Expert: Harriet B Jacobster, Au.D. - 7/20/2008

Question
Dear Dr. Jacobster,

I have a question regarding dizziness I have been experiencing  since a sailboat ride the end of April.  I had experienced some vertigo when I went down below into the cabin for a brief moment, but it went away as soon as I came back outside.  It was rather rocky.  I was fine for the rest of the day; however, I woke up the following morning with the room spinning.  These spells lasted just over two weeks.  Towards the end of those two weeks, I had been referred to an ENT doctor who briefly looked into my ears telling me nothing was wrong and sent me on my way with no other testing.  

I was fine again until we went back on the boat last weekend.  I was looking down when I switched sides as the boat was turning and going over a wave at the same time.  I experienced some vertigo while looking down, but this time, it stayed with me and I have been dizzy since.  It has been one week from the time of this letter.  It's not the kind of dizziness where you feel like you are still walking on a boat.  It's difficult to explain.  More like oscillations and buzzing sensations in the head while the dizzy spells are occurring, but not actual spinning.  The spells come and go with no pattern.  The first time this happened a few months ago, it was worse in the morning clearing up as the day went on, but this time, it lasts all day.  The ER doctor thought it might be an inner ear infection the first time this happened.  I just think it is odd that the boat ride is what brought it on both times.  The other odd part is that I was on the boat for the entire weekend two weeks ago, and that didn't bring about any dizziness.  I had a bit of land legs for a few hours afterwards, but that subsided that evening.

I went to my family doctor who wasn't of much help as he didn't ask enough about my symptoms.  As soon as he heard the word "dizziness", he said he thinks it might be Meniere's Disease, but I do not have any ringing, pressure or hearing loss associated with these ongoing dizzy spells.  He also told me he noticed a lump in my right ear pressing against my ear drum, but didn't think it was related and never investigated it further.  Also, it doesn't just occur with changing head direction.  It happens also when I'm just looking straight ahead, standing, sitting or walking, although sitting still seems to be worse.

I should also mention that I have always had a problem equalizing my ears on descent when flying.  I flew in February during the tail end of a cold which caused severe pain in my left ear lasting a few days after the flight which I believe still has fluid trapped in it as I hear knocking noises in there from time to time up to this day.  I flew again last month, and while pinching my nose trying to blow air up into my Eustachian tube, I could feel a burst of fluid being pushed up into my right side.  I'm not sure if these could be contributing factors or not, but these dizzy spells set off from the boat have occurred since the flight that caused the pain and fluid.  Also, I woke up this morning with my left ear feeling a bit plugged followed by bouts of pain in that ear that only lasted a couple of seconds each time, and subsided after an hour or so.  I am still dizzy with crashing fatigue.

Thank you in advance for your expert advice.  

Answer
Hi Pam,
It seems to me that, according to your description, you are suffering from something known as "Mal de Debarquement Syndrome" (Disembarkment disease).  Mal de Debarquement or "MDD" is a type of vertigo and imbalance that occurs after getting off of a boat, most common in women in their 40's. It can last for days or even years.  Here is a great site that will give you excellent information: http://www.dizziness-and-balance.com/disorders/central/mdd.html
Obviously, you need to see and ear specialist and audiologist who can evaluate you, do tests on your balance system, recommend a regimen of balance therapy., and also look at your other concerns, e.g., the "lump" in your right ear and your Eustachian Tube dysfunction. This lump especially needs to be investigated.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified Doctor of Audiology