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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Perspectives on Vestibular Testing and More Common Errors

I have done a couple of blogs over the years under the heading “Vestibular Brain Droppings.” Credit goes to George Carlin for the title. Basically, “Brain Droppings” consist of unrelated factoids or opinions that don’t fit neatly anywhere else. I am day five into home quarantine, so my brain is eager to be productive. I will ask it to be

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I Got 99 Ways to Treat BPPV, and Meclizine Ain’t One

Yes, I am paraphrasing Jay Z to discuss effective treatment of Benign Paroxysmal Positional Vertigo – or BPPV for short. It is difficult now to imagine that when I first started practicing in the early 80s, canalith repositioning (CRP) techniques for BPPV did not exist. My first exposure came when a personal friend came to my office with complaints of

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Dizziness and Driving

It is not unusual for patients to ask about their ability to drive after being diagnosed with a vestibular disorder. It is a reasonable and responsible concern without a clear answer. Our litigious society dampens our ability to clear a patient when we feel that they have adequately compensated from a chronic vestibular injury, or when BPPV symptoms have resolved.

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vHIT Helpful in Diagnosing Meniere’s Disease

Meniere’s disease (MD) is notoriously difficult to diagnose under the best of circumstances, as symptoms (tinnitus, vertigo and hearing loss) are transient. Vestibular tests and audiograms may be normal in the early stages. Caloric responses may be decreased or increased relative to the healthy ear depending on how recently the patient had an episode. Because testing often fails to produce

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“Just Say No” to a Code for vHIT

Think you want a code for vHIT? Think again. Currently there is no code for vHIT, but I frequently hear from practicing Audiologists that there should be. Most of the procedures we use for the diagnostic evaluation of the dizzy patient have been assigned Current Procedural Terminology (CPT) codes. These codes describe the service, and each code is assigned

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Bogus Balance Billing Busted in Brooklyn

Last week I attended a meeting of the American Medical Association (AMA) where we were tasked with redefining and re-valuing the code for Computerized Dynamic Posturography (CPT 92548). The proceedings surrounding the development of values for codes are confidential; so I cannot discuss the results of these deliberations. In the process of researching this code in preparation for these discussions

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What Happens to the Otoconia (Rocks, Particles, Crystal, Otoliths) After the Epley Manuever?

Canalith Repositioning (CRP), more commonly referred to as the Epley maneuver, has become the “go to” treatment for the complaint of positional vertigo. I have been at this long enough to see the transition from skepticism that any condition could be quickly treated by lying down and rolling over in bed, to the current habit of people being treated for

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Common Errors in Vestibular Management

Editor’s Note: While our editorial team takes the week off for the holiday’s, we hope you enjoy our favorite post for 2018 at the Dizziness Depot. This post was originally published on June 25, 2018. Disorders of the inner ear are, for the most part, not visible through imaging and are not detected through blood tests. We get a limited and

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The State of Vestibular Testing

An Analysis of the Numbers Dizziness, vertigo, imbalance, falling and fear of falling are very common complaints in the adult population, and increase with age. Emergency Department (ED) data obtained from the National Ambulatory Care Survey show a 97% increase in annual visits for dizziness from 1995 to 2011, accounting for 3.9 million visits in 2011 at a cost of

Featured image for “A Non-Sedating Option for Vertigo and Nausea?”

A Non-Sedating Option for Vertigo and Nausea?

As I have reported here over the years, meclizine (Antivert) is a commonly prescribed medication for the treatment of vertigo. A recent survey reveals that meclizine is prescribed to 21.4% of elderly patients complaining of a “balance or dizziness problem.” Meclizine is an anti-cholinergic that reduces nausea from acute vestibular disorders as well as motion sickness. In fact, over the