Preoperative dexamethasone did not speed recovery after free-flap head and neck surgery

The edition in brief

A Japanese phase III double-blind trial, published in July, randomised 180 adults having head and neck cancer resection with free-flap reconstruction to a single 8 mg dose of dexamethasone or placebo before surgery. Quality-of-recovery scores, pain, nausea, complications and length of stay did not differ, although interleukin-6 and CRP fell. A single dose is unlikely to add much to recovery after surgery of this size, though it may still be given for other reasons. A Turkish randomised study of 77 patients with apogeotropic horizontal canal BPPV found the Appiani and Zuma manoeuvres similarly effective, resolving 68% and 59% after one session, with patients aged 60 or over more often needing repeat sessions. In 769 tonsillectomy specimens at a US safety-net hospital, no child had a malignancy, and 19 of 20 adult cancers were expected or suspected beforehand, supporting risk-based rather than routine pathology. A meta-analysis found pepsin in about 72% of middle ear effusions in children with chronic or recurrent otitis media, an association that does not yet justify reflux treatment. The pearl covers red flags in unilateral otitis media with effusion in adults.