Emergency Consultations Research Articles

Using artificial intelligence based language interpretation in non-urgent paediatric emergency consultations: a clinical performance test and legal evaluation

ObjectiveTo evaluate the accuracy of Google Translate (GT) in translating low-acuity paediatric emergency consultations involving respiratory symptoms and fever, and to examine legal and policy implications of using AI-based language interpretation in healthcare.MethodsBased on the methodology used for conducting language performance testing routinely at the Interpreter Services Department of the Hospital for Sick Children, clinical performance testing was completed using a paediatric emergency scenario (child with respiratory illness and fever) on five languages: Spanish, French, Urdu, Arabic, and Mandarin. The study focused on GT's translation accuracy and a legal and policy evaluation regarding AI-based interpretation in healthcare was conducted by legal scholars.ResultsGT demonstrated strong translation performance, with accuracy rates from 83.5% in Urdu to 95.4% in French. Challenges included dialect sensitivity and pronoun misinterpretations. Legal evaluation indicated inconsistent access to language interpretation services across healthcare jurisdictions and potential risks involving data privacy, consent, and malpractice when using AI-based translation tools.ConclusionsGoogle Translate can effectively support communication in specific non-critical paediatric emergency scenarios. However, its use necessitates careful monitoring, understanding of its limitations, and attention to dialect and literal translation risks along with equity considerations. Establishing legal and policy frameworks for language interpretation in healthcare is crucial, alongside addressing funding and data security concerns, to optimize the use of AI-based translation tools in healthcare contexts.

Emergency Healthcare Utilization and Unmet Care Needs in Chemsex Users: A Cross-Sectional Survey among Sexual Minority Men.

Chemsex entails potential risks that may lead to medical emergencies. This cross-sectional study analyzed data from an anonymous, self-administered online survey on substance use among 1,203 sexual minority men (SMM) who engage in chemsex in Spain. The study aimed to determine the proportion of chemsex users that have sought emergency care following a session, identify their reasons for consultation, examine associated sociodemographic factors, and assess the proportion who felt they should have sought emergency care but did not. Frequencies of emergency consultations following chemsex sessions and episodes where participants felt they should have sought care but did not were calculated. Associations between seeking emergency care and sociodemographic and substance use factors were analyzed using Poisson regressions. Reasons for consultation were categorized based on responses to an open-ended question. 15.4% (95%CI:12.9-17.8) of chemsex users sought emergency care to request HIV post-exposure prophylaxis (PEP), and 4.0% (95%CI: 2.9-5.1) for other reasons. However, 21.8% (95%CI:19.3-24.2) did not seek care despite feeling they should have. The most common reasons for consultation were overdose symptoms, STI symptoms, and trauma. Living in smaller towns was associated with 2.4 times lower likelihood of visiting emergency services (95% CI:1.2-5.0). Injection substance use and mephedrone use were associated with 2.7 (95%CI:1.2-5.9) and 2.3 (95%CI:1.0-5.2) times higher likelihood of seeking care, respectively. Emergency visits for reasons other than requesting PEP were infrequent among chemsex users; however, a notable percentage felt they should have sought care but did not. Risk reduction strategies should prioritize addressing injection use and mephedrone consumption.

Impact of Earthquakes During COVID-19 Lockdown on the Pediatric Injury Pattern in the Zagreb Urban Area.

Background/Objectives: Previous works on the epidemiology of pediatric trauma during the COVID-19 lockdown observed a decrease in pediatric surgical emergency consultations and fracture referrals. None of those works describes a unique situation in which there is the coexistence of another opposing factor, like an earthquake, that influences the number of injured children's referrals. Therefore, this study aimed to investigate the influence of earthquakes during the COVID-19 lockdown on pediatric injury pattern referrals at a tertiary care hospital in a urban setting. Methods: A retrospective single-center case-control study comprised a time interval at the time of the COVID-19 lockdown, starting with a day when the biggest earthquake happened and finishing at the end of the confinement period in Zagreb, Croatia (22 March-27 April 2020). The control group comprised the identical time interval in 2019. We identified all successive pediatric trauma patients referred to the Pediatric Emergency Department. Demographics and leading injury characteristics were analyzed. Results: We analyzed data from 1166 patients. In the case group, the median age was lower than in the control group but without gender differences. We detected a decrease in Pediatric Emergency Department referrals and a reduced proportion of pediatric trauma patients in the case group. Additionally, the proportion of shoulder/elbow injuries and head injuries was higher, and the proportion of foot/ankle injuries was lower in the case period than in the control period. Conclusions: Earthquakes during the COVID-19 lockdown changed the pattern of pediatric injuries. These data can be used to restructure health resources during similar conditions to provide optimal health care to children.

