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 “Dizziness from Drinking: Cerebellar Dysfunction and Chronic Alcohol Abuse”

Dizziness from Drinking: Cerebellar Dysfunction and Chronic Alcohol Abuse

I recently saw a patient referred for the generic complaint of “Dizziness.” When he got up from the chair in the waiting room, he had an obvious gait disorder and used both a cane and a family member’s arm to make it back to the examining room. He did not complain of vertigo or lightheadedness, but reported that he had

Featured image for “Motion Intolerance from Vestibular Disorders”

Motion Intolerance from Vestibular Disorders

After a unilateral peripheral injury, such as would occur with vestibular neuritis, there is a predictable set of clinical signs and symptoms that occur. In addition to an initial period of acute vertigo, there is often a period of motion intolerance that follows. The acute vertigo usually lasts for several hours, but gradually decreases over a period of three to

Featured image for “Smartphone Use in Vestibular Diagnosis”

Smartphone Use in Vestibular Diagnosis

Multiple sources agree that the most common causes of the complaints of dizziness and vertigo include benign paroxysmal positional vertigo, vestibular migraine, orthostatic hypotension, vestibular neuritis, and Ménière’s disease. There are subtle differences in the symptom presentation, duration, provoking or exacerbating factors that guide the examiner to the diagnosis. Vestibular neuritis almost always presents as an isolated episode of vertigo

Featured image for “A Simple, Quick, and Effective Tool to Help Diagnosis Dizziness and Vertigo”

A Simple, Quick, and Effective Tool to Help Diagnosis Dizziness and Vertigo

As we and many others have discussed in previous blogs and articles, the word “dizzy” is a broad and ineffective descriptor of symptoms that might bring someone to a vestibular clinic. I did an eight part series on this topic about ten years ago. It is important to get additional information to venture any guess as to the possible cause of the

Featured image for “Canal vs. Otolith Vestibular Dysfunction, is there a difference?”

Canal vs. Otolith Vestibular Dysfunction, is there a difference?

Recently, I was reading an article discussing the differences in symptoms among adults with canal versus otolith vestibular dysfunction, which raises some important questions for the future of vestibular assessment. As most clinicians know, a detailed case history is essential in establishing a diagnosis of peripheral vestibular dysfunction, with the qualitative nature of the symptoms being important in reaching a

Featured image for “Romberg Testing for Imbalance – What is it and What Does a Positive Result Mean?”

Romberg Testing for Imbalance – What is it and What Does a Positive Result Mean?

The Romberg test, sometimes spelled Rhomberg, is a commonly used but often misunderstood screening test for standing balance. It involves having the patient stand with feet together and arms either folded across the chest or at the sides. Initially, the patient’s ability to maintain this position with minimal swaying is observed. Subsequently, the patient is asked to stand with eyes

Featured image for “Questions from a Fellow Vestibular Neuritis Survivor”

Questions from a Fellow Vestibular Neuritis Survivor

I received an email a couple of weeks ago from Deanne asking questions about Vestibular Neuritis (VN) and associated chronic symptoms. With her permission, because her questions are both relevant and typical of many patients with VN, I am responding through this blog in a Q and A format. Deanne’s questions in Italics. My responses in bold. Links to relevant

Featured image for “An Effective Approach to Acute Vertigo”

An Effective Approach to Acute Vertigo

My most recent blog discussed the state (or lack thereof) of the development of a Clinical Practice Guideline (CPG) for acute vertigo. I ended the blog with the following thought: “Is it possible that a Clinical Practice Guideline for acute vertigo could result in more accurate diagnosis and more effective treatment, while at the same time dramatically reducing cost? There

Featured image for “Clinical Practice Guideline for Acute Vertigo? It’s Past Time”

Clinical Practice Guideline for Acute Vertigo? It’s Past Time

When patients arrive in the Emergency Department with the complaint of dizziness or vertigo, there is a 40 to 50% chance that a cranial CT will be ordered. When that same patient is evaluated through telehealth by a specialist with advanced knowledge and skill in evaluating dizziness and vertigo, there is only a 2% chance that a cranial CT will

Featured image for “Migraine Causes Dizziness, and Impacts Vestibular Disorders”

Migraine Causes Dizziness, and Impacts Vestibular Disorders

By Alan L. Desmond, AuD. Vestibular Migraine (VM) is one of the most common causes of dizziness and vertigo. Just like migraine headache, there is no specific diagnostic test, so the diagnosis is based on an agreed upon set of clinical signs and symptoms. In the case of VM, two professional societies, the International Headache Society and the Barany Society