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

## TL;DR

This paper introduces the CLEAR algorithm to help doctors identify and manage residual dizziness after treating BPPV, aiming to improve patient outcomes.

## Contribution

The CLEAR algorithm is introduced as a novel tool for recognizing and managing BPPV-related residual dizziness.

## Key findings

- BPPV-related residual dizziness is distressing and impacts quality of life, with prevalence ranging from 23 to 70%.
- The CLEAR algorithm is proposed to assist clinicians in identifying and following up on BPPV-related residual dizziness cases.

## Abstract

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.

CLEAR (Clinician-Led Evaluation for Assessment of Residual dizziness): Recognition, risk factors and potential follow-up strategies for BPPV-related RD.A QR code is provided to access the CLEAR online algorithm for the evaluation of patients for residual dizziness after resolution of BPPV. The graphical abstract includes a visual representation of how delayed vestibular adaptation may cause BPPV-related RD, with stages labeled Pre-BPPV, BPPV, CRM, and Residual Dizziness. Arrows indicate adaptation and delayed adaptation between these stages. A dashed arrow at the bottom represents central vestibular compensation. It also contains a table of follow-up strategies for BPPV-related RD, including avoiding vestibular suppressants, facilitating central vestibular compensation through rehabilitation or pharmacological therapy, and managing comorbidities.

CLEAR (Clinician-Led Evaluation for Assessment of Residual dizziness): Recognition, risk factors and potential follow-up strategies for BPPV-related RD.