Acute gastroenteritis in the Central Health Region. Belize. 2019-2023

Introduction: Acute gastroenteritis is one of the most frequent pathologies of significant morbidity and mortality worldwide. It can occur at any age, but its incidence is higher in infants. It represents one of the main reasons for consultation in Health facilities in Belize. This article aims to characterize patients diagnosed with acute gastroenteritis according to epidemiological and microbiological variables. Methods: A retrospective descriptive approach was conducted including all patients diagnosed with acute gastroenteritis in the Central Health Region of Belize, from 2019 to 2023. Data was obtained from the Belize Health Information System. Results: Acute gastroenteritis was the second reason for medical attention among communicable diseases, accounting 10 485 cases in the study period. The most affected age group was 1 to 4 years old (1 708 cases), with no differences in terms of sex. The largest number of patients were treated in outpatient and emergency consultations, with only 4% requiring admission. Matron Roberts Polyclinic II and Cleopatra White Polyclinic were the facilities that diagnosed the largest number of cases. The most frequently identified germs in 1 306 patients studied were Escherichia coli, Staphylococcus sp. and Proteus mirabilis. Conclusions: Acute gastroenteritis remains as one of the most common communicable diseases, being more frequent in children from 1 to 4 years old. Only few patients developed complications or required admission. Microbiological studies proved to be useful to identify E. coli as the most common bacterial agent causing gastroenteritis in our sample.

A Qualitative Study Evaluating the Challenges of Orthopedists and Internists in the Earthquake Zone

Abstract Background The earthquake centered in Kahramanmaras province, Turkey, on February 6, 2023, with a magnitude of 7.7, resulted in the loss of 53,537 lives and the injury of 107,213 people. This study was conducted to evaluate the challenges and experiences of physicians who provided post-disaster medical care. Methods We conducted a qualitative study with orthopedists and internists who had worked in the earthquake zone using in-depth interviews. Participants were selected through snowball sampling. Interviews explored challenges in the disaster zone, obstacles related to healthcare services, and disaster management. Thematic analysis was used. Results A total of 13 physicians participated in the study. Data revealed four main themes: disaster management, organizational deficiencies, challenges faced, and logistical issues. Participants indicated that the Ministry of Health didn’t have a priori operational emergency action plan, which led to problems in healthcare service delivery. Some physicians complained that they had to serve just as emergency consultants and were not able to carry out tasks compatible with their expertise. Some indicated that they organized the services rather than providing medical care. Almost all encountered a variety of interesting cases and evaluated their experience as significant. Logistical needs were met mostly with the support of non-governmental organizations. Conclusions We need to have a priori operational emergency action plan to ensure the effective delivery of healthcare services in the aftermath of a disaster. The Ministry of Health needs to allocate and coordinate healthcare personnel in line with their areas of expertise and prevent service disruptions. Key messages • There is a need to make an operational emergency action plan beforehand to deliver healthcare services effectively following a disaster. • Physicians should be allocated in line with their specialty of expertise to efficiently address the healthcare needs.

Emergency consultations to pediatric dermatology at a large children’s hospital in Saudi Arabia

Dermatology is commonly considered a non-urgent and outpatient-centered specialty. Limited studies have evaluated skin diseases presenting to the pediatric emergency department. This study aims to characterize the most common pediatric dermatological conditions prompting an emergency department visit between August 2018 and August 2023 in a large children’s hospital in Riyadh, Saudi Arabia. A total of 183 patients were included. The majority of patients were 2 years old and younger [87 (47.5%)]. Gender was almost equally distributed, with 51.4% of the population being females. Infectious and inflammatory disorders were the most commonly encountered conditions, accounting for 35.5% and 33.9%, respectively. The top three diagnoses were atopic dermatitis (12.02%), impetigo (6.56%), and infantile hemangioma (6.01%). Understanding the variety of skin disorders presented to pediatric emergency departments can positively enhance patient care in dermatology clinics and promote preventative public health initiatives, thus minimizing emergency department visits.

