TürkçeThe constant feeling that an earthquake is occurring may medically be associated with pseudoseismic perception or vestibular-related imbalance. This condition generally appears as a symptom of dizziness, imbalance, or anxiety disorders.
Vestibular system disorders, particularly displaced inner ear crystals, Vestibular Migraine, or Meniere’s disease, are among the most common causes of this sensation. A disturbance in the brain’s perception of balance causes the person to feel as though they are constantly being shaken.
Psychological factors may also trigger this sensation. A constant perception of rocking or an earthquake occurring is frequently observed in individuals with panic attacks, anxiety, and post-traumatic stress disorder. In this case, both psychiatric and audiological evaluation are required.
Treatment is arranged according to the underlying cause. Vestibular rehabilitation, medication therapy, or psychological support methods may be applied. Early diagnosis and a multidisciplinary approach produce effective results in bringing this sensation under control.
The Vestibular System and Balance
The vestibular system provides the patient’s balance and movement coordination through the balance structures located in the inner ear. This system contains sensitive mechanisms specialized in detecting the position of the head and body in space.
The system consists of the following components:
- Semicircular canals: Detect angular movements of the head.
- Otolith organs (utricle and saccule): Detect linear movements of the head and changes in gravity.
During head movements, these structures detect mechanical movements and convert them into electrical signals, and the resulting signals are transmitted first to the brainstem and then to the cerebellum. The function of the cerebellum is to maintain balance and regulate body movements. For this reason, the vestibular system is in constant integration with visual and proprioceptive information.
This integration process takes place through three important reflexes:
- Vestibulo-ocular reflex (VOR): This reflex synchronizes eye movements with head movements, thereby providing clear vision even while moving.
- Vestibulospinal reflexes: These reflexes send corrective signals to the muscles in response to head and body movements, thereby maintaining balance and postural stability.
- Vestibulocollic reflex: This is the response occurring in the neck muscles during head movement. Through this reflex, the position of the head is adjusted and upright posture is stabilized.
Which Vestibular Disorders Cause Persistent Dizziness?
Vestibular disorders that cause persistent dizziness are highly varied. The most commonly encountered conditions include Persistent Postural-Perceptual Dizziness (PPPD), Meniere’s disease, Vestibular Migraine, and previous but incompletely resolved BPPV.
- Persistent Postural-Perceptual Dizziness is a chronic condition that causes imbalance and visual discomfort without a spinning sensation. It generally develops after an acute vestibular event, and symptoms last for at least three months. Symptoms worsen with upright posture, movement, or complex visual stimuli. A mismatch between the brain’s sensory inputs and excessive dependence on somatosensory cues are the most important underlying causes of this condition.
- Meniere’s Disease is a complex condition characterized by abnormal fluid accumulation in the inner ear, affecting both the hearing and balance systems. It generally follows a unilateral course. It may rarely occur in both ears. Genetic predisposition and viral infections are among the best-known underlying causes. Symptoms generally include fluctuating hearing loss observed unilaterally, tinnitus, fullness in the ear, and episodic vertigo attacks lasting several hours.
- Vestibular Migraine is a condition characterized by severe headaches, dizziness, and a sensation of imbalance. Vertigo attacks may last several hours and are generally triggered by sensory stimuli. Sensitivity to light, sound, and smell, as well as nausea, occurs during dizziness.
What Triggers Provoke (Worsen) Vestibular Symptoms?
Various triggers are among the causes of the constant feeling that an earthquake is occurring. Visual stimuli hold an important place among these triggers. For example, places with complex visual patterns such as supermarkets and shopping malls, certain carpet patterns, bright lights, or visual elements such as moving text may trigger dizziness and a feeling of imbalance. Visual complexity is particularly challenging for individuals in crowded and highly stimulating environments.
Sudden head movements, such as looking upward or bending the head downward, may also complicate the condition experienced by patients and lead to worsening symptoms.
Stress and anxiety may trigger dizziness and a feeling of imbalance. These emotional states may create a vicious cycle that causes symptoms to increase. Vestibular symptoms may become more pronounced in individuals under stress.
Lack of sleep is also among the factors that worsen dizziness. Poor-quality sleep leads to increased fatigue and consequently causes balance problems to be felt more intensely. Sleep pattern disorders may worsen symptoms, particularly in patients with vestibular migraine.
What Is Mal de Débarquement Syndrome and How Does It Cause a Rocking Sensation?
