REVIEW article
Front. Neurol.
Sec. Neuro-Otology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1689617
Enhancing patient care with BPPV-related residual dizziness: Introducing the CLEAR algorithm to support BPPV-RD recognition and follow-up strategies
Provisionally accepted
- 1Aalborg Universitetshospital, Aalborg, Denmark
- 2Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
- 3MSA ENT Academy Center, Cassino, Italy
- 4Aix-Marseille Universite, Marseille, France
- 5Bayindir Hastanesi Sogutozu, Ankara, Türkiye
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Benign paroxysmal positional vertigo (BPPV)-related residual dizziness (RD), a type of dizziness following successful treatment of BPPV, is increasingly recognized, with a reported prevalence ranging from 23% to 70%. BPPV-related RD is characterized by nonspecific dizziness in the absence of positional vertigo and nystagmus. It can be very distressing and lead to substantial impacts on 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 the 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 manoevres (CRM); 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 the follow-up strategies. The aim is to help specialist ENT clinicians and neurologists to recognize BPPV-related RD quickly and follow up appropriately to resolve symptoms as quickly as possible (see graphical abstract).
Keywords: BPPV, Residual dizziness, algorithm, Risk factors, vestibular compensation, type 1BPPV-related residual dizziness, type 2 BPPV-related residual dizziness
Received: 20 Aug 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Kingma, Manzari and Özgirgin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Herman Kingma, hermanuskingma@gmail.com
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