Factors Associated with Intra Hospital Neonatal Mortality: A Case Study of the Neonatology Department at the Regional Hospital Center of Agadir (Morocco)

Background: Neonatal mortality (NNM) has significantly decreased in developed countries. However, it remains a major public health issue and a particular challenge in developing countries, with Morocco being no exception, as its NNM rate remains high. Objectives: This study aims to identify factors associated with NNM within the Neonatology Department at the Regional Hospital Center of Agadir. Methods: An analytical cross-sectional study design was chosen. To determine factors associated with early NNM, we employed binary logistic regression in both univariate and multivariate analyses, including all statistically significant variables in the multivariate model. Results: Three hundred and eight deceased neonates were included. The intra-hospital NNM rate was 17.4%, 95% CI (13.2 - 21.7), during the period from 2018 to 2021. A predominance of early NNM (81.8%). 52.3% were females. 47.7% of the deceased had low birth weight. 65.9% of the cases had an Apgar score < 7. 44.2% were resuscitated. The factors that were statistically associated with the risk of early NNM were as follows: Admission age ≤ 1 day (aOR: 17.87; 95% CI: 5.78 - 55.29), neonatal admission age 2 - 7 days (aOR: 6.64; 95% CI: 1.68 - 26.30). Intra-hospital referral (aOR: 4.49; 95% CI: 1.59 - 12.65); emergency consultations (aOR: 4.25; 95% CI: 1.28 - 14.01). Conclusions: Neonatal mortality remains a major public health challenge in Morocco. Different risk factors associated with NNM have been identified. Addressing these factors could reduce neonatal deaths in low-resource countries. For this reason, we need to intensify our efforts to develop reliable and precise approaches.

The utilization of ophthalmological emergency departments is on the rise : 14-year results from aGerman tertiary university outpatient department

The increasing congestion in emergency departments of all specialties is one of the most pressing challenges of our time. The aim of this study is to make awell-founded contribution to the development of emergency case numbers in the tertiary sector (specialist clinics) of German ophthalmology. From this, the need to develop new control and triage mechanisms for ophthalmology can be derived. Retrospectively, > 140,000 emergency treatment cases at the University Eye Hospital Tübingen in the period from 1January 2010 to 31December 2023 were analyzed. Sub-analyses were conducted to quantify the impact of the COVID-19 pandemic and differences between weekend and weekday visits. In addition, aquestionnaire survey on the referral status of emergency consultations at off-peak times and at weekends was conducted in 2022. The number of emergency consultations more than doubled between 2010 and 2023 and more than tripled at weekends. The peak load, which is relevant for guaranteeing treatment, has increased to the same extent. In the long term, ashift in emergency treatment from core to off-peak times can be observed, particularly at weekends. The majority of consultations (up to 87%) take place without areferral from adoctor. In 2023, the treatment figures returned to the level before the start of the COVID-19 pandemic. The emergency outpatient clinic at the University Eye Hospital is increasingly exposed to adouble burden: providing treatment for emergency cases with specialist referrals and at the same time acting as acatchment basin for general emergencies. New control and triage mechanisms are urgently needed to ensure good care in the long term.

Emergency of oral haemorrhage: Retrospective study over 2 years.

Oral haemorrhages (OH) represent a relatively rare reason for an emergency consultation, among dental pain, infectious processes and traumas. Various haemorrhagic risk factors are described, particularly those related to a general medical context or local factors. It is common to associate OH with haemorrhagic risk patients. Current studies mainly focus on patients considered at risk, but there is limited data on the characteristics of OH in patients without known haemorrhagic risk. We conducted a 2-year retrospective study in a dental emergency department to identify OH occurring in patients without known haemorrhagic risk and to study their characteristics. OH accounted for approximately 2% of the reasons for consultation among all consultations carried out for dental emergencies. Their frequency was similar in the population of patients without hemorrhagic risk and those with a confirmed risk. They mainly occurred in young patients, without medical history. They also led to the diagnosis of an underlying pathology in about 1% of cases. This study underscores the importance of accurately documenting patients' medical history during preoperative consultations, as well as identifying associated risk factors. It also highlights that OH can be an early sign of a systemic disorder.

Myocardial infarction in a 17-year-old patient diagnosed with MPOD II syndrome.

