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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Evaluating Acute Vertigo: Benign versus Stroke

This week, we delve into the pivotal work of evaluating patients with sudden-onset acute vertigo. Accurately distinguishing between benign labyrinthine conditions and life-threatening strokes is critical, particularly in cases presenting with the acute vestibular syndrome (AVS). Limitations of Imaging in Acute Vertigo Diagnosis Traditionally, emergency departments have relied on imaging techniques, such as cranial CT scans and MRI, to assess

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Ramsay Hunt Syndrome – Symptoms, Evaluation, Diagnosis and Treatment

Ramsay Hunt Syndrome (RHS) is a condition caused by the varicella-zoster virus (chicken pox), part of the herpesvirus family, which can remain dormant in cranial nerves or dorsal root ganglia after the initial infection, commonly known as chickenpox. Later in life, when the virus reactivates due to physiological stress or immunocompromise, it can result in herpes zoster or “shingles” anywhere

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Positional Vertigo: Hula Hoops and Other BPPV Analogies

Last week, I told a story about my difficulty in getting a patient to understand the role of meclizine in the treatment of Benign Paroxysmal Positional Vertigo (BPPV). It got me thinking about some of the analogies we use to describe certain concepts about BPPV that may be more relatable to a patient than trying to help them understand things

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Still Dizzy After the Epley Maneuver?

A few years ago, I did a post here discussing patients that continued to complain of imbalance and “fleeting disorientation” after successful treatment using the Epley maneuver or some other form of canalith repositioning. So let’s revisit that and explore some related newer reports, as well as talk about people that do not improve after repositioning for BPPV type of

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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

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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

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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 Farmacia-Rome.com , 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