Vestibular Disease In Dogs
Written by Shula Berg BVSc CertAVP(GSAS) GPAdvCert(SASTS) MRCVS
Clinically reviewed by Elizabeth McLennan-Green BVM&S CertAVP(SAM) MRCVS
Table of Contents
- Overview
- Symptoms
- Diagnosis
- Treatment
- Outlook
The vestibular system is located in the labyrinth of the inner ear, extending into the brainstem. The vestibular system controls balance, telling the brain where the head is in relation to the body and the outside world. It also helps control movement of the head and eyes. Vestibular disease is common in older dogs, and seen rarely in cats. It often comes on very quickly, sometimes progressing in a matter of hours.
Vestibular disease encompasses several conditions leading to malfunction of the vestibular system. Causes can be related to the inner ear, known as peripheral vestibular syndrome, or the brainstem, known as central vestibular syndrome. Peripheral disease is much more common, and usually less serious. The most common cause is idiopathic vestibular syndrome, in which no underlying cause is identified.
What are the symptoms of Vestibular Disease?
The most common symptoms of vestibular syndrome are a head tilt and nystagmus. A head tilt is when the animal is holding the head with one ear higher than the other, and cannot correct it to a straight position. This is due to reduced muscle tone on one side of the neck. Nystagmus refers to abnormal eye movement, where the pupils drift across to one side of the eye before quickly flicking back to the other side. This is most often side-to-side, but can be up-and-down or rotational.
Some animals may also experience difficulty with balance. They may be unable to walk in a straight line, turn persistently in one direction, or occasionally be completely unable to stand. Lack of balance may cause nausea, seen as reluctance to eat or vomiting.
Animals with central vestibular disease are likely to also be dull or less responsive, and may have other nerve deficits affecting the muscles controlling facial expression, swallowing and limbs.
Which tests are used to diagnose Vestibular Disease?
A suspicion of vestibular disease is based on initial examination and history, as the symptoms are very characteristic. A neurological examination can usually distinguish between peripheral and central vestibular syndrome. Although idiopathic vestibular syndrome is seen most often, other causes must be ruled out before this diagnosis is made.
The most common underlying cause of peripheral vestibular disease is inflammation or infection in the middle (inner) ear. This is often, but not always, accompanied by an external ear infection. Your vet will look down your pet’s ears as part of the examination. If there is ear disease present, a full examination under sedation or anaesthetic may be required to determine the extent of the problem. Uncommonly, vestibular syndrome in dogs can be caused by an underactive thyroid (hypothyroidism). This usually causes other symptoms, such as weight gain, lethargy and hair loss, but a blood test may be recommended to check levels of thyroid hormone (T4) and thyroid stimulating hormone (TSH).
If central vestibular disease is suspected, or peripheral vestibular disease is not responding to treatment, further investigation will be required. This most commonly involves an MRI (magnetic resonance imaging) scan, and may require referral to a specialist neurologist. It is very uncommon, but vestibular disease can be caused by more serious problems, such as tumours of the inner ear or brain.
How is Vestibular Disease treated?
Treatment will depend on the cause of the vestibular syndrome. If no underlying cause is found, and a diagnosis of idiopathic vestibular syndrome is made, treatment is supportive only. This usually consists of anti-nausea medication, with fluids and nursing care if needed. Most animals can be managed at home, provided they do not vomit enough to become dehydrated. They should be confined to a small area with nothing they could injure themselves on, and taken out to the garden to toilet every few hours.
What is the outlook for dogs with Vestibular Disease?
The prognosis for animals with idiopathic vestibular syndrome is very good. The majority of animals will show some improvement in 2-3 days, and make a complete recovery in 2-6 weeks. In a small number of pets, the head tilt does not fully resolve. However, animals quickly learn to compensate and this rarely causes a problem.
The prognosis for other causes of vestibular syndrome are more variable, and depend largely on the diagnosis. Your vet will be able to advise you further if this applies to your pet.
Disclaimer
Please note that the content made available on this webpage is for general information purposes only. Whilst we try to ensure that at the time of writing all material is up to date and reflects industry standards, we make no representation, warranties or guarantees that the information made available is up to date, accurate or complete. Any reliance placed by yourselves is done so at your own risk.
Page last reviewed: 21st June 2024
Next review due: 21st June 2026