Microcephalic osteodysplastic primordial dwarfism (MOPD) syndrome type 2, caused by a mutation in the PCNT gene (21q22.3), is a rare autosomal recessive disorder. Patients present with bone dysplasia, insulin resistance, kidney diseases, and cardiac malformations, making them prone to vascular diseases. Cardiomyopathy, hypertension, and coronary diseases are documented. The prognosis is associated with cerebrovascular complications. We report a case of a patient with MOPD type II who suffered a myocardial infarction in our institution. Informed consent for publishing was obtained. A 17-year-old female with MPOD II syndrome (20 kg and 86 cm) was referred for chest pain. Thoracic pains had been occurring for over a month, increasing in intensity, with an episode prompting emergency consultation. Initial tests revealed elevated troponin and an inflammatory response. Electrocardiogram (ECG) showed ST-segment depression and elevation. Echocardiography revealed hypokinetic inferior walls with moderate concentric hypertrophy. A coronary CT scan showed subendocardial hypodensity. Diagnostic coronary angiography revealed tri-branch lesions and almost complete stenoses or occlusions on the circumflex artery (Image). No indication for interventional treatment due to diffuse atheromatous lesions. Exclusive medical treatment was initiated. MPOD II syndrome is associated with cardiac malformations and neurovascular complications, including myocardial infarction. Regular ECG monitoring is advisable. Active surveillance for coronary diseases is necessary from adolescence. Recognising this complication allows for prompt intervention. This case highlights the need for specific monitoring and prompt management of chest pain in patients with MPOD II syndrome. Primary prevention could mitigate the occurrence of coronary events in this high-risk population.

Accident and emergency consultations for head injuries in older adults.

Head injuries are a common reason for hospitalisation, and patients often arrive via accident and emergency departments. This study aimed to investigate changes in accident and emergency consultations due to head injuries for patients ≥50 years. Electronic reimbursement claims by accident and emergency doctors for. In the age group ≥50 years, the overall consultation rate in accident and emergency departments increased from 21674 per 100000 inhabitants in 2006 to 22444 in 2023. The consultation rate for head injuries increased from 92 to 270 per 100000 inhabitants. For the age group 50-66 years, the increase was from 83 to 166, for the age group 67-79 years from 86 to 269, for the age group 80-89 years from 138 to 698, and for the age group ≥90 years from 277 to 1420. Accident and emergency consultations due to head injuries increased in all age groups ≥50 years. Among patients ≥90 years, the consultation rate was more than five times higher in 2023 compared to 2006.

The impact of life events on child and adolescent psychiatry consultations

Purpose: Children are exposed to many adverse life events, and this may cause psychiatric disorders. In this study, we aimed to investigate the effects of two different life events, the COVID-19 pandemic and the earthquake, on the consultations requested. Materials and Methods: 1268 consultations requested from the child and adolescent psychiatry department between March 2019 and March 2023 were reviewed from hospital records. The specified period was divided into four distinct parts with one-year intervals: pre-pandemic, the first year of the pandemic, the second year of the pandemic, and post-pandemic. The age, gender, diagnoses of the cases, the department requesting consultation and the reason for consultation were recorded. Results: There were statistically significant differences between periods in terms of departments requested consultation, consultation reasons, and diagnoses. Compared to previous periods, a decrease was found in pediatric emergency and general pediatric clinic consultations in the post-pandemic period. In contrast, an increase was seen in nephrology and intensive care unit department consultations because of earthquakes. In the first year of the pandemic, more consultations were requested from the hematology & oncology department compared to other years. While the rate of consultations requested for suicide attempts decreased in the post-pandemic period, consultations for psychiatric assessment increased. Conclusion: Consultation-liaison psychiatry, which is at the center of interdisciplinary interaction, maintains its importance in the prevention and early diagnosis of psychological symptoms that can develop due to both organic events and the effect of trauma itself after the life events.

Care trajectories for musculoskeletal disorders following a new episode of low back pain.

This study explored diverse care trajectories (CTs) for low back pain (LBP) and other musculoskeletal disorders (MSDs), over a 5-year period following a first episode of LBP. Based on Quebec's administrative health data from 2007 to 2011, this longitudinal cohort study involved 12,608 adults seeking health care for LBP. Using a new multidimensional state sequence analysis, we identified 6 distinct types of CTs. The most prevalent types 1, 2, and 3 (comprising 79.2%, 18.0%, and 21.7% of the cohort, respectively) exhibit rapid recovery and similar patterns of healthcare use over 5 years but differing in initial diagnoses: nonspecific LBP in type 1, trauma-related LBP in type 2 (mostly younger men and highest initial emergency consultation), and specific LBP in type 3. Types 4 to 6, representing smaller groups, show high healthcare utilization with comparable mixed LBP diagnoses at entry but distinctive subsequent care use patterns. Patients in types 4 and 6 (mainly older age groups and women) sought care for other MSDs from general practitioners or specialists, while middle-aged patients in type 5 experienced persistent nonspecific LBP with frequent general practitioner consultations over 5 years. The CTs typology revealed several key areas for improvement in nonpharmacological interventions, including the need to address possible inappropriate medical imaging and invasive interventions for older women with MSDs and the lack of ambulatory care access for younger patients with trauma-related LBP. Finally, results clearly highlighted poor access to rehabilitation physicians and rehabilitation services for all patients suffering from LBP and MSDs.

