Vestibular Disease in Dogs

What is vestibular disease?

Vestibular disease is a condition that affects the vestibular system, which helps a dog maintain balance and move normally. The vestibular system has central components in the brain and peripheral components in the inner and the nerves that connect it to the brain. Disease or damage in any of these areas can affect a dog’s balance and coordination.

What are the signs of vestibular disease?

Signs of vestibular disease usually develop suddenly, often in less than an hour. Signs include:

• Sudden loss of balance and coordination
• Disorientation
• Falling or circling to one side
• A head tilt
• Involuntary, darting eye movements called nystagmus
• Reluctance to stand or walk
• Nausea, vomiting, or reduced appetite

What causes vestibular disease?

 Common causes of vestibular disease include:

• Middle- and inner-ear infections
• Trauma or injury
• Tumors
• Hypothyroidism
• Certain medications that can damage the inner ear

When no specific cause is found, the condition is called idiopathic vestibular syndrome. Idiopathic cases are distinguished by the sudden onset of clinical signs followed by rapid improvement with little or no medical intervention.

How is vestibular disease diagnosed?

Your veterinarian will diagnose vestibular disease based on your pet’s medical history and physical, neurological, and ear examinations. Additional tests may be recommended to identify the underlying cause or rule out more serious conditions. Tests may include:

• Blood and urine tests
• Ear exam (a ruptured or bulging eardrum can be a sign of a middle or inner ear infection)
• Blood pressure measurement 
• Skull radiographs (X-rays)
• Oral and otoscopic (ear) exam under anesthesia with cytology and/or culture of any exudate (discharge or fluids)
• Spinal fluid analysis
• Specific infectious disease testing
• Magnetic resonance imaging (MRI) or computed tomography (CT) scans to look for tumors or other brain abnormalities
• Brainstem auditory evoked response (BAER) testing may be used in some dogs to assess hearing

 Findings that may support a diagnosis of canine idiopathic vestibular syndrome include:

• Older age
• Sudden onset of peripheral vestibular signs
• No identifiable underlying cause
• Rapid improvement, with signs resolving on their own over several weeks

How is vestibular disease treated?

Treatment depends on the underlying cause. Antibiotics or anti-fungal medications may be used in middle- or inner-ear infection cases. Drugs that help combat nausea or motion sickness may be beneficial. Corticosteroids have been used in the past, but they are generally not recommended.

In severe cases, supportive therapy such as intravenous fluids and hospitalization may be required until the dog can eat and walk on their own. If the dog is seriously disoriented or ataxic (stumbling, unable to stand or walk), they may be given medication to help them relax. In less severe cases, nursing care at home will likely be sufficient. This care includes helping your dog get up, walk, and go to the bathroom. They may also require help with eating, drinking, and keeping themselves clean in case of accidents.

What is the prognosis for a dog diagnosed with vestibular disease?

The prognosis depends on the cause of the vestibular disease. Signs are often most severe during the first 24 to 48 hours, and many dogs begin to improve within 72 hours. The head tilt and stumbling often improve over a 7- to 10-day period. Most dogs recover completely within two to three weeks, although some may have a lasting head tilt or slight unsteadiness. Dogs who have had an episode may be prone to recurrence, depending on the cause. 

If your dog does not improve or gets worse, a more serious underlying disorder may be present. Your veterinarian may recommend advanced diagnostic testing or referral to a veterinary neurologist.