The Role of Otorhinolaryngologists in the Medical Examination and Treatment of Infants in the Neonatal Intensive Care Unit or With Chronic Lung Disease Hiroshi Suzumura Division of Neonatology, Perinatal Medical Center, Dokkyo University School of Medicine Otorhinolaryngologists using endoscopy examined twenty-eight neonates in the Neonatal Intensive Care Unit for the assessment of respiratory distress. Abnormal findings were disclosed in 18 neonates. In 54 neonates who developed chronic lung disease, 3 infants were confirmed to have airway abnormalities as complications of long-term intubation, the complications included one case of subglottic stenosis, one case of tracheal stenosis, and one case of tracheomalacia. During the follow-up period after discharge, a laryngeal papilloma was discovered by endoscopy conducted for the evaluation of inspiratory respiratory distress. The role of otorhinolaryngologists in the evaluation of neonatal respiratory problems is important. Pediatricians should cooperate with otorhinolaryngologists in the medical assessment of neonatal respiratory disorder. Key words: endoscopy, neonate, chronic lung disease, airway abnormality, otorhinolaryngologist

1) Miller Rw, Woo P, Kellman RK, et al.: Tracheobronchial abnormalities in infants with bronchopulmonary dysplasia. J Pediatr 111: 779-782, 1987. 2) Cohn RC, Kercsmar C, Dearborn D: Safety and efficacy of flexible endoscopy in children with bronchopulmonary dyspalasia. Am J Dis Child 142: 1225-1228, 1988. 3) Downing GJ, Kilbride HW: Evaluation of airway complications in high-risk preterm infants: application of flexible fiberoptic airway endoscopy. Pediatrics 95: 567-572, 1995. 4) Sotomayor JL, Godinez RI, Bordon S, et al.: Largeairway collapse due to acquired tracheobronchomalacia in infancy. Am J Dis Child 140: 367-371, 1986. 5) Duncan S, Eid N: Tracheomalacia and bronchopulmonary dysplasia, Ann Otol Rhinol Laryngol 100: 856-858, 1991. 6) Doull IJM, Mok Q, Tasker RC: Tracheobronchomalacia in Preterm infants with chronic lung disease. Arch Dis Child 76: F203-F205, 1997. 7) Suzumura H, Nitta A, Tanaka G: Role of infection in the development of acquired subglottic stenosis in neonataes With prolonged intubation. Pediatr Int 42: 508-513, 2000.

Laryngeal Anomaly-Caused Respiratory Distress Noriko Morimoto, M. D., Nobuko Kawashiro, M. D., Hidenobu Taiji, M. D. Department of Otolaryngology, National Center for Child Health and Development Congenital laryngeal stridor is frequently accompanied by laryngeal anomaly in the pediatric period. We report 97 patients with congenital laryngeal stridor, consisting of 30%, 20%, and 50% with laryngeal malacia, vocal cord paralysis, and laryngeal stenosis, respectively. Severe dyspnea was seen in some of the patients needing tracheostomy. Some of the other patients with mild dyspnea were carefully followed up as outpatients. Stridor was ameliorated in some cases. Tracheostomy is a fast and reliable method for achieving the relief of upper airway dyspnea in children; however, occasional complications are inevitable. Therefore, choices for the treatment of laryngeal dyspnea should be elaborately discussed with pediatricians to prevent possible complications. Key words: tracheostomy, stridor, children, vocal cord paralysis

Treatment for vocal cord paralysis in children Niro Tayama Department of Otolaryngology, Tracheo-esophagology, International Medical Center of Japan The treatment policy for bilateral vocal fold paralysis in children is the same as for adults. However, there are many important considerations from diagnosis to treatment. Sometimes, the diagnosis and evaluation of vocal fold paralysis are complicated, because it is difficult to perform voice tests and laryngeal endoscopy in children. As the larynx undergoes growth in childhood, the optimum framework surgery is not readily obvious. Furthermore, it is hard for a pediatric patient to decide between preserving voice function and airway function. Accordingly, their final treatment should be decided after the patients have physically and mentally matured. Key words: bilateral vocal fold paralysis, voice function, airway, framework surgery

3) King, BT.: A New and function-restoring operation for bilateral abductor cord paralysis. Preliminary report. JAMA 112: 814-823, 1939. 4) Kelly, JD.: Surgical treatment of bilateral paralysis of the abductor muscles. Arch otolaryng 33: 239-304, 1941. 5) Woodman de G.: A modification of the extralaryngeal approach to arytenoidectomy for bilateral abductor paralysis. Arch. Otolaryng 43: 63-65, 1946. 6) Kleinsasser, 0: Microlaryngoscopy and endolaryngeal microsurgery. W. B. Saunders Co. Philadelphia, 1968. 7) Thornell, WC.: A new intralaryngeal approach in arytenoidectomy in bilateral abductor paralysis of the vocal cords. Arch Otolaryngol 50: 634-639, 1949. 8) Ejnell H, et al: A simple operation for bilateral vocal cord paralysis. Laryngoscope 94: 954-8, 1984. 9) Hoover WB.: Bilateral abductor paralysis. Arch Otolaryng 15: 339-335, 1932. 10) Rethi A.: The operation for relief of bilateral vocal cord paralysis. J. Laryng 64: 632-639, 1950. 11) Lore JM.: A suggested operative procedure for relief of stenosis in double abductor paralysis: Anatomic study. Ann Otol 45: 679-686, 1936. 12) Young N.: Treatment of bilateral abductor palsy of larynx. L Larynci 69: 390-39R_ 1965.

Use of an Anterior Cricoid Split for Suglottic Stenosis in Children Shoichiro Kamagata, Seiichi Hirobe, Miku Toma, Takao Shiseki, Lee Kwang Jong, Yumiko Saruwatari, Akira Hayashi, Chikako Nakajima, Tomoo Miyagawa Department of Surgery and Respiratory Unit, Tokyo Metropolitan Kiyose Children's Hospital A retrospective study was carried out to evaluate the outcome following the anterior cricoid split (ACS) for the treatment of subglottic stenosis in children. Analysis of the results suggests that the ACS is a valuable first-line procedure. Moreover, tracheomalacia indicates a high likelihood of failure of ACS. Key words: Subglottic stenosis,. anterior cricoid split

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