An exploratory cross-sectional study of awareness and barriers to adoption of telemedicine services among patients in Bangladesh

Objectives Telemedicine has emerged as a promising solution to address healthcare challenges, particularly in resource-constrained settings such as Bangladesh. Understanding patient perspectives on telemedicine adoption is vital for improving healthcare delivery in such contexts. Material and Methods This cross-sectional study surveyed 120 patients in Bangladesh to explore awareness, acceptance, and barriers to telemedicine adoption. Data were collected using structured surveys administered face-to-face in 2024. Descriptive statistical techniques were employed for data analysis. Results Most respondents demonstrated awareness of telemedicine services, primarily learning about them through friends or online sources. They viewed telemedicine positively, especially for follow-up appointments and mental health services, expressing satisfaction with the services used. However, concerns regarding its effectiveness for emergency consultations were noted. Barriers to adoption included limited internet connectivity, trust/security issues, lack of awareness, regulatory challenges, and cultural resistance. Conclusion Despite positive attitudes towards telemedicine, challenges such as internet connectivity, trust concerns, and cultural barriers persist in Bangladesh. Addressing these challenges is essential for the successful implementation and widespread adoption of telemedicine, ultimately improving access to quality healthcare services. Future research should explore the perspectives of healthcare providers and policymakers and employ longitudinal and qualitative methods to gain deeper insights.

Case Report: - Sudden sensorineural hearing loss and vertigo due to inner ear hemorrhage

Sudden deafness is a common cause of emergency consultation in otology. Usually, despite investigations, no etiology is known. Intracochlear hemorrhage is a rare cause of sudden sensorineural hearing loss (SSNHL) and may be associated with various labyrinthine disorders. In such cases, magnetic resonance imaging (MRI) is the clef of the diagnosis. We report the case of a 70-year-old patient who was referred to our department for sudden hearing loss, tinnitus, and vertigo. Otoscopic and neurological examinations were normal, and pure-tone audiometry revealed left profound sensorineural hearing loss. Videonystagmography (VNG) revealed left vestibular deficit. MRI demonstrated a high signal intensity inside the cochlea on unenhanced T1-weighted images, and no other abnormalities were found; in particular, no enhancement after intravenous administration of gadolinium. No etiology was identified. Vertigo disappeared rapidly with corticosteroid treatment and hyperbaric oxygen therapy, but hearing did not improve. Intra-labyrinthine hemorrhage causing SSNHL is rare, and the hearing prognosis is poor.

“Psychiatric emergency consultations of minors: a qualitative study of professionals’ experiences”

BackgroundPsychiatric emergency assessment of minors can be a complex process, especially for professional staff who are not specifically trained in handling child and adolescent emergency patients. As minors cannot usually express their feelings and experiences as well as adults, it is difficult to form an accurate picture of their condition and to determine what kind of emergency care is needed, for instance whether or not a psychiatric emergency admission is necessary. We lack insight in what professionals at emergency departments need to adequately assess these minors and their families. The aim of this study was to explore staff members’ experiences with assessing minors and explore recommendations for improving their ability to provide appropriate support.MethodsGuided by a topic list with open-ended questions, we conducted 11 semi-structured interviews with staff working at psychiatric emergency services. Thematic analysis enabled us to identify five main themes: (1) young age and the crucial role of parents; (2) professionals’ feelings, especially uncertainty; (3) psychiatric emergency admissions and the alternatives to them; (4) regional differences in organization and tasks; and (5) options for improving care.ResultsThe staff interviewed all agreed that it was often complicated and time consuming to take full responsibility when assessing minors with serious and urgent psychiatric problems. Most found it difficult to determine which behaviors were and were not age-appropriate, and how to handle systemic problems during the assessment. When assessing minors and their families in crisis, this led to uncertainty. Professionals were especially insecure when assessing children under age 12 and their families, feeling they lacked the appropriate knowledge and routine.ConclusionCustomized expertise development and improved regional embedding of the psychiatric emergency service in the child and adolescent services will reduce professionals’ uncertainty and improve psychiatric emergency care for minors.

