# Unnecessary magnetic resonance imaging is associated with diagnostic delay and financial burden in benign paroxysmal positional vertigo: a retrospective study in Mongolia

## TL;DR

Unnecessary MRI scans for benign vertigo in Mongolia cause delays in diagnosis and financial strain, despite effective treatments being available.

## Contribution

This study reveals the impact of unnecessary MRI use on diagnostic delay and financial burden in BPPV patients in Mongolia.

## Key findings

- 62.5% of BPPV patients were referred from other hospitals, with only 3.7% correctly diagnosed before referral.
- MRI use caused a significantly longer diagnostic delay (24.4 days) compared to non-MRI cases (7.5 days).
- A single MRI scan costs 72% of a minimum-wage worker’s monthly income in Mongolia.

## Abstract

This single-center, retrospective cohort study investigated the clinical characteristics, diagnostic pathways, and economic burden of benign paroxysmal positional vertigo (BPPV) at a national tertiary referral ENT hospital in Ulaanbaatar, Mongolia.

We analyzed 162 patients (mean age, 50.0 ± 11.7 years) with confirmed BPPV who completed follow-up between January 2019 and January 2021. Patients were treated with canalith repositioning procedures and instructed to perform self-maneuvers. The primary outcome was symptom resolution at 7, 14, and 28 days, and the secondary outcome was the change in Dizziness Handicap Inventory (DHI) scores.

Results showed that 102 patients (62.5%) were referred from other hospitals, yet only 6 (3.7%) were correctly diagnosed prior to referral. Multivariate logistic regression identified no specific clinical symptoms predicting magnetic resonance imaging (MRI) usage, suggesting that neuroimaging was largely driven by patient-initiated demand in the private sector. The mean diagnostic delay was significantly longer in the MRI group (24.4 ± 19.5 days) compared to the non-MRI group (7.5 ± 5.9 days, p < 0.001). Cost analysis based on 2024 metrics revealed that a single potentially low-yield MRI consumes 72.0% of a minimum-wage worker’s monthly income, creating a catastrophic financial burden. Treatment was highly effective, with resolution rates of 75.9, 93.8, and 99.4% at 7, 14, and 28 days, respectively. The mean DHI score improved significantly from 39.93 to 4.12 (p < 0.001).

BPPV patients in Mongolia face significant diagnostic delays and high misdiagnosis rates. While standardized maneuvers are effective, the reliance on costly imaging highlights an urgent need for educational initiatives to improve awareness and primary care triage in developing countries.