Vestibular disease in cats

Vestibular disease is the most common cause of sudden balance problems in cats. It can affect cats of any age or breed, but it’s most likely to happen in certain breeds and in older cats. 

Vestibular disease comes on suddenly and can look scarily as if your cat has had a stroke. They may have flickering eyes and a head tilt and struggle to stand or walk. A number of things can cause vestibular disease symptoms, but sometimes the cause is unknown. Affected cats usually recover over a few days. But recovery and the long-term outlook also depend on the underlying cause.



What is vestibular disease in cats?

Vestibular disease is an abnormality of your cat’s nervous system. It happens when the part of the brain that controls balance and position gets damaged or inflamed.

Cat’s (and human’s) sense of balance is controlled by three parts of their body working together:

  • Eyes (sight)
  • Nerve signals from muscles and joints
  • The vestibular system, located in the inner ear

Vestibular disease happens when two or more of these aren’t working properly. Unfortunately, when the vestibular system isn’t working, your cat’s eyes start to flicker, so they can’t see properly. This means they lose balance even though their actual eyesight isn’t damaged.


Causes of vestibular disease in cats

  • Inner ear disease (otitis interna) and middle ear disease (otitis media)
  • Idiopathic vestibular syndrome: many cases of vestibular disease in older cats have no known cause.
  • Encephalitis: inflammation of the brain (FIP and other illnesses)
  • Thiamine (Vitamine B1) deficiency: raw fish diets, gastrointestinal disease, other illnesses
  • Certain drugs and household toxins: rodenticides, recreational drugs, salt
  • Trauma: road accident or blow to the head
  • Growths and polyps located in the passages between the nose and throat,  in the inner ear or in the brain
  • Birth defects



Symptoms of vestibular disease in cats

Symptoms of vestibular disease come on suddenly and include:

  • Difficulty standing, or falling over
  • Drifting to one side or walking in circles
  • General wobbliness
  • Head tilted to one side: one ear looks lower than the other
  • Jerky eyeball movements: vets call this nystagmus
  • Vomiting or drooling like being seasick



Cats at higher risk of vestibular disease

  • Cats with chronic or recurrent ear infections (otitis externa) can lead to a perforated eardrum and spread of infection to the middle and inner ear.
  • Cats with other illnesses such as sugar diabetes, hyperthyroidism, liver and intestinal diseases
  • Cats fed exclusively raw fish diets
  • Certain breeds: Siamese and Burmese cats with an inherited genetic defect
  • Cats receiving certain antibiotics, such as metronidazole


Is my family at risk of catching vestibular disease?

Vestibular disease doesn’t spread between animals or from animals to people.



Diagnosis of vestibular disease in cats

Vets usually diagnose vestibular disease based on your cat’s symptoms.

Other testing may include:

  • Blood and urine tests to look for evidence of inflammation or other illnesses
  • X-rays of the middle ear and skull
  • Looking down the ear canals with a special camera (video otoscopy)
  • Advanced imaging – MRI or CT scan to examine the structures of the brain and inner ear


Vet treatment

Vet treatment of vestibular disease in cats

Immediate treatment of vestibular disease symptoms includes supportive treatment and treating any underlying cause.

Supportive treatment

  • Protection from falls or further injury
  • Fluids into your cat’s veins to prevent or treat dehydration
  • Medicine to treat nausea and motion sickness


Specific treatment

Depends on finding the underlying or suspected cause:

  • Inner and middle ear infections: antibiotic treatment for 8-16 weeks. Anti-inflammatory painkillers for the first few weeks. Sometimes your cat needs an anaesthetic so the vet can look inside the ear with a camera, take samples, and clean the ear well.
  • Idiopathic vestibular syndrome has no specific cure. Symptoms gradually improve, and around 80% of cats will make a good recovery with nursing care.
  • Thiamine deficiency: Thiamine injections and medicine by mouth.
  • Drug toxicity or poisons: cause is withdrawn and supportive treatment provided.
  • Brain inflammation: treatment depends on the particular cause but can include antibiotics, antiviral drugs and steroids.
  • Polyps: an operation to remove them.
  • Cancer: treatment options are limited, but may include chemotherapy, radiotherapy and specialist surgery.

Cancer and brain inflammation cause more severe vestibular disease. Seizures, weakness and generalised illness are more likely. Vets call this central vestibular disease. Specific symptoms depend on the cause or parts of the brain affected. Cats with this form of vestibular disease are less likely to recover.


Home treatment

Caring for your cat with vestibular disease at home

Protect your cat from injury due to falls or stumbles:

  • Don’t let them sleep on your bed or sofa unattended while they’re still wobbly
  • Put a thick, rolled up blanket around them to keep them secure
  • Keep litter trays close and easy to get into

Help with feeding and hydration:

  • Hand feed soft food to avoid choking
  • Encourage them to drink and check they stay hydrated (moist pink gums and springy skin)

Massage muscles and move limbs: keep the blood flowing in your cat’s muscles until they can get around better.

Give prescribed medicine as directed.

Stay calm: caring for a cat with vestibular disease can be stressful. But if your cat picks up on your anxiety, it’ll make things worse.


Living with a cat with vestibular disease

Most cats with idiopathic vestibular disease recover completely within a few days. Sometimes recovery takes longer, and your cat may be left with a mild deficit, like a head tilt. If your cat still has a head tilt after 6 months, this is likely to be permanent.

Most cats adapt well over time to mild deficits, but they may need some help with feeding or mobility:

  • Keep food bowls at ground level and easy to get to if your cat struggles with balance.
  • Don’t let your cat go up or down stairs unsupervised. Fitting child safety gates might help with this.
  • Try not to carry your cat too much if they can get around by themselves. They’ll need to keep practising to recover their movement control.

Middle Ear infections need prolonged courses of antibiotic treatment over several months.

  • Your cat may not want to take the medicine.
  • Long courses of antibiotic treatment may be expensive.



Tips to prevent vestibular disease in cats

Thamine deficiency: feed your cat a balanced diet suitable for their age, health and lifestyle.

Idiopathic vestibular syndrome: we don’t know the cause, so we can’t prevent it.

Middle and Inner ear disease: treat external ear infections (otitis externa) promptly to reduce the risk of spread to the middle ear.

Infectious disease: keep your cat’s vaccinations up-to-date.

Toxin exposure: Keep potentially-hazardous chemicals out of sight and reach of your cat

When to worry

When to worry about vestibular disease in cats

Seek a vet in practice immediately if your cat suddenly develops balance problems after:

  • Suffering a blow to their head
  • Starting a new medicine
  • Being exposed to possible toxins: human drugs, household chemicals, poisons
  • Showing signs of pain and a high temperature: hot to touch, panting, lethargic

Call a vet immediately if your cat has a seizure or goes blind.

Worrying signs of severe central vestibular disease or worsening vestibular disease include:

  • Muscle weakness as well as balance problems
  • Seizures
  • Blindness
  • Dragging or knuckling feet
  • Vomiting that won’t go away or keeps coming back
  • Not eating, even after treatment.

Call and speak to a vet if your cat suddenly loses balance or can’t stand properly.

Joii can help with

  • Recognising the symptoms of vestibular disease
  • Caring for a cat with balance problems
  • Balanced meals for cats
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