PURPOSE: The incidence of endobronchial tuberculosis in children is unknown, due to the inconsistent implementation of bronchoscopy in pediatric patients with pulmonary tuberculosis. In this study, our aim was to determine the incidence and clinical course of endobronchial tuberculosis in children. METHODS: We performed a retrospective chart review of patients less than 18 years of age, who was diagnosed with endobronchial tuberculosis via fiberoptic bronchoscopy. RESULTS: Out of the 101 patients with pulmonary tuberculosis, 16 patients had endobronchial tuberculosis. The median age at diagnosis was 11.2 years (range, 5 months to 16.1 years). Tuberculin skin test was positive in 9 cases (56.2%), and 6 patients (37.5%) had a history of household contact with tuberculosis. Consolidation lesion was common in the simple chest radiographs of patients with endobronchial tuberculosis. According to the bronchoscopic finding, actively caseating type was most common (43.8%). Nine of the 16 patients of endobronchial tuberculosis progressed to bronchial obstruction and 4 patients underwent pneumonectomy or lobectomy. Fibrostenotic and tumorous type tend to progress to endobronchial obstruction compared with actively caseating type. CONCLUSION: The incidence of endobronchial tuberculosis in pediatric pulmonary tuberculosis was 15.8%. Early detection and effective treatment of endobronchial tuberculosis are important to decrease the secondary complication, such as bronchial obstruction.
Bronchoscopy ; Child ; Family Characteristics ; Humans ; Incidence ; Pneumonectomy ; Retrospective Studies ; Skin Tests ; Thorax ; Tuberculin ; Tuberculosis ; Tuberculosis, Pulmonary

OBJECTIVES: As endoscopic instrumentation, techniques and knowledges have significantly improved recently, endoscopic ear surgery has become increasingly popular. Transcanal endoscopic ear surgery (TEES) can provide better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal. We aimed to describe outcomes for TEES for congenital cholesteatoma in a pediatric population. METHODS: Twenty-five children (age, 17 months to 9 years) with congenital cholesteatoma confined to the middle ear underwent TEES by an experienced surgeon; 13 children had been classified as Potsic stage I, seven as stage II, and five as stage III. The mean follow-up period was 24 months. Recurrence of congenital cholesteatoma and surgical complication was observed. RESULTS: Congenital cholesteatoma can be removed successfully via transcanal endoscopic approach in all patients, and no surgical complications occurred; only one patient with a stage II cholesteatoma showed recurrence during the follow-up visit, and the patient underwent revision surgery. The other patients underwent one-stage operations and showed no cholesteatoma recurrence at their last visits. Two patients underwent second-stage ossicular reconstruction. CONCLUSION: Although the follow-up period and number of patients were limited, pediatric congenital cholesteatoma limited to the middle ear cavity could be safely and effectively removed using TEES.
Child ; Cholesteatoma* ; Ear* ; Ear, Middle ; Endoscopy ; Follow-Up Studies ; Humans ; Minimally Invasive Surgical Procedures ; Recurrence

PURPOSE: Tracheostomy is used to aid airway management in perdiatric respiratory care. This study was designed to review causes and outcomes of pediatric tracheostomy. METHODS: We performed a retrospective chart review of 153 patients, less than 18 years of age, who underwent tracheostomy between January 1995 and July 2010. Age at tracheostomy, indications, durations, complications and mortality were evaluated. RESULTS: Subglottic stenosis (19%) was the most common indication for tracheostomy. The median age at tracheostomy was 1.3 years (range, 22 days to 17.8 years). Seventy-three (47.7%) tracheostomies were performed in children under 1 year of age. Respiratory diseases were significantly more prevalent in patients under 1 year of age, while neuromuscular disease were more frequently found in patients older than 1 year (P=0.013). Stoma or tracheal granuloma formation (36.6%) was the most common complication of pediatric tracheostomy. Decannulation was accomplished in 61 (39.9%) patients with median cannulation time of 141 days (range, 1 to 2,529 days). Overall mortality rate was 10.5% (n=16), but only one patient (0.7%) died from tracheostomy-related complications. CONCLUSION: Respiratory diseases, such as subglottic stenosis and neuromuscular disease, are the main cause of pediatric tracheostomy. Although complications, like stoma or tracheal granuloma formation occur, tracheostomy in children is a safe way to aid airway management.
Airway Management ; Catheterization ; Child ; Constriction, Pathologic ; Granuloma ; Humans ; Neuromuscular Diseases ; Retrospective Studies ; Tracheostomy

