ObjectiveTo determine whether incision and drainage of infected thyroglossal duct cysts (TGDCs) is associated with increased risk of recurrence after Sistrunk procedure when compared with antibiotic treatment alone.DesignRetrospective case review.SettingTertiary referral practice.PatientsPatients treated for thyroglossal duct remnants in a tertiary care pediatric center from January 1, 2002, through December 31, 2008. Study subjects were identified using the diagnosis code for TGDC or the procedure code for excision of thyroglossal duct cyst or sinus.Main Outcome MeasuresThe presence of infection, treatment of infected TGDCs, and relationship between infection, treatment of infection, and recurrence.ResultsWe identified 120 patients from 2002 through 2008 who met the search criteria. The mean age at the time of presentation was 5.1 years; at the time of surgery, 5.4 years. More than half the patients (58.2%) were male, and the most common presentation was an asymptomatic midline neck mass. Forty-nine of our patients (40.8%) had a history of infection and 6 of these (12%) required incision and drainage. The overall recurrence rate was 10.8%. Ten of the patients with preoperative infection (20%) had a recurrence compared with 3 of the 71 patients (4%) without preoperative infection (P = .002). Of all patients with recurrences, only 1 had undergone incision and drainage.ConclusionsThis case series suggests that preoperative infection is associated with an increased recurrence rate. Incision and drainage of an infected TGDC may not increase the risk of postoperative recurrence. The results of this case series may assist in preoperative counseling and management of infected TGDC prior to definitive surgery.

Objectives: To identify clinical risk factors that predict a higher incidence of hearing loss in children with bacterial meningitis, to determine the overall incidence of hearing loss in a large group of children proven by culture findings to have bacterial meningitis, and to compare clinical characteristics among patients with Streptococcus pneumoniae meningitis and Neisseria meningitidis meningitis.Design: Retrospective reviewSetting: Tertiary pediatric hospital.Patients: A total of 171 children identified with bacterial meningitis who met inclusion criteria over a consecutive 10-year period.Main Outcome Measure: Presence of sensorineural hearing loss.Results: Of 134 patients who underwent audiologic testing during their initial hospitalization, 41 (30.6%) were found to have at least a unilateral mild sensorineural hearing loss. The incidence of hearing loss was greater in patients with S pneumoniae meningitis than in patients with N meningitidis meningitis (35.9% and 23.9%, respectively). Length of hospitalization, development of seizures, elevated cerebrospinal fluid protein, and decreased cerebrospinal fluid glucose were significant predictors for hearing loss in children with bacterial meningitis. These factors were not found to be as strong a predictor for hearing loss in patients with N meningitidis meningitis. Stability of hearing was demonstrated with limited follow-up audiometry.Conclusions: Sensorineural hearing loss is a common sequela in children with bacterial meningitis. Identification of hearing loss in children with bacterial meningitis and early rehabilitation will lessen the long-term educational and social difficulties these children may experience.