Many people know about benign paroxysmal positional vertigo (BPPV)—a very common cause of brief spinning sensations triggered by changes in head position. BPPV is usually treated effectively with specific head-movement maneuvers (called canalith repositioning maneuvers, or CRMs) that help tiny particles in the inner ear settle into the correct position. However, even after successful treatment, a lot of patients don’t fully feel “normal” again. Instead, they develop ongoing, nonspecific dizziness, unsteadiness, or a general feeling of imbalance that isn’t spinning vertigo and can last for weeks to months. This lingering symptom is known as residual dizziness (RD).
This review article explains why residual dizziness matters and how clinicians can better recognize and help these patients. Researchers note that RD is extremely common. Studies report that about 23% to 70% of people treated for BPPV experience it, showing that this isn’t a rare problem but a frequent and distressing one, that deserves proper attention and treatment.
Why Residual Dizziness Is a Big Deal
Even though RD isn’t the intense spinning most people associate with vertigo, it can still be very disruptive:
People describe it as light-headedness, a floating sensation, “head heaviness,” or unsteadiness when walking or turning.
Especially in older adults, dizziness of any kind is strongly linked to a higher risk of falls, reduced quality of life, social isolation, anxiety, and loss of independence. In fact, dizziness in people with vestibular problems is associated with a significantly increased risk of future falls.
Some people feel the residual symptoms are worse than the original BPPV because they can’t predict when they’ll feel off-balance and can’t avoid it simply by avoiding head positions.
Who Is Most at Risk?
The article summarizes known risk factors for developing RD after BPPV:
- Older age and female sex
- Hybrid cases where BPPV resolved on its own rather than through maneuvers
- A longer duration of BPPV symptoms before treatment
- Signs of vestibular system dysfunction on certain lab tests
- Higher anxiety or worse dizziness reported before treatment
- Some bone and metabolic conditions, like osteopenia or low vitamin D, might also play a role—though more research is needed.
Crucially, not all patients with RD have clear risk factors, and in many cases the exact reason people continue to feel dizzy isn’t fully understood.
Introducing the CLEAR Algorithm
To help doctors better spot and manage BPPV-related RD, the authors introduce an online decision-support tool called CLEAR (Clinician-Led Evaluation for Assessment of Residual Dizziness). Though this isn’t a treatment per se, it’s a structured way for clinicians to evaluate symptoms, consider risk factors, and plan appropriate follow-ups. This might include monitoring, referrals for vestibular rehabilitation therapy, or other strategies to support recovery and reduce the impact of dizziness.
Why This Matters for Patients and Clinicians
The bottom line is this: residual dizziness after BPPV is common, impactful, and under-recognized. Greater awareness among clinicians—and tools like CLEAR—can help patients receive better support, tailor follow-up care, and reduce long-term effects such as falls and loss of confidence. This research helps shift RD from a poorly understood “afterthought” in BPPV to an issue taken seriously in clinical practice with proper treatment.