PURPOSE: The aim of this study was to compare the effects of breast milk (BM) feeding with those of maternal cow milk (CM) restriction and extensively hydrolyzed CM formula feeding on the duration of CM allergy as well as changes in specific immunoglobulin E (IgE) levels in infants with CM allergy. METHODS: Children diagnosed with CM allergy before 12 months age and BM fed were included retrospectively. CM allergy was diagnosed by CM specific IgE over 0.35 kU/L and 1) obvious clinical symptoms, 2) a suspicious history with positive provocation test, or 3) CM specific IgE over the 95% positive predictive value and subsequent documented report of clinical symptoms. The patients were classified into three groups by feeding regimen: BM group, extensively hydrolyzed formula (eHF) group, or mixed feeding (MF) group. Analysis of the groups regarding the duration of food allergy and changes in CM specific IgE was then performed. RESULTS: Forty-six children were included. Twenty-four children were in the BM group, 13 children were in the eHF group, and 9 children comprised the MF group. Thirteen patients reached tolerance. The means of the tolerance age were 69.7+/-5.4 months in the BM group, 36.6+/-4.6 months in the eHF group, and 38.2+/-7.9 months in the MF group. The survival curves of tolerance showed significant difference among the three groups (P=0.04). CM specific IgE levels measured at a second time period were 9.6 kU/L (interquartile range, 3.6-44.2) in the BM group, 2.0 kU/L (1.0-18.0) in the eHF group, and 4.8 kU/L (0.2-10.4) in the MF group (P=0.04). CONCLUSION: Feeding regimen influences the duration of CM allergy. Exclusively BM-fed children achieved tolerance later than eHF-fed children. Prospective and randomized controlled studies are required.
Breast ; Child ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Infant ; Milk ; Milk, Human ; Retrospective Studies

PURPOSE: The present study aimed to evaluate the accuracy of determining the prevalence of atopic dermatitis (AD) with a questionnaire by diagnosing AD with both a questionnaire and pediatricians' physical examinations and to determine the possible risk factors for AD. METHODS: A survey was conducted from December 2008 to February 2009 in four elementary schools. The Korean version of the International Study of Asthma and Allergies in Childhood written questionnaire (WQ) was used to identify AD ever and AD during the last 12 months. Current AD was diagnosed by well-trained pediatricians according to the Hanifin and Rajka's diagnostic criteria. A total of 2,729 children who completed the questionnaire and underwent a physical examination by pediatricians were included in this analysis. RESULTS: According to the WQ, the prevalence of AD in the entire life and in the last 12 months was 18.4% and 12.9%, respectively. The prevalence of clinically diagnosed AD by pediatricians was 8.8%. There was a significant positive relationship between the prevalence of AD diagnosed by physical examination and past history of allergic rhinitis (adjusted odds ratio [aOR], 1.45), allergy history of the mother (aOR, 2.48), and AD history of the mother (aOR, 1.61). According to the WQ, there was also a significant positive relationship between the prevalence of AD in the last 12 months and past history of asthma (aOR, 2.55) and AD history of the mother (aOR, 1.71). CONCLUSION: Prevalence and risk factors of AD were different according to the survey methods. When prevalence of AD is determined with a questionnaire in the future, more careful attention should be used, because the result can be overestimated compared to the actual prevalence.
Asthma ; Child ; Dermatitis, Atopic ; Humans ; Hypersensitivity ; Mothers ; Odds Ratio ; Physical Examination ; Prevalence ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors

