title: [Evaluation of benign paroxysmal positional vertigo in primary health-care and first level specialist care].
abstract: BACKGROUND
  Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo, but it is not well known in routine clinical practice.
  
  
  OBJECTIVE
  To determine the awareness of BPPV outside the ENT clinic.
  
  
  METHODS
  Retrospective study of sixty-nine patients treated for BPPV between June 2005 and December 2006 at the specialist clinic. We analyzed the routes and details for their referral and the time elapsed since the start of the symptoms.
  
  
  RESULTS
  42 patients (61 %) were referred through the conventional route (primary health-care or non-hospital ENT); 17 patients (25 %) came from the emergency room (one third of them were admitted); the remainder were patients hospitalized for some other problem (5 %) or informal consultations (9 %). Only one patient had been referred with a specific diagnosis of BPPV. The onset of vertigo symptoms before treatment was, on average, 20 weeks (SD, 32 weeks) and was significantly longer among patients coming from primary care (28 weeks) as compared with the other groups (P < .01, Kruskall-Wallis test). The mean time to referral was shorter among patients with idiopathic BPPV or with BPPV secondary to recurrent vestibulopathy whereas it was more prolonged among patients with a concomitant pathology capable of justifying the presence of positional symptoms, such as vestibular neuritis or post-traumatic BPPV (P < .01, Kruskall-Wallis test). The medical cost of treating BPPV prior to referral has been calculated at euro364 per individual (mostly for non-specific medical treatments) instead of the euro136 needed for effective positional treatment.
  
  
  CONCLUSIONS
  BPPV continues to be a poorly understood pathology outside specialist neuro-otologic clinics, leading to delays in diagnosis and treatment, as well as the unnecessary consumption of resources.
authors.affiliation: Servicio de Otorrinolaringología. Hospital de Cabueñes. Gijón. Asturias. España. paz.perez@sespa.princast.es
authors.forename: Paz
authors.initials: P
authors.lastname: Pérez
authors.forename: Covadonga
authors.initials: C
authors.lastname: Manrique
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Alvarez
authors.forename: Patricia
authors.initials: P
authors.lastname: Aldama
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Alvarez
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Fernández
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Méndez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D013038:Specialization; D014717:Vertigo / Q000175:diagnosis*