YouTube Searching and Self-Treatment Behaviors Among Patients With Benign Paroxysmal Positional Vertigo Before and After Clinic Visits: Prospective Observational Study

Introduction

The influence of social media on health, public health, and disease management through information searching and acquisition is increasing [1]. In particular, the use of YouTube for obtaining health-related information is steadily rising, and its impact on health is becoming increasingly significant [2]. As a video-sharing platform, YouTube provides viewers with tools that facilitate the easy replication of behaviors observed in videos. Benign paroxysmal positional vertigo (BPPV) is a condition characterized by the displacement of otoconia from the maculae of the utricle into one or more of the three semicircular canals or their adhesion to the cupula, causing clinical symptoms due to positional changes [3]. The diagnosis of BPPV is based on identifying characteristic nystagmus, along with a thorough history taking and physical examination, using methods such as the Dix-Hallpike test and the head roll test [4,5]. The standard and highly effective treatment for BPPV is the canalith repositioning maneuver (CRM), with success rates exceeding 80% when the diagnosis is accurate [6].

The first study evaluating YouTube video content related to BPPV was published in 2012 [7]. Since then, only a few additional studies have examined BPPV-related YouTube content, and most of these have primarily focused on evaluating the validity of the information. While YouTube contains information on almost all diseases, numerous studies have assessed the reliability and accuracy of this content across various medical topics.

What distinguishes BPPV from other conditions is that YouTube hosts video content specifically on CRM, the standard treatment for BPPV, which patients can follow to potentially achieve direct therapeutic effects. In Korea, BPPV is also the most common cause of dizziness [8], and a significant amount of information about BPPV is available through YouTube searches. People in Korea often search for BPPV using Korean-language terms when looking for information online.

In our recent clinical practice, we have observed an increasing number of patients with dizziness symptoms who report searching for BPPV information on YouTube or attempting self-treatment before visiting a hospital. While previous studies focused on evaluating YouTube content from an expert perspective, this study adopts a user-centered approach to explore how patients experience and use BPPV-related information on YouTube. Specifically, it aims to examine how YouTube searching and self-treatment behaviors change before and after clinic visits, and to assess whether self-treatment influences standard in-clinic management for BPPV.

Methods

Study Design

This prospective study was conducted with patients diagnosed with BPPV who visited the otorhinolaryngology clinic due to vertigo symptoms from August 2024 to July 2025. A total of 149 patients met the eligibility criteria, and 147 of them were included in the final analysis. When a patient presented with vertigo symptoms and abnormal findings were noted during medical history taking, general otolaryngological examination, and physical examination using Frenzel glasses, videonystagmography tests were performed. After a diagnosis of BPPV was confirmed, CRMs were performed once per session, typically 2‐3 times per week. The specific maneuver was selected according to the involved canal: the modified Epley method was used for canalolithiasis of the posterior semicircular canal, the Barbecue rotation method was used for canalolithiasis of the lateral semicircular canal, and the Appiani and Gufoni methods were used for lateral-canal cupulolithiasis. In cases of multicanal involvement, only one canal was treated per session. On the final day of treatment, a survey was administered, and patient chart reviews were conducted to collect information on sex, age, number of CRM sessions, chronic disease status (hypertension or diabetes), canal involvement, preclinic YouTube searching, preclinic self-treatment, YouTube searching during treatment (postclinic), and self-treatment during treatment.

Ethical Considerations

This study was approved by the Korea National Institute for Bioethics Policy (P01-202408-01-036). All patients gave their informed consent prior to their inclusion in the study, and this study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and its later amendments. Data collection was conducted in July 2025 for research purposes. All data were fully anonymized prior to analysis, and the authors had no access to personally identifiable information. Participants did not receive any financial or nonfinancial compensation for their participation in this study.

Statistical Analysis

Descriptive statistics were used to summarize the included studies by author, origin country, publication type, research focus, and primary topic area. Differences in pre- and postclinic YouTube searching and self-treatment behavior by gender were analyzed using Generalized Estimating Equations (GEE) for repeated measures. To assess the effect of self-treatment on the number of CRM procedures, Poisson regression was initially applied, but overdispersion was confirmed (Value/df=372), leading to the use of a negative binomial regression model. A P value of <0.05 was considered statistically significant. All analyses were conducted using SPSS software (version 19.0; IBM Corp).