Lipoma is a common benign tumor found at various sites in the body, but it is rarely encountered in the middle ear. We report a case of a 5-month-old girl who presented a middle ear lipoma, which was successfully removed by canal wall up mastoidectomy. To the best our knowledge, this is the youngest case of rare middle ear lipoma, which has ever been reported in the literature.
Ear, Middle ; Female ; Humans ; Infant ; Lipoma ; Otitis Media

Cogan’s syndrome is a rare inflammatory disease characterized by non-syphilitic keratitis and vestibulo-auditory symptoms including hearing loss, tinnitus, and vertigo. Although its precise pathogenesis is not known, Cogan’s syndrome is generally considered an autoimmune disease. This hypothesis is supported by the frequently successful remission of hearing loss after steroid administration and the association with other autoimmune disorders such as rheumatoid arthritis. Medical treatment of Cogan’s syndrome depends on disease severity and on how extensive the disease is. The involvement of inner ear pathology requires systemic corticosteroid therapy. In cases of treatment failure or the need for a corticosteroid-sparing effect, other immunosuppressive drugs can be used. We experienced two patients with typical Cogan’s syndrome, presenting bilateral progressive sensorineural hearing loss and dizziness with ocular involvement, which we have successfully treated with systemic steroid administration and immunosuppressive therapy.

Lipoma is a common benign tumor found at various sites in the body, but it is rarely encountered in the middle ear. We report a case of a 5-month-old girl who presented a middle ear lipoma, which was successfully removed by canal wall up mastoidectomy. To the best our knowledge, this is the youngest case of rare middle ear lipoma, which has ever been reported in the literature.

Wernicke encephalopathy (WE) is an uncommon but severe neurological disorder caused by thiamine (vitamin B1) deficiency. It is characterized by the sudden onset of altered consciousness, ophthalmoplegia, and ataxia. Apart from chronic alcoholism, a lot of other conditions causing malnutrition and decreasing thiamine absorption must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, resulting in persistent dysfunctions or death. Therefore, early diagnosis and prompt treatment with intravenous thiamine supplement might prevent encephalopathy and other neurologic or systemic complications of thiamine depletion. We hereby report of our experience of a WE patient who presented with predominantly vestibular symptoms and signs; the patient was successfully diagnosed and treated with high-dose intravenous thiamine repletion.

Hyperimmunoglobulin E syndrome (HIES) is a rare immunodeficiency disease which is characterized by high serum IgE levels, eczema, and recurrent infections. Herein we present the case of a patient with HIES associated with STAT3 gene (stat3) mutation. A 16 year-old girl was admitted to our hospital due to hemoptysis caused by pneumonia with bronchiectasis. She had a history of recurrent skin and respiratory tract infections, such as pneumonia caused by MRSA (methicillin-resistant Staphylococcus aureus) and Pseudomonas aeruginosa. On physical examination, a broad round shaped nose, oral thrush, and chronic eczematous skin rash over her whole body were found. Laboratory data showed an elevated eosinophil count (750/microliter) and total IgE level (5,001 U/mL). The patient's National Institutes of Health (NIH) score for HIES was 44. Direct sequencing of the STAT3 gene revealed that the patient was heterozygous for a missense mutation in the DNA binding domain of the STAT3 protein (c.1144C>T, p. Arg382Trp). HIES should be suspected in patients with recurrent infections and can be confirmed by clinical scoring and genetic analysis.
Bronchiectasis ; Candidiasis, Oral ; DNA ; Eczema ; Eosinophils ; Exanthema ; Hemoptysis ; Humans ; Immunoglobulin E ; Job's Syndrome ; Methicillin-Resistant Staphylococcus aureus ; Mutation, Missense ; National Institutes of Health (U.S.) ; Nose ; Physical Examination ; Pneumonia ; Pseudomonas aeruginosa ; Respiratory Tract Infections ; Skin ; Staphylococcus ; STAT3 Transcription Factor