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.

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Is BPPV Different for Migraineurs?

Simple answer, “Yes.” In addition to typical focal headaches, many migraineurs also experience photophobia, phonophobia, and/or osmophobia, both during and between headache episodes. Many migraineurs describe sensory hypersensitivity which results in common everyday situations being intolerable. Lights are too bright, sounds are too loud, smells are too strong. Most of us can relate the discomfort of having a bright light

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Managing Recurrent BPPV: What Patients Can Do

Benign Paroxysmal Positional Vertigo (BPPV) has a recurrence rate estimated between 15% and 40% within one to two years after an initial episode. While many patients respond well to canalith repositioning procedures (CRPs), a smaller subset experiences more frequent recurrences. Understandably, these individuals often ask what they can do to prevent future episodes. This post explores several actions patients can

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Vestibular Neuritis

Symptomatically, Vestibular Neuritis (VN) typically presents as sudden onset spontaneous acute vertigo, often associated with nausea and vomiting. The vertigo typically lasts for a minimum of several hours to sometimes days. While the intensity of the symptoms can be exacerbated by movement, they are not resolved by lying or sitting still in the first 24 hours, which differentiates VN from

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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

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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