Complete Guide To Vestibular Disease in Dogs [8 Causes] + Vet Q&A

Nothing breaks our hearts more than seeing our furry baby ill. 

Vestibular disease is specifically torturous because it has such obvious physical signs. 

But you should know that Vestibular disease in dogs is not fatal by itself and symptoms observed in the first 48h should subside with veterinary care.  

We created this guide to help dogs and their owners better understand the disease, learn to recognize symptoms and we answered the most common questions related to this condition. 

Let’s begin.

Vestibular disease in dogs Quick explaination

What is Vestibular disease in dogs? 

Vestibular Disease, also known as Canine Vestibular Syndrome or Geriatric Vestibular Syndrome, is a condition that affects a dog’s vestibular system responsible for maintaining balance and orientation in the body.

The vestibular system includes the inner ear, the brainstem, and the cerebellum and it is responsible for balance and orientation. 

When there is a dysfunction within this system, a dog can experience:

  • loss of balance
  • disorientation
  • involuntary eye movement

Vestibular Disease is most commonly seen in dogs over the age of 8, but it can affect dogs of any age. 

Vestibular disease in dogs

Types of Vestibular Disease in Dogs

Three types of Vestibular disease can affect dogs:

  • Geriatric Vestibular Disease
  • Peripheral Vestibular Disease
  • Central Vestibular Disease

Geriatric Vestibular Disease 

Also known as “old dog vestibular disease“ typically occurs suddenly and does not progress or worsen over time. 

Symptoms may include: 

  • loss of balance
  • head tilt
  • flickering eye movements

Peripheral Vestibular Disease 

Peripheral vestibular disease refers to a disturbance of balance that is caused by issues in the peripheral components of the vestibular system, including the inner and middle ear. 

Common causes of peripheral vestibular disease in dogs include: 

  • ear infections
  • perforated eardrums
  • tumors
  • recent trauma
  • hypothyroidism
  • or rarely certain medications like antibiotics

Central Vestibular Disease

Central vestibular disease occurs when there is a problem within the brain affecting the central components of the vestibular system. 

This type of vestibular disease can lead to additional neurological symptoms such as seizures, weakness, or loss of vision. 

Causes of central vestibular disease in dogs include inflammation in the central nervous system, cancer, ear tumors, stroke, seizures, hypothyroidism, or trauma to any part of the vestibular system

It can cause more severe symptoms such as: 

  • paralysis 
  • coma

Causes of Vestibular Disease in Dogs

1. Ear infections

  • Inner Ear Infection
  • Middle Ear Infection

Inner ear infections (Otitis Interna)

Inner ear infections are most commonly caused by a bacterial infection, although fungus or yeast can also be implicated. 

The infection typically originates from an external ear infection that progresses into the middle ear and ultimately affects the inner ear. 

When the inner ear becomes inflamed due to infection, it can affect the vestibular system, which is responsible for maintaining balance, posture, and head position in dogs. 

The vestibular system is located within the inner ear and consists of structures that control balance and spatial orientation. 

The inflammation disrupts the normal function of the vestibular system, leading to vestibular disease.

Dogs with long, heavy ears, such as Spaniel breeds (e.g., Cocker Spaniel) and hound breeds (e.g., Bloodhound, Basset Hound), are more prone to developing chronic ear infections that can lead to otitis interna.

Clinical signs of otitis interna may include: 

  • recurrent outer ear infections
  • head shaking
  • pain when opening the mouth
  • Horner syndrome (a neurological disorder that affects the eyes and facial muscles)
  • dry eye
  • facial nerve palsy

In severe cases, an inner ear infection can spread to the brain, potentially affecting the areas responsible for controlling breathing and heart rate, although this is rare. 

Long-term complications of inner ear infection can include a permanently altered sense of balance, persistent signs of Horner’s syndrome, and even permanent deafness in the affected ear.

Middle Ear Infection (Otitis Media)

When a dog has a middle ear infection, it means that there is inflammation and infection in the space located between the eardrum and the inner ear.

When the middle ear becomes infected, the inflammation and resulting fluid accumulation can disrupt the normal functioning of the balance center. 

This disruption can lead to a sudden and non-progressive disturbance of balance (vestibular disease). 

Treatment for vestibular disease caused by a middle ear infection focuses on addressing the underlying infection. Depending on the severity, supportive therapy such as intravenous fluids and hospitalization may be necessary until the dog can eat and walk on its own.