Mal de Débarquement Syndrome is a neurological disorder that generally begins after sea, air, or land travel. This condition is particularly characterized by the persistence of the sensation of movement that would normally be expected to disappear after motion ends. Patients frequently feel as though they are continuously rocking on a boat. These sensations generally continue after reaching land and may sometimes last for years.
It has two main types:
- Motion-triggered MdDS: It occurs particularly after passive motion such as sea or air travel.
- Spontaneous-onset MdDS: It occurs without a specific motion trigger.
The exact cause of this syndrome is not yet fully understood, and the system is responsible for balance and motion perception. These signals, perceived by the central nervous system as incompatibility or conflict, may cause the individual to perceive movement even when there is actually none. This incompatibility is associated with dysfunctions of the vestibulo-ocular reflex.
MdDS is more common in women and generally affects middle-aged women. Studies show that the vast majority of patients are women. In addition, the intensity of symptoms may increase during the perimenopausal period. This suggests that hormonal changes may influence the syndrome.
How Do Head Injuries Cause Vestibular Dysfunction?
Head injuries may cause vestibular dysfunction. Peripheral and central damage hold an important place among these conditions.
- Peripheral Vestibular Damage: Head injuries may affect the semicircular canals responsible for angular head movements and the otolith organs responsible for linear movements. These structures play a critical role in detecting gravity and head movements. Damage reduces the ability to detect linear acceleration, which causes a feeling of imbalance and dizziness.
- Vestibulo-Ocular Reflex (VOR) Dysfunction: Head injuries may cause concussion. The VOR may be damaged as a result of the resulting brain injury. An individual with a normally functioning VOR stabilizes vision by keeping the gaze on the fovea during head movements. In an individual whose VOR does not function properly, this impairment causes visual blurring, the illusion that the surroundings are moving or slipping, and dizziness.
- Central Vestibular System Disorder: Head injuries may affect the central vestibular pathways within the brain. As a result of the damage, communication disruptions, nystagmus (abnormal eye movements) as a physiological consequence of dizziness, and balance problems may occur.
- Long-Term Consequences: According to statistics on peripheral dizziness, the acute condition improves within a few weeks in most individuals, while some individuals may experience persistent dizziness. This condition is known as PPPD and causes constant imbalance and a sensation of movement. Complex visual environments may cause feelings of anxiety in these individuals.
Frequently Asked Questions
The constant feeling that an earthquake is occurring may arise from different causes such as inner ear balance disorders, Mal de Débarquement Syndrome (MdDS), vestibular migraine, PPPD, or anxiety. A detailed evaluation is required to determine the exact cause.
A constant rocking sensation that begins after a long sea, air, or vehicle journey may be related to Mal de Débarquement Syndrome. Even when motionless, the person may feel as though the ground is shaking, and symptoms may last for days or months.
Vestibular migraine may cause rocking, imbalance, and a sensation of movement with or without a headache. A feeling that an earthquake is occurring may be described during attacks, and a detailed evaluation should be performed for diagnosis.
A detailed patient history, audiological evaluation, hearing tests, and vestibular tests play an important role in diagnosis. When necessary, v-HIT, VEMP, VNG, and imaging methods may be used for differential diagnosis.
Vestibular rehabilitation may be effective in inner ear-related balance disorders and some chronic vestibular conditions. Exercises planned by an audiologist help the balance system readapt.
Intense stress and anxiety may cause existing balance problems to be felt more prominently. However, these complaints should not be attributed solely to stress, and an evaluation should first be performed for vestibular and neurological causes.
The duration varies according to the underlying cause. While symptoms improve within a few days in some people, they may continue for weeks or months in conditions such as MdDS or PPPD. Early diagnosis may support the recovery process.
Regular sleep, adequate fluid intake, avoiding sudden head movements, and performing balance exercises recommended by a specialist may contribute to symptom management. Self-medication should be avoided.
If the rocking sensation is accompanied by sudden hearing loss, severe headache, speech impairment, double vision, altered consciousness, or weakness in the arms or legs, urgent medical evaluation should be performed without delay.
If the sensation that an earthquake is occurring lasts longer than a few days, recurs, or affects daily life, an audiologist and an ear, nose, and throat specialist should be consulted. Early evaluation helps establish the correct diagnosis and an appropriate treatment plan.
Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. She specialized in Pediatric Audiology, Otologic Disorders, and Vestibular System Disorders, and served for 15 years at the Istanbul Training and Research Hospital. In 2015, she joined the Acıbadem Healthcare Group. She currently works as an Audiologist at the Acıbadem Altunizade Hospital and also serves as a faculty member and program director in the Acıbadem University Vocational School of Health Services Audiometry Program.
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