当院を受診した良性発作性頭位めまい症患者の前医での診療実態と課題

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Background: Benign paroxysmal positional vertigo (BPPV) is one of the most frequently encountered peripheral vestibular disorders in both specialized and primary care settings. Despite its high prevalence, standardized diagnostic and treatment approaches in primary care remain inadequately established.

Objective: This study was aimed at evaluating the diagnostic and treatment practices for BPPV at referring medical institutions and to identify challenges in its management in the primary care setting.

Methods: We conducted a retrospective analysis of 73 patients diagnosed as having BPPV between January 2020 and December 2024 who initially sought treatment at other medical institutions. We analyzed the patient demographics, diagnostic procedures (including positional and positioning nystagmus tests), treatment modalities, and utilization of imaging studies in this patient cohort.

Results: Older patients showed significantly longer delays before seeking medical attention. Internal medicine clinics were the most common first point of contact; however, positional and positioning nystagmus tests were rarely performed outside of otorhinolaryngology clinics. Imaging studies were overutilized, particularly in hospital settings, despite their limited diagnostic value for BPPV. Canalith repositioning maneuvers were underutilized, whereas pharmacotherapy (often prescribed without strong supporting evidence) was commonly prescribed.

Conclusion: Our findings highlight the need for better standardization of BPPV diagnosis and treatment in the primary care setting. Strengthening healthcare provider education, promoting dissemination of the diagnostic criteria, reducing unnecessary imaging examinations, and encouraging evidence-based management strategies, such as canalith repositioning procedures, are essential for improving patient outcomes and reducing healthcare costs.