Antibiotics or other appropriate medications can treat middle ear infection

2. Inflammation in the Central Nervous System (CNS)

Inflammation in the Central Nervous System refers to the immune response and subsequent inflammation that affects the brain, spinal cord, and surrounding tissues. 

The vestibular system, responsible for maintaining balance and coordination, relies on the proper communication between the brain, spinal cord, and inner ear structures. 

When inflammation affects the CNS, it can interfere with the transmission of signals within the vestibular system, resulting in clinical signs of vestibular disease.

Immune-mediated inflammation is recognized as a significant cause of central nervous system disease in dogs, accounting for about 25% of cases. This type of inflammation can affect dogs of all ages and breeds, although young to middle-aged small-breed dogs may be overrepresented.

The clinical signs of vestibular disease associated with CNS inflammation in dogs include: 

  • loss of balance
  • head tilt
  • disorientation
  • rapid eye movements (nystagmus) 

Diagnosing the connection between CNS inflammation and vestibular disease typically involves a combination of advanced imaging techniques such as magnetic resonance imaging (MRI) to visualize the CNS, cerebrospinal fluid analysis, and other diagnostic tests 

These tests help identify the presence of inflammation and determine the underlying cause.

Treatment for vestibular disease caused by CNS inflammation focuses on managing the inflammatory response and addressing the underlying cause if possible. 

Depending on the severity and cause, treatment may include anti-inflammatory medications, immunosuppressive drugs, supportive care, and specific treatments for any identified infectious agents.

3. Central Vestibular Syndrome

Central Vestibular Syndrome can cause vestibular disease through its impact on the brainstem, specifically the involvement of the Ascending Reticular Activating System (ARAS) 

The ARAS plays a crucial role in regulating consciousness and maintaining alertness. Central vestibular syndrome affecting the ARAS can lead to altered mentation and signs of depressed consciousness in dogs.

The clinical signs of vestibular disease associated with central vestibular syndrome include:

  • vestibular ataxia (damage of the vestibular system – nerves connecting the inner ear to the brain, particularly the cerebellum)
  • unsteady walk
  • difficulty maintaining balance
  • inability to coordinate movements 

Central Vestibular Syndrome can be caused by various factors, including inflammation in the central nervous system, infarctions/strokes, and tumors. 

This type of vestibular disease can lead to additional neurological symptoms such as seizures, weakness, or loss of vision. 

4. Hypothyroidism

In dogs with hypothyroidism, the central vestibular disease is characterized by abnormal nystagmus (eye movement), head tilt, paresis (weakness), and ataxia (loss of coordination).

The exact mechanisms through which hypothyroidism leads to vestibular disease are not fully understood. 

However, ischemic infarction, which refers to reduced blood supply resulting in tissue damage, plays a role in central vestibular disease associated with hypothyroidism. 

Magnetic resonance imaging (MRI) can detect ischemic infarction in affected dogs.

Diagnosing hypothyroidism-related vestibular disease requires a thorough evaluation by a veterinarian. 

In addition to the characteristic neurologic signs, blood tests, including the measurement of thyroid hormone levels, combined testing that includes serum T4 concentration along with fT4 and/or TSH levels may be needed for a definitive diagnosis.

Treating vestibular disease associated with hypothyroidism involves managing the underlying hypothyroidism itself. 

The primary treatment for hypothyroidism in dogs is oral administration of levothyroxine, a synthetic thyroid hormone replacement. 

5. Idiopathic vestibular disease (CIVD)

Idiopathic Vestibular Disease (IVD) in dogs, also known as Canine Idiopathic Vestibular Syndrome, refers to a condition characterized by sudden onset loss of balance and coordination in dogs. 

The term “idiopathic” indicates that the cause of the disease is unknown, and “vestibular” refers to the balance and coordination system within the inner ear.

IVD is relatively common in older dogs and can present with symptoms: 

  • sudden wobbliness
  • head tilt
  • falling
  • rolling
  • flickering of the eyes (nystagmus), 
  • vomiting. 

Despite its alarming clinical presentation, IVD can improve without intervention in many cases.

To diagnose IVD, a veterinarian may perform a neurological examination to confirm whether the vestibular dysfunction is of peripheral or central nervous system origin. 

Other potential causes of balance loss, such as ear infections, tumors, vascular problems, or drug toxicity, must be ruled out through a thorough examination.

 In cases of peripheral vestibular disease, IVD is the most common cause.

6. Trauma, toxins, or Injury

Head trauma can result from accidents, falls, or any significant impact on the head. 

When the head is injured, it can disrupt the structures responsible for maintaining balance and spatial orientation, such as the