Sudden sensorineural hearing loss (SSNHL) is defined as a hearing loss of at least 30 decibels (dB) affecting 3 or more contiguous frequencies and occurring during 3 days without a known cause.¹ Usually SSNHL is attributed to inner ear hair cell damage; however, many patients demonstrate partial or complete hearing recovery.^2,3 Quiz Ref ID Factors believed to affect the rate of hearing recovery in patients with SSNHL include initial hearing loss severity, duration, time to starting treatment, age at presentation, and coexisting vertigo or tinnitus.^4,5

Objective To determine the effect of the method of tonsillectomy on postoperative pain in pediatric patients. Design Prospective, randomized, single-blind, controlled clinical trial. Setting A university pediatric hospital in Aberdeen, Scotland. Patients A volunteer sample of 54 children, aged 3 to 12 years, with recurrent tonsillitis or symptomatic adenotonsillar hypertrophy. Two patients withdrew consent. Interventions Twenty-six children underwent a nonelectrical (ie, cold) dissection tonsillectomy with cold steel instruments, 5 of whom also had adenoidectomy by curettage. Monopolar diathermy forceps were used for tonsillar bed hemostasis. Twenty-four children had electrocautery (ie, hot) dissection tonsillectomy, 7 of whom underwent adenoidectomy by curettage without a suction coagulator. Main Outcome Measures Postoperative analgesic consumption, time to regain normal diet and activity levels, and complications. Results Patients who underwent hot dissection tonsillectomy showed no difference in time to first drink or analgesic use within the first 24 postoperative hours compared with children undergoing cold nonelectrical dissection tonsillectomy. The hot dissection tonsillectomy group took 7.5 (95% confidence interval [CI], 1-14.1) more doses of analgesics than the cold dissection group over the next 12 days (P<.05). The hot dissection tonsillectomy group took 2.5 more days than the cold dissection tonsillectomy group to regain normal diet (P<.05). Thirteen children (54%; 95% CI, 34-74) in the hot dissection tonsillectomy group and 6 (23%; 95% CI, 7-39) in the cold dissection tonsillectomy group sought outpatient care for throat pain, otalgia, poor diet, pyrexia, and/or bleeding (P<.05). Throat pain delayed in onset or of prolonged duration affected 9 children (38%; 95% CI, 19-57) in the hot dissection tonsillectomy group as opposed to 3 children (12%; 95% CI, 0-24) in the cold dissection tonsillectomy group (P<.05). Conclusion Hot dissection tonsillectomy increases morbidity in pediatric patients in the recovery period following hospital discharge.

Background. Recent studies in mice have suggested that T cell immunity may be protective against pneumococcal infection.Methods. CD4 T cell prolifera

The management of medically intractable epilepsy is frequently assisted by the identification of structural abnormalities made possible by modern imaging techniques. The association between meningoencephaloceles and epileptic seizures is well reported in the literature. We report a patient with refractory right frontal lobe epilepsy caused by a right nasal meningoencephalocele who was rendered seizure free by endoscopic nasal excision and skull base repair, obviating the need for resective epilepsy surgery. Epilepsy patterns associated with encephalocele and their management are reviewed.