return groups, and the effectiveness of the hearing aid in the target population. The overall continue rate was 72%, with 63% in the bilateral atresia/stenotic group, 79% in the unilateral atresia/stenotic group, and 25% in the open ear canal group. The continuation rate demonstrated a tendency to decrease with increasing age. No significant difference was observed in functional gain between the continuation and return groups. The decision to purchase or continue was influenced by several factors, including the effectiveness of the hearing aid, the cost, and the user’s perception of the device. In unilateral cases, an improvement in binaural hearing and sound localization resulted in a higher continuation rate. Conversely, the continue rate was lower in open ear canal cases compared to air conductive hearing aids. This study validates the efficacy of cartilage conduction hearing aids for continuation and return in pediatric cases and underscores the significance of active listening.

Super-absorbent polymer (SAP) beads are small, ranging from a few millimeters to more than 10 millimeters in diameter, but they expand as much as 10 times after exposing to fluid.

We report the case of 5-year-old girl with SAP bead as a foreign body in her right ear. Her chief complaint was right ear pain. She was referred to out department from otolaryngology clinic under the tentative diagnosis of refractory acute otitis media. The right external auditory canal was filled with granulation and brown hard material. We obtained the careful history about small toys from her mother and suspected SAP beads which was probably inserted about 4 months ago. The foreign body was removed under general anesthesia one week after the first visit. Tympanic membrane was highly compressed toward the promontory and was accompanied with a perforation in the posterior inferior quadrant.

Tympanoplasty was planned one year after the first surgery for the purpose of closing the perforation of tympanic membrane and improving her hearing as 20.0 dB with 10 dB air-bone gap. During the second surgery, the ossicles was united by scarring and part of them was not observed. Postoperatively her hearing recovered as much as the opposite side.

SAP beads should be informed to be the risk of causing tympanic membrane perforation and ossicular defects when they are left to be in the external auditory canal for months.

Recently, endoscopic piriformis fistulectomy for hypopharyngeal piriform sinus fistula (PSF) has been reported. As a result, we present two cases that underwent this procedure.

Case 1: A 13-year-old boy had a history of drainage of a left cervical abscess two years before coming to our hospital. The abscess recurred one month prior to his visit, thus he was referred to our department for further evaluation and treatment. Hypopharyngeal fluorography confirmed a PSF. Two weeks before surgery, the patient received antibiotic treatment for a fever and cervical edema.

Case 2: A 6-year-old boy had a history of an abscess extending from the left pharyngeal wall to the left lobe of the thyroid gland that was drained 2 years prior to presentation. Hypopharyngeal fluorography did not reveal a PSF, but given the clinical course, a PSF was highly suspected, and the treatment was initiated.

In both cases, the PSF was easily identified by detailed endoscopic observation of the hypopharynx under general anesthesia. The mucosa around the fistula was incised with an electric needle knife, and the fistula was traced to the submucosal margin of the thyroid cartilage, which was then resected. The postoperative course was uneventful, with no complications or recurrence of abscess in either case.

Hallermann-Streiff syndrome (HSS) is a rare congenital syndrome with micrognathia, beak nose, proportional short stature, hypotrichosis, microphthalmia and bilateral congenital cataracts. The upper airways narrowing due to micrognathia may lead to sleep apnea, not only in childhood but in later.

We report a case of HSS diagnosed as hypertension coming of age. Suspected sleep apnea because of her micrognathia, the polysomnography (PSG) confirmed sleep apnea. CPAP therapy produced a good response for hypertension as well as sleep apnea.

Here, we give an overview of diagnostic process and treatment course with a PSG report and the distinctive facial features.