The objective of the study is to compare the pain level of three methods of intratympanic (IT) injections using prospective, randomized clinical study in a tertiary care center. 39 patients with Ménière's disease and 30 patients with sudden sensorineural hearing loss are included. Excluded were patients treated for a chronic pain or those who took any pain killer for the last 24 h. Each patient received one IT injection a week, for three consecutive weeks. Three methods of IT injections were compared, with the application of EMLA cream on the tympanic membrane filling the external auditory canal 60 min before the procedure, with subcutaneous injection of lidocaine 1% with 1:100,000 epinephrine in the external auditory canal, and finally with an IT injection without any previous anesthesia. The pain intensity was immediately measured at 5 min, and then 45 min after the procedure, each time using four pain rating scales (visual analogue scale, numerical rating scale, verbal rating scale and categorical rating scale). No difference in pain intensity between the three methods of IT injections was detected by the visual analogue scale and numerical rating scale (p > 0.05). 45.8% of patients preferred the IT injection without previous anesthesia. However, methylprednisolone has been associated with pain intensity greater than that of gentamicin 45 min after the injection (p < 0.05). The IT injection performed without any previous anesthesia is an interesting option since it has not been shown to be more painful than the other methods of injections, and spares the patient from disadvantages associated with the anesthesia.

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A delay between symptom onset and the first intratympanic methylprednisolone injection does not seem to affect prognosis.

Mesenteric cysts are documented as a rare entity in pediatric population. They are considered as benign intra-abdominal tumors with an unknown etiology. Symptoms are not specific and knowledge of such condition is essential in order to establish a proper management. We report three pediatrics cases of mesenteric cysts managed between 2000 and 2009 in the pediatric surgery Department of Monastir College Hospital. We described the clinical, radiological and operative findings. Two males and a female were managed (age range: 10 days-5years, mean age: 6,3years). Two patients were presented with an intestinal obstruction. A preoperative diagnosis was made basing on imaging. Thus, abdominal ultrasonography was performed in all of our reported cases and showed a cystic mass in all cases. The cystic nature of the mass, its margins and its extension were better described on tomographic images. The mesenteric cyst was completely and successfully removed in all cases. The histopathological report confirmed the diagnosis and showed a multiloculated cyst with columnar mesothelial lining, without any defined muscular layer or cellular atypia and without any evidence of malignancy. The children were evaluated post-operatively with a mean follow-up of 2 years and a half. No recurrence was noted in our patients during the follow-up period. It is known that clinical features are not specific of such anomaly but once the diagnosis is made, the complete surgical removal of the cyst remains the treatment of choice with excellent outcomes.