Vestibular Disease in Dogs: Signs, Causes and What Vets Do

Vestibular disease is a group of symptoms caused by a problem in the balance centre in the inner ear and brain, and the PDSA explains that a dog with it can feel as though the room is spinning. It usually starts very suddenly in older dogs and is often mistaken for a stroke, so speak to your vet rather than guess.

At a glance

• What it is: a group of balance problems caused by trouble in the inner ear or brain.
• Who it affects: the geriatric (idiopathic) type affects older dogs; other causes are listed below.
• Urgency: same-day appointment if your dog is vomiting or distressed, otherwise contact your vet for an appointment.
• Vet needed? Yes. Only a vet can work out the cause.

Signs to look for

The PDSA lists these as the usual signs:

• Loss of balance, leaning to one side and falling over
• A head tilt
• Flickering eye movements (called nystagmus)
• Vomiting
• Standing with the legs wide apart
• Walking in circles
• Collapsing or struggling to stand

In a 2020 study in BMC Veterinary Research of 188 dogs with one form of the condition (peripheral vestibular disease, meaning the problem sits in the ear-side parts of the balance system), head tilt was the most frequent sign, followed by poor co-ordination, facial paralysis and flickering eyes. These were referred dogs, so milder cases may be under-represented.

Causes and risk factors

According to the PDSA, causes include:

• Geriatric (idiopathic) vestibular disease: affects older dogs, and “idiopathic” simply means no cause is found.
• Middle or inner ear problems: infection, inflammation, a tumour or a benign polyp.
• Brain problems: infection, inflammation or a tumour.
• Certain medicines: some are toxic to the ears.

In the BMC study, 128 of the 188 dogs (68%) had idiopathic disease, 49 (26%) had an ear infection or inflammation, and 7 (4%) had an underactive thyroid (see hypothyroidism in dogs). The PDSA names no breeds, and neither did the sources we read, so we won’t guess.

When to call your vet

The PDSA says to contact your vet for an appointment if you see these signs, and to ask for a same-day appointment if your dog is vomiting or distressed. If you don’t have a regular practice, our vets guide helps you find one. Because a stroke-like wobble can have several causes, please speak to your vet instead of waiting to see how it goes. Our sick dog symptoms guide can help you judge how quickly to ring when the signs are less clear.

How vets diagnose it

The PDSA says that if there is no improvement, or the vet suspects something more serious, further tests may be needed. These include an ear swab, X-rays, a CT or MRI scan, or a spinal tap (sampling the fluid around the brain and spine), sometimes at a referral centre. In the BMC study, about 45% of the dogs had a normal MRI.

What vets generally do about it

Treatment depends on the cause, and your vet decides it. The PDSA says that with the geriatric type, most dogs improve over two to three days with nursing and anti-sickness medication if needed, and severe cases may need intensive care in hospital. For an ear infection, treatment is typically antibiotics, nursing and anti-sickness drugs, and some dogs need surgery to drain the middle ear. The PDSA says curing an inner ear infection can take several months.

Living with it and prevention

Once your vet has advised, the PDSA’s home nursing suggestions are to keep your dog in a small area with soft flooring, make sure he eats and drinks (hand-feeding may be needed at first), support him when he needs the toilet, using a towel, sling or blanket under the belly, and use non-slip mats without raised edges.

Recovery varies. The PDSA says dogs with the geriatric type usually improve a lot within a couple of days and recover fully within one to two weeks, though a head tilt can remain and the condition can come back. The BMC study looked at a different group: referred dogs with peripheral disease from a mix of causes, not only the geriatric type. Of the 148 dogs with follow-up, about 52% still had some deficit (most often head tilt or facial weakness) at a median of 12 months, and 17.6% had a recurrence. The two are not like-for-like, so ask your vet what to expect for your dog. Treatment for longer-term cases or referral can be costly, so it is worth reading our guide to UK pet insurance before you need it. We found no source describing a way to prevent the idiopathic type. For older dogs more broadly, see how long dogs live.

Related conditions

• Ear infections in dogs, one of the causes the PDSA lists
• Epilepsy and seizures in dogs
• Vomiting in dogs, which the PDSA lists as one of the signs
• Hypothyroidism in dogs
• Cancer in dogs, as tumours can sometimes be behind balance problems
• Back to the dog illnesses and conditions A-Z

Sources

• PDSA, Vestibular disease in dogs
• Orlandi R et al., BMC Veterinary Research (2020), Clinical signs, MRI findings and outcome in dogs with peripheral vestibular disease: a retrospective study

This page is general information, not veterinary advice. If you are worried about your dog, speak to your vet. Written by Georgiana & Figo, who are dog owners, not vets. Have a look around Calmshops for everyday dog essentials.