Alan Desmond

Alan Desmond, AuD, is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. He has written several books and book chapters on balance disorders and vestibular function. He is the co-author of the Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo (BPPV). In 2015, he was the recipient of the President's Award from the American Academy of Audiology.

Featured image for “Modifications of the Dix-Hallpike Test for BPPV”

Modifications of the Dix-Hallpike Test for BPPV

Editor’s Note: This blog was written by Carrie Nuss, BS. Carrie is a fourth -year AuD student at the University of Louisville, doing a vestibular (among other things) residency at Atrium Wake Forest Medical Center. –Alan Desmond, AuD by Carrie Nuss BPPV is common, bothersome, potentially disabling, but generally quickly resolved once a specific diagnosis has been established. The gold

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Initial Case History Interview with Vestibular Patients

Most vestibular disorders cannot be diagnosed by testing alone. With the exception of BPPV, patient’s test findings must be placed in context with the medical history and symptoms. Some common disorders, such as vestibular migraine, suffer from no diagnostic tests, and diagnosis is primarily based on patient report of symptoms. Financial pressures which affect both generalists and specialists alike, have

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vHIT Tracks Compensation Following Acute Vestibular Neuritis

In the Fall of 2017, I experienced an episode of acute right vestibular neuritis (VN). I joke that I likely have the most well documented case of VN on record. I am often the first live patient most of our students test as I am a willing example of “abnormal.” Seven years later, my permanent vestibular dysfunction has faded to

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Video Based Education in the Vestibular Clinic

I am a “late career” audiologist that specializes in vestibular disorders. It is never boring, as each patient brings with them some mystery, some challenge. There is little that is more rewarding than solving that mystery in a patient that has given up hope after months or years of symptoms with prior incorrect diagnosis and ineffective treatments. On the other

Featured image for “Checklist for Evaluating Acute and Recent Onset Vertigo and Dizziness”

Checklist for Evaluating Acute and Recent Onset Vertigo and Dizziness

In my last blog post, I reviewed the new GRACE 3 guideline for acute dizziness and vertigo in the emergency department. The first recommendation from that guideline was that Emergency Department (ED) physicians need training in bedside tests such as the HINTS protocol, the Dix-Hallpike test, and performing the Epley maneuver when applicable. I also suggested that those of us

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Understanding Motion Sickness

I have been told that it is rude to ask people what they do for a living in Italy. I know that seems like a strange way to start a blog about vestibular disorders, but hang in here with me for a minute. I just got back from a week-long vacation visiting friends at their lake house in Michigan. I

Featured image for “Academy of Emergency Medicine Releases Guideline for Acute Vertigo”

Academy of Emergency Medicine Releases Guideline for Acute Vertigo

The Society for Academic Emergency Medicine, in May of 2023, published GRACE-3. Grace is an acronym for Guideline for Reasonable and Appropriate Care in the Emergency Department. GRACE 1 and 2 offer guidelines for chest pain and abdominal pain. GRACE-3 addresses “acute vertigo and dizziness in the emergency department”. This is a welcome, much needed, and frankly overdue development as

Featured image for “Motion Sickness – Result of Sensory Conflict”

Motion Sickness – Result of Sensory Conflict

Last week I discussed motion sickness, pointing out that it often has nothing to do with any inner ear disorder. However, occasionally it is directly related to an inner ear disorder. I will try to explain… Seasickness Seasickness represents an extended sensory conflict, whereas brief sensory conflicts typically do not induce nausea despite causing momentary disorientation. A familiar example of

Featured image for “Vestibular Ocular Reflex (VOR) Exercises”

Vestibular Ocular Reflex (VOR) Exercises

If the results of the rotary chair examination indicate a deficit of the VOR, particularly decreased gain or a significant asymmetry, we may start the patient on a series of exercises known to enhance the function of the VOR. Like most exercises, the goal is to push the limit of your performance to gradually increase your limit. Below, you will

Featured image for “CT Scans for Dizziness: Good or Bad Idea?”

CT Scans for Dizziness: Good or Bad Idea?

Approximately one year ago, I embarked on an exploration of the most efficient and cost-effective methods for assessing patients experiencing acute dizziness. This investigation took the form of a comprehensive five-part blog series titled “Acute Vertigo: Could It Be A Stroke?” Within this series, I underscored a crucial point: the prevalent imaging techniques often employed in the Emergency Room setting