Vitamin D halved BPPV recurrence in deficient adults, and a UK guideline makes the case for MT-RNR1 testing before aminoglycosides

The edition in brief

Five findings for ENT surgeons and the GPs who see these patients first. A double-blind trial in Iraq randomised 160 adults with idiopathic BPPV and 25-hydroxyvitamin D below 20 ng/mL to cholecalciferol 10,000 IU weekly or placebo; two-year recurrence was 27.5% vs 55.0%, a number needed to treat of 3.6, with no hypercalcaemia. A UK pharmacogenomics guideline recommends avoiding aminoglycosides in carriers of MT-RNR1 variants (about 1 in 330 people), which can cause irreversible hearing loss after a single dose, while never delaying urgent treatment for a result. A US trial of 275 adults with age-related hearing loss found bilateral aids gave more self-reported benefit than one aid (APHAB difference 5.3 points), though its authors are unsure this is clinically meaningful. A meta-analysis of 25 studies found adverse airway events in 10.3% of head and neck reconstructions managed without elective tracheostomy, with floor-of-mouth tumours and bilateral neck dissection the strongest predictors, while tracheostomy itself doubled flap complications. A 30,002-flap meta-analysis found compromise in 8.2%, linked to modifiable factors including fluid overload and low albumin. At a US safety-net hospital, none of 307 paediatric tonsillectomy specimens contained cancer.