How is Mal de debarquement diagnosed?

Mal de debarquement syndrome (MdDS) is a clinical diagnosis primarily based on a patient's history of persistent rocking or swaying sensations following passive motion, such as travel by boat, plane, or car. Because there are no standard blood tests or imaging scans to confirm Mal de debarquement, diagnosis relies on excluding other vestibular disorders through a comprehensive clinical evaluation by an otolaryngologist or neurologist.

How is Mal de debarquement diagnosed?

The diagnostic process for Mal de debarquement is often challenging because the condition does not show up on conventional medical imaging. A physician will typically begin by taking a detailed patient history to establish the "trigger event"—the period of passive motion that preceded the onset of symptoms. Since Mal de debarquement is a diagnosis of exclusion, clinicians must rule out other vestibular and neurological conditions that mimic the sensation of "land sickness."

What tests are used to evaluate Mal de debarquement?

There is currently no biomarker, genetic test, or biopsy that confirms Mal de debarquement. Instead, your medical team will use a combination of examinations to ensure your symptoms are not caused by structural issues. Common evaluations include:

• Vestibular Function Testing: Tests like videonystagmography (VNG) or rotary chair testing to assess the inner ear's balance mechanisms.


• Neurological Imaging: MRI or CT scans of the brain to rule out tumors, multiple sclerosis, or structural abnormalities in the cerebellum.


• Audiometry: Hearing tests to differentiate Mal de debarquement from Meniere’s disease or other inner ear disorders.


• Clinical Balance Assessments: Physical examinations that test gait, posture, and coordination (e.g., Romberg test).

What are the official diagnostic criteria?

According to the Barany Society’s International Classification of Vestibular Disorders, the criteria for Mal de debarquement include a persistent sensation of rocking, swaying, or bobbing that is present for at least one month. A key diagnostic feature is that these symptoms typically improve while the patient is in passive motion (such as driving in a car) and worsen when stationary. Patients often experience a long "diagnostic odyssey," sometimes waiting months or even years to receive an accurate diagnosis, as many general practitioners are unfamiliar with the nuances of Mal de debarquement.

Which specialists should I consult?

It is common to feel frustrated when initial doctors dismiss these symptoms as anxiety or "all in your head." Because Mal de debarquement is rare, it is vital to seek out specialists who focus on neuro-otology or vestibular disorders. A neuro-otologist or a neurologist with a sub-specialty in balance disorders is best equipped to recognize the pattern of symptoms. At DiseaseMaps.org, we have seen 11 community members navigate this journey; connecting with others who have been through this process can provide much-needed validation and guidance in finding the right care.

Differential diagnosis: What else could it be?

Before confirming Mal de debarquement, doctors must distinguish it from conditions with overlapping symptoms, such as Persistent Postural-Perceptual Dizziness (PPPD), Meniere's disease, vestibular migraine, and superior canal dehiscence. Accurate diagnosis is essential because the treatment pathways for these conditions differ significantly.

Next steps

• Seek a specialist: Request a referral to a neuro-otologist or a balance center at a major university hospital.


• Keep a symptom diary: Document your triggers, the duration of your swaying sensations, and any factors that provide temporary relief.


• Join our community: Connect with the 11 other members on DiseaseMaps.org who are living with Mal de debarquement to share experiences and provider recommendations.


• Bring literature: Print out the Barany Society diagnostic criteria to share with your primary care physician if they are unfamiliar with the condition.

Medical disclaimer: This information is for educational purposes only and does not constitute medical advice; please consult a qualified healthcare professional for diagnosis and treatment.

References

• Strupp M, et al. "Proposed diagnostic criteria for Mal de debarquement syndrome." Journal of Vestibular Research.


• NIH Genetic and Rare Diseases Information Center (GARD).


• MdDS Balance Disorder Foundation.


• Orphanet: Mal de debarquement syndrome.