No clear difference between two repositioning manoeuvres for apogeotropic horizontal canal BPPV

The edition in brief

In 77 patients with apogeotropic horizontal canal BPPV confirmed on videonystagmography, the Appiani manoeuvre resolved positional nystagmus after one session in 68.4% and the Zuma manoeuvre in 59.0%, with no significant difference. Patients aged 60 or over needed two or more sessions far more often (82% vs 47%). Either manoeuvre is reasonable; plan for repeat sessions in older adults. In a 36-patient trial during endolaryngeal surgery, PaCO2 rose steadily with high-flow nasal oxygen to a median 66.5 mmHg by the end, against 44.5 mmHg with jet ventilation, with lower pH and higher lactate; the authors suggest about 20 minutes as a practical limit for apnoeic high-flow technique. A meta-analysis of 28 studies found pepsin in about 72% of middle ear effusions in children with chronic or recurrent otitis media, but diagnostic methods varied widely and this does not support routine acid suppression. In 455 patients with Ménière's disease, higher MRI hydrops grade was consistently associated with worse hearing. The pearl covers sudden sensorineural hearing loss as an emergency.