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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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

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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

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When the Dix-Hallpike (and everything else) is Negative

It is not uncommon to have a patient describing a history consistent with current active BPPV, and to have your exams, including Dix-Hallpike tests, be negative. My last post described techniques that can improve the likelihood of a positive test in these patients, but sometimes despite your best efforts, you cannot trigger an episode of positional vertigo in your office.

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Improving the Sensitivity of the Dix-Hallpike Test for BPPV

Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder and most common cause of episodic vertigo. Once identified, Canalith Repositioning procedures are very safe, fast and effective at resolving this condition. So effective, that when repositioning does not quickly relieve the symptoms, the most likely explanation is that the diagnosis is wrong, or the repositioning is being done

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Update on Management of BPPV

I’ve got some good news and I’ve got some bad news BPPV (Benign Paroxysmal Positional Vertigo) is the most common and most treatable cause of episodic dizziness and vertigo. Various studies suggest that BPPV is the source of the complaint in approximately one quarter of all dizzy patients, and accounts for approximately half of all vestibular disorders. As a result,

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The Value of Audiology- A Student Perspective

Editor’s Note: This week, we have a contribution from Alyssa Fischer. Alyssa is a third year AuD student at UNC Chapel Hill, and has spent the last few months in our vestibular lab at Wake Forest. Her perspective is unique in that her mother and brother are both audiologists, so she has some insight into the fact that there are

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Practitioner’s Guide to the Dizzy Patient

Vestibular Specialists know a few things. We know that when a patient complains of “dizziness” they could be referring to vertigo, lightheadedness, imbalance, fear of falling, blurred vision or disorientation. We know that these are different complaints with different possible causes, requiring different examinations and different treatments. We know patients often have a hard time describing their symptoms. We know

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Vestibular Compensation

Vestibular compensation is often referred to as central compensation. In the world of vestibular function, central generally refers to brain function, while peripheral generally refers to ear function. This is an important distinction because in many cases of peripheral or inner ear dysfunction, the injury to the inner ear may be permanent; however, the symptoms are not. Central compensation refers

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Vestibular Testing Equipment: What is Essential?

We continue to respond to questions posed by readers as we make our way through this quarantine. Andy, AuD asked the following question: “I work in a multi-specialty private clinic here in the Caribbean. As our budget is somewhat limited, what diagnostic equipment is recommended or considered essential for establishing an appropriate vestibular clinic. We have family medicine and physiotherapy

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The Dizziness History Interview

The importance of asking the right questions (and getting those questions answered) Today’s blog is inspired by a comment by Bruce Piner, AuD. We are all trying to be productive during this quarantine, so I have asked readers for suggestions. See Dr. Piner’s comments at the end of this blog. Having a clear understanding of the complaint is crucial to