Comparison of the efficacy of paracetamol and ibuprofen for fever in children under 5 years of age

Fever accounts for a significant proportion of pediatric emergency consultations, with up to 40% of children under the age of five see a doctor for this condition. Fever is usually the result of acute respiratory viral infection, is short-lived and resolves on its own. However, in the hyperergic variant or with depletion of compensatory mechanisms, fever can be the cause of the development of pathological conditions. Therefore, timely and effective control of fever has always been a subject of interest to parents and pediatricians. Current guidelines define fever above 38.5 °C as a condition in which the use of antipyretics is indicated. Paracetamol (acetaminophen) and ibuprofen are the most widely prescribed and available over-the-counter antipyretics in children. Despite the widespread use of these drugs, recommendations for the treatment of young children remain varied, leading to irrational use of antipyretics. Therefore, the aim of this review is to analyze existing clinical trials comparing paracetamol and ibuprofen to develop guidelines for pediatricians on the management of febrile pediatric patients.

Splinting of Low-Risk Pediatric Fractures.

This review covers common orthopedic injuries seen after acute traumatic injury. A thorough physical examination and radiographic review of these injuries are key to ensuring appropriate management. Although many injuries may require urgent or emergent orthopedic consultation and management, this review focuses on injuries that are low-risk and amenable to splinting with outpatient orthopedic follow-up. This review covers key physical examination features, radiographic findings that help providers assess injuries, as well as reviewing splinting application to help facilitate rapid management of these injuries in the acute care setting.

Clinical Profile of Hospitalized Varicella Cases From Pediatric Emergency Consultations: A Retrospective Cohort Study.

Varicella is a very common childhood infectious disease. It is generally benign, but it can lead to fatal complications. Our study aimed to describe theclinical and therapeutic profile of varicella based on consultations in the pediatric emergency department, to determine the incidence of hospitalized varicellacasesin the pediatric department for complementary management,and to specify the incidence of varicella complications in hospitalized patients. We conducted a retrospective descriptive cohort study over 12 months. It took place in the pediatrics and pediatric emergency departments of the Mother-Child Hospital of the Mohammed VI University Hospital, Mohammed I University, in Oujda, Morocco. We collected 120 cases of varicella. The mean age of patients was 4.5 years. The most common age range was 4-6 years (69%). Males predominated. The reason for consulting the pediatric emergency department wasa febrile rash in 65% of cases. Treatment in pediatric emergencies was mostly symptomatic. Antibiotic treatment for superinfection of lesions was used in 11% of cases. The number of hospitalizations due to complicated and/or severe varicella was 17 cases. The median age was 6.3 years. Most of the children (82%) were immunodeficient and 18% were immunocompetent.Sixteen patients had underlying risk factors. Infectious skin and soft tissue complications were noted in most hospitalized patients (47%). They were mainly presented by cutaneous reinfections with alteration of general health (41%). Neurological complications ranked second (23%). The majority were febrile convulsions (17%). One case of bronchopulmonary complication was noted. No hematological, digestive, renal, or cardiac complications were noted. Intravenous antiviral treatment was used in 88% of hospitalized cases. The drug of choice was acyclovir. Antibiotic therapy was used in 53% of cases. No patient received corticosteroid therapy.The median length of hospitalization for our patients was 14 days. The evolution was favorable in 100% of cases. Varicella remains a benign disease in children, rarely leading to hospitalization. However, complications may develop in cases of comorbidity or children with risk factors. The introduction of the varicella vaccine into the national immunization program could considerably reduce the number of children hospitalized in the near future.

Case Report - Sudden sensorineural hearing loss and vertigo due to inner ear hemorrhage

Sudden deafness is a common cause of emergency consultation in otology. Usually, despite investigations, no etiology is known. Intracochlear hemorrhage is a rare cause of sudden sensorineural hearing loss (SSNHL) and may be associated with various labyrinthine disorders. In such cases, magnetic resonance imaging (MRI) is the clef of the diagnosis. We report the case of a 70-year-old patient who was referred to our department for sudden hearing loss, tinnitus, and vertigo. Otoscopic and neurological examinations were normal, and pure-tone audiometry revealed left profound sensorineural hearing loss. Videonystagmography (VNG) revealed left vestibular deficit. MRI demonstrated a high signal intensity inside the cochlea on unenhanced T1-weighted images, and no other abnormalities were found; in particular, no enhancement after intravenous administration of gadolinium. No etiology was identified. Vertigo disappeared rapidly with corticosteroid treatment and hyperbaric oxygen therapy, but hearing did not improve. Intra-labyrinthine hemorrhage causing SSNHL is rare, and the hearing prognosis is poor.