Results

A total of 147 patients were included in the analysis, comprising 104 (71%) women and 43 (29%) men. The age of women ranged from 17 to 86 years (mean 55.6, SD 13.3), while that of men ranged from 11 to 80 years (mean 52.7, SD 15.5). Among the 147 patients, regarding canal involvement, 18 patients (12%) had posterior canal BPPV, 56 (38%) had lateral canal involvement, 41 (28%) had multiple canal involvement, and 32 (22%) had combined canal and cupulolithiasis involvement. A history of hypertension or diabetes was present in 53/147 patients (36%).

Until the end of treatment, the number of CRM performed was 2 sessions in 21/147 patients (14%), 3 sessions in 48 patients (33%), 4 sessions in 51 patients (35%), 5 sessions in 17 patients (12%), and 6 sessions in 10 patients (6%), with a mean of 3.6 (SD 1.0).

Preclinic YouTube searching was reported by 36/147 patients (women: n=28, 19%; men: n=8, 6%), and preclinic self-treatment was reported by 11 patients (women: n=9, 7%; men: n=2, 1%). Postclinic YouTube searching was reported by 21 patients (women: n=14, 10%; men: n=7, 5%), and postclinic self-treatment was reported by 5 patients (women: n=4, 3%; men: n=1, 1%).

In the gender-stratified GEE repeated measures analysis of YouTube searching behavior, women showed significantly higher odds of searching before the clinic visit compared to after (odds ratio [OR] 2.389, 95% CI 1.195‐4.778; P=.01) (Table 1).

In the gender-stratified GEE analysis of self-treatment behavior, women with chronic disease had significantly lower odds of self-treatment compared to those without chronic disease (OR 0.125, 95% CI 0.016‐0.976; P=.047) (Table 2).

Negative binomial regression analysis evaluating the impact of self-treatment status (preclinic or postclinic) on the number of CRM sessions revealed no statistically significant association (P=.92 and P=.97, respectively) (Table 3).

Table 4 presents an overview of the included studies by author, origin country, publication type, research focus, and primary topic area. This summary provides a contextual understanding of the existing literature on BPPV, YouTube-based health information, and related digital health research.

Discussion

Principal Results

Social media, including YouTube, are dynamic and interactive computer-mediated communication tools with high penetration rates in the general population in high-income and middle-income countries. However, in medicine and health care, many stakeholders remain unaware of social media’s relevance [1]. CRMs, the standard treatment for BPPV, typically take about 10‐15 minutes to perform. Because of the procedural complexity, patients cannot accurately perform self-treatment based on short-form content or brief blog posts. Currently, YouTube is the only widely accessible platform that allows patients to visually observe and replicate these maneuvers. Therefore, almost all previous studies investigating online resources related to BPPV have focused exclusively on YouTube as the primary platform. Analyzing the overall results of YouTube content related to health reveals several key issues. Much of the information is misleading, with a high probability that consumers will encounter such content during their searches [2]. Posts created by professional organizations are more reliable. In contrast, videos uploaded by individual users are less useful [9,10]. Additionally, there is little difference in view counts between misleading and accurate posts. Most studies have focused on evaluating the validity of the information, classifying it as valid, erroneous, or anecdotal [11].

Public media serves as an avenue for informal science learning, and women may engage with YouTube content differently than men, viewing it more as an educational resource. Women are often motivated by practical or instrumental needs rather than by pure curiosity [12]. Our study found that women’s YouTube searching behavior significantly decreased after visiting the clinic, unlike men, whose search rates remained nearly unchanged. Specifically, the proportion of women engaging in YouTube searching was reduced by half following their clinic visit, suggesting that clinical consultation may have a stronger impact on modifying information-seeking behavior among women.

Previous studies have reported that approximately 30%‐35% of adults with chronic conditions such as hypertension and diabetes use YouTube to watch health-related videos [13]. In our study, despite BPPV being an acute condition, the preclinic YouTube searching rate was 25%, suggesting that patients with acute dizziness symptoms are also highly likely to seek online information before clinic visits. This relatively high level of previsit searching underscores the need for clinicians to address online health information use during consultations.

Patients often find the video format on YouTube easy to learn from and tend to evaluate the accuracy of health information by cross-checking multiple videos or judging the credibility of presenters [14].

Previous research has identified several motivations for YouTube use, such as information-seeking, social interaction, and entertainment [15,16]. Studies have also documented gender differences in YouTube usage patterns. Generally, men are more likely to watch educational or science-related content, whereas women more frequently view health and wellness videos. Moreover, the motivations for engaging with science-related content differ by gender—men more often seek entertainment or general information, while women tend to use such videos for learning or practical purposes [12]. In line with these previous findings, our study also showed that women were more likely than men to use YouTube videos as a tool for self-treatment related to BPPV.

People are increasingly using YouTube as a platform to seek support from others with similar health conditions, find answers to health-related questions, and gather information before planned medical procedures [17]. The impact of YouTube on users’ health-related behaviors and decisions is substantial; more than 50% of surveyed users reported that online health-related content influenced their decisions regarding health [18].

According to a recent study by Mohamed et al, 87.6% (n=2630) of participants watched health-related content on YouTube, and 84.7% (n=2542) reported making decisions based on the content viewed. Among users, 40% watched YouTube videos to decide whether to consult a physician or adopt a specific health-related practice [19]. In this study, women with chronic disease showed significantly lower odds of attempting self-treatment. This suggests that these patients may be more cautious about adopting unsupervised online practices and more likely to rely on professional guidance.

Research on BPPV and YouTube includes studies that evaluated the accuracy of videos on the treatment of posterior canal BPPV using the Epley maneuver. In one study, 21 out of 33 videos were found to be valid and potentially useful for patient home treatment or educational purposes [7]. Other studies have focused on evaluating educational videos for treating posterior canal BPPV following a physician’s diagnosis and providing a web-based diagnosis and treatment for BPPV in cases of symptom recurrence [20,21]. While these studies focused on the validity and accuracy of YouTube or video content, our study is distinct in that it adopts a user-centered approach.

However, this study found that prior self-treatment did not significantly affect the number of in-clinic CRM sessions required, suggesting that while inappropriate self-treatment may complicate diagnosis, it does not necessarily increase the overall treatment burden when managed in a clinical setting.

According to Liu et al [22], digital health behavior among older adults was conceptualized by extending Social Learning Theory into five dimensions. While our study focuses on actual clinical and behavioral aspects, both studies intersect in the mechanism of self-learning through observation. In particular, the observational learning dimension corresponds to visual imitation and behavioral acquisition through watching YouTube videos, whereas self-efficacy relates to patients’ confidence and belief that they can perform self-treatment independently after viewing such instructional content [22].

Lau et al [23] conducted a meta-analysis that quantitatively verified the therapeutic efficacy of artificial intelligence, AI-based psychotherapeutic interventions. In the future, the findings of our study may help overcome the limitations and risks associated with nonprofessional self-treatment and contribute to the development of AI-assisted approaches for the management of BPPV [23].

Limitations

This study has several limitations. Because the questionnaire was administered after treatment, there is a potential for recall bias, as some participants may have inaccurately reported their prior exposure to YouTube or other online resources. There is a possibility of a type II error in the study sample. Patients whose symptoms improved through self-treatment using YouTube videos might not have visited the hospital, thereby being excluded from the survey and potentially affecting the study results. Additionally, this study’s relatively small sample size did not allow for an investigation of other sociodemographic factors, such as occupation and education level, and their association with YouTube usage.

Conclusion

Our findings show that clinical consultation leads to meaningful changes in YouTube searching and self-treatment behaviors for BPPV, especially among women. While prior self-treatment attempts did not increase the number of CRM sessions needed, our findings underscore the importance of addressing online health information use and supporting patient education during clinical care.