Enhancing patient care in BPPV-related residual dizziness: introducing the CLEAR algorithm to support BPPV-RD recognition and follow-up strategies

Benign paroxysmal positional vertigo (BPPV)-related residual dizziness (RD), a type of dizziness following successful treatment of BPPV, has been increasingly recognized, with a reported prevalence ranging from 23 to 70%. BPPV-related RD is characterized by non-specific dizziness in the absence of positional vertigo and nystagmus. It can be very distressing and lead to substantial impacts on the quality of life and morbidity, especially the risk of falling. This review examines the risk factors and underlying mechanisms contributing to BPPV-related RD, focusing on peripheral and central mechanisms. Based on clinical experience, two subtypes of BPPV-related RD are suggested: type 1, the classic BPPV-related RD occurring after canalith repositioning maneuvers; and type 2, a novel subtype arising after spontaneously resolved BPPV that requires a history of BPPV but not previous confirmation by clinical examination (subjective BPPV). This review introduces a special online algorithm, the Clinician-Led Evaluation for Assessment of Residual dizziness (CLEAR), to help clinicians recognize patients with BPPV-related RD, and reviews follow-up strategies. The aim is to help specialist ear, nose, and throat clinicians and neurologists recognize BPPV-related RD quickly and follow up appropriately to resolve symptoms as quickly as possible.