Vestibular disease in dogs

Vestibular disease is a condition where dogs suddenly develop problems with their balance. Around 1 in 1000 dogs will develop vestibular disease. It can affect dogs of any age or breed, but it’s most common in older dogs.

Vestibular disease comes on suddenly and can look scarily as if your dog’s had a stroke. They may develop flickering eyes and a head tilt, and struggle to stand or walk. A number of things can cause vestibular disease symptoms, but often the cause is unknown. Symptoms usually improve over several days to a few weeks. But recovery and the long-term outlook also depend on the underlying cause.

Overview

What is vestibular disease in dogs?

Vestibular disease is often called ‘old dog syndrome’. It happens when part of your dog’s brain that controls balance and position gets damaged or inflamed.

Dog’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. But when the vestibular system isn’t working, your dog’s eyes start to flicker, so they can’t see properly. This means they lose balance even though their actual eyesight isn’t damaged.

Most cases of vestibular disease happen in older dogs and have no known cause. Vets call this Idiopathic vestibular syndrome.

Other causes of vestibular disease

Inner ear infections (otitis interna) and middle ear infections (otitis media)
Certain prescription medicines
Trauma: road accident or blow to the head
Brain infections, called encephalitis
Cancer
Toxins, including recreational drugs
Birth defects

Symptoms

Symptoms of vestibular disease in dogs

Symptoms of vestibular disease come on suddenly. They’re usually worst when they first happen and improve over time.

Symptoms include:

Difficulty standing, or falling over
Drifting to one side or walking in circles
Standing with legs wider apart than normal
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

Risk

Dogs at higher risk of vestibular disease

Age is the single biggest risk factor for vestibular disease. It’s most common in dogs over 11 years old.
Certain breeds : French bulldogs, bulldogs, Cavalier King Charles spaniels, German Shepherd dogs, Dobermann Pinscher.
Dogs over 10kg in body weight.
Dogs who suffer from chronic or recurrent ear infections (otitis externa), which can lead to a perforated eardrum and spread of infection to the middle and inner ear.
Dogs receiving certain antibiotics.

Is my family at risk of catching vestibular disease?

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

Diagnosis

Diagnosis of vestibular disease in dogs

Vets usually diagnose vestibular disease based on your dog’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 for vestibular disease in dogs

Immediate treatment of vestibular disease symptoms

Supportive treatment, including help to eat, toilet and move around
Protection from falls or further injury
Medicine to treat nausea and motion sickness

Specific treatment

Depends on the underlying or suspected cause

Idiopathic vestibular syndrome has no specific cure. Symptoms gradually improve, and around 80% of dogs will make a good recovery with nursing care.
Inner ear and middle ear infections: antibiotic treatment for 6-8 weeks. Anti-inflammatory painkillers for the first few weeks. Sometimes your dog needs an anaesthetic so the vet can look inside the ear with a camera, take samples and clean the ear well.
Brain inflammation: depends on the particular cause but can include antibiotics, antiviral drugs and steroids.
Drug toxicity or poisons: cause is withdrawn and supportive treatment provided
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. Dogs with this form of vestibular disease are less likely to recover.

Home treatment

Caring for your dog with vestibular disease at home

Protect your dog from injury due to falls or stumbles

Restrict them to a small room or crate
Cover hard edges and corners of furniture with cushions or throws
Don’t let them sleep on sofas or beds while they’re still wobbly

Help them outside for toileting

Two or more people for larger dogs
It may help to support them with a towel or sheet under their tummy

Help with feeding: Hand feed food formed into soft balls to reduce risk of choking

Massage muscles and move limbs: Keep the blood flowing in your dog’s muscles until they can get around better

Give prescribed medicine as directed.

Living with a dog with vestibular disease

Most dogs with vestibular disease will gradually recover, but the timescale and degree of recovery vary.

Dogs usually recover the majority of normal function within 2-3 days, but some need hospital support for several weeks.

Your dog may recover completely or may be left with a mild deficit, like a head tilt.

If your dog still has a head tilt after 6 months, this is likely to be permanent.

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

Provide raised food bowls if your dog struggles with balance
Don’t let your dog go up or down stairs unsupervised. Fitting child safety gates will help with this.
Use ramps or portable steps to make it easier for your dog getting in and out of the car or getting up steps to the house.

If your dog has had one episode of idiopathic vestibular disease or ‘old dog syndrome’, they’re more likely to have another at some point in the future. This could be any time, from days to years. We can’t predict if or when it will happen.

A second or subsequent episode may be the same, more severe or less severe. Again, we can’t predict in advance.

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

Persevere with giving prescription medicines for the full duration
Long courses of antibiotic treatment will be costly, especially for larger dogs.

Quality of life and when to say goodbye

Sadly, about 20% of the dogs who get vestibular disease don’t recover. And some who recover well from a first episode may suffer more severely from a second or subsequent one.

When this happens, you may worry about your companion’s quality of life. You wonder if it’s fair to carry on with treatment or whether the time has come to think about euthanasia

Deciding when to say goodbye is a decision that’s very hard to make and distressing for everyone involved. The best any of us can do is focus on what’s best for our beloved companion. We can start by thinking about their quality of life. Do good things outweigh the bad?

Do they still enjoy things and take an interest in life?

Are other illnesses well-controlled?

Are the symptoms of pain or anxiety controlled?

Are you and they exhausted?

Prevention

Tips to prevent vestibular disease in dogs

Idiopathic vestibular syndrome: we don’t know the cause of ‘old dog syndrome’ 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 diseases: keep your dog’s vaccinations up-to-date

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

When to worry

When to worry about vestibular disease in your dog

Seek a vet in practice immediately if your dog 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 and speak to a vet if your dog suddenly loses balance or can’t stand properly.

While most dogs will recover enough to manage daily life, not all do. And for those who seem to recover, a repeated episode may be much more severe and have a poorer outcome.

The outlook is poorer if your dog:

Is unable to stand with support after a week and unaided after three weeks
Is unable to toilet independently and is too heavy to be supported to do so regularly

Cancer and brain infections cause more severe vestibular disease and have additional symptoms. These have a more guarded outlook.

Vestibular disease is more worrying if accompanied by: