Vestibular disease

Dizziness, falling, lack of coordination, a tilting head…these are all symptoms of vestibular syndrome in dogs and cats. It looks scary, but depending on the cause, the prognosis is promising.

What would you think if your dog or cat developed a sudden head tilt, seemed uncoordinated and had trouble controlling his facial muscles? You might assume he’d had a stroke. Even though strokes are seen in these animals, there’s another condition that looks similar and is more common – vestibular disease.

Vestibular disease occurs when there’s a problem in the body’s balance system. The balance center has two components – one in the middle ear (peripheral) and the other in the brain (central). When something goes wrong with either component, the dog or cat does not know where he is in space (see below for symptoms). When vestibular disease is suspected, it’s important to determine if the pet has the peripheral or central form.

Signs of vestibular problems

  1. Lack of coordination and falling (ataxia)
  2. Dizziness
  3. Motion sickness – nausea, drooling, vomiting
  4. Head tilt
  5. Rolling
  6. Nystagmus (rapid back-and-forth movement of the ears)
  7. Circling
  8. Loss of control of facial muscles

If the disease affects only one ear, head tilting and circling will be in the direction of that ear. Sometimes, only one side of the head is affected and then, only the eye on that side may develop nystagmus. Vestibular disease in geriatric dogs is often mistaken for a stroke.

Causes of vestibular disease

  • Peripheral vestibular disease is the most common form and can be caused by many things:
    • Chronic or recurrent ear infections that involve the middle ear
    • Vigorous ear cleaning that perforates the ear drum
    • Head trauma
    • Middle ear tumors
    • Ear polyps
    • Hypothyroidism
    • Meningoencephalitis
    • Certain antibiotics (most notably, aminoglycosides such as gentamycin and tobramycin)

Some ear cleaners have been implicated, particularly if the ear drum is not intact; the cleaner irritates the delicate nerve endings in the inner ear

Occasionally, peripheral vestibular disease can be a congenital issue in young dogs, occurring between birth and three months of age. Breeds predisposed to this condition include the German shepherd, Doberman pinscher, Akita, English cocker spaniel, beagle, smooth fox terrier, and the Tibetan terrier.

One other cause that’s often overlooked is a displaced otolith in the semicircular canals of the inner ear, likely caused by trauma to the head or ear.

Idiopathic vestibular disease is seen in both dogs and cats and is the most common cause in both species. In dogs, this tends to occur in older animals, but in cats it can occur at any age. Cats develop the condition more frequently in July and August; it may be related to migration of Cuterebra larvae (an abnormal parasite for the cat) or a prior viral infection.

  • Central vestibular disease, though less common, is more serious. Causes include brain tumors, inflammatory diseases such as FIP, infections due to bacteria, fungus or protozoa, trauma with loss of blood flow to the brain or bleeding in the brain.

Treatment – conventional and holistic options

The treatment depends on the cause of the condition – if infection is present, for example, it needs to be treated. If an otolith is displaced, physical therapy maneuvers are needed to replace it. If hypothyroidism is the cause, symptoms of vestibular disease cease once the dog is taking thyroid replacement. With the congenital form, affected pets soon adapt to their condition; rehabilitation therapy can help tremendously with this group of animals. Pets with ear polyps may require surgery to cure the problem. Generally, these polyps are non-cancerous and the prognosis is good.

Dogs and cats diagnosed with central vestibular disease have a much poorer prognosis than those with peripheral disease. Integrative palliative care may include corticosteroids, acupuncture or herbals to help the inflammation in the brain. If a brain infection is diagnosed, antibiotics will be needed for an appropriate period of time.


A correct diagnosis is important

When vestibular disease occurs, it is important to figure out what area is causing the problem. Is the brain involved or only the inner ear? There are some clues as to where the affected area is.

  • If there are more cranial nerves involved (mostly facial nerves but they can also be in the ear, eye or tongue) and they are on the opposite side of the head tilt, then the problem is likely in the brain.
  • If the eyes are rolling up and down rather than side to side, the lesion is usually in the brain.
  • If central vestibular disease is present, there will be deficits in postural reactions such as limb placing and proprioception (positioning), along with diminished mental awareness (depression or decreased consciousness).

A thorough physical and neurological exam, including an otic (ear) exam, some x-rays and blood work, are needed to help with the diagnosis. Sometimes, advanced imaging such as CT or MRI is required for a final diagnosis.

The good news is that most pets with head tilts and rolling eyes have peripheral problems (that is, not in the brain) and most have the idiopathic form. This form of vestibular syndrome comes on very quickly, and gets better quickly. Conventional treatment includes supportive care with anti-nausea medication, and a wait-and-see approach. Some of these pets are so dizzy and nauseated they are unable to eat, and require intravenous fluids or hand-feeding. Harnesses can be employed to assist large dogs who may have difficulty getting outside to potty. Some dogs and cats are so stressed with vestibular disease that they require some sedation or natural calmers.

A holistic veterinarian can offer you and your pet more options to speed recovery. L-theanine, Rescue Remedy, GABA and chamomile can be used for calming anxious animals. Acupuncture combined with physical therapy, homeopathy, vitamin supplements and herbs speed recovery of the idiopathic form of the disease. Using this combination, success is usually seen within a few days. Placing the pet in a standing position for five minutes every hour also enhances and speeds recovery.

Idiopathic feline vestibular disease tends to be an isolated event and generally does not recur; however, idiopathic canine geriatric vestibular disease can recur in some older dogs.  It looks scary, but for most pets the prognosis is good. Given enough time and support, and an integrative approach to treatment, most of these animals will recover. Some may be left with a residual head tilt, but they seem to adapt quite well to this new outlook on life!


Veterinarian Dr. Janice Huntingford is a graduate of the Ontario Veterinary College, University of Guelph, and certified in animal chiropractic and acupuncture. She received her certification in Veterinary Rehabilitation through the Canine Rehabilitation Institute, and opened Ontario’s first saltwater canine therapy pool and rehabilitation center. She is a Certified TCVM Practitioner, a Certified Veterinary Pain Practitioner, and a board certified specialist, earning a Diploma from the American College of Veterinary Sports Medicine and Rehabilitation. She practices in Essex, Ontario (