Mal de Debarquement

P.A. Hanna, T.C.Hain, M.A.Rheinberger

Mal de Debarquement (MDD) refers to prolonged sensations of movement that typically follow exposure to an ocean cruise. As only 10 cases of MDD have been reported in the world literature, we undertook a survey to better characterize this entity.

A 12-page questionnaire was distributed to patients solicited through an article in the Vestibular Disorders Association newsletter. The questionaire asked for responses from persons diagnosed with MDD or having symptoms of rocking following ocean travel. Our criterian for MDD was a sensation of rocking or swaying which persisted for at least one month following exposure to motion on an airplane or boat for at least 6 hours. A total of 35 individuals responded of whom 31 met these criteria. We further excluded patients diagnosed as having perilymphatic fistula (2), stapes surgery (1), or a CNS disorder (1) leaving a total of 26 subjects.

There were 25 females and one male. Twenty-four had onset of symptoms after boat travel and 2 after airplane travel. The mean age of onset was 49 and 58% of the subjects were between the ages of 40-49 at the time of onset. Symptoms were constant in 22 and intermittent in the remaining 4. Symptoms were increased following further motion exposure in 23. There was an increased incidence of migraine (9/26) vs. the general population. Many patients with MDD reported transient or persistent otological symptoms including fullness (20), tinnitus (19), hyperacusis (16), otalgia (12), and decreased hearing (10). There was a positive family history in 4/26. Twenty-four patients were of European descent, and two were Hispanic.

Symptoms were alleviated while driving in 17. Benzodiazepine medications were the most helpful with 3/6 users of Klonopin finding it helpful. Elavil was helpful in 2/7 subjects. Neither meclizine nor scopolomine were helpful (0/17, 0/12). Vestibular rehabilitation was moderately helpful (10/15).

We conclude that MDD is typically a prolonged rocking vertigo which usually is triggered by a sea-going voyage. MDD is almost exclusively found in Caucasian females. Most cases of MDD have onset in their 40's. Anticholinergic medications are typically ineffective. The cause of MDD remains uncertain.

Hain TC, Hanna P, Rheinberger M. Mal de Debarquement Syndrome.Archives of Otolaryngology-Head Neck Surgery, 1999:125:615-620, Also see local link to Mal de Debarquement, and PDF file

Published in Archives of Otology, Head Neck Surgery, July 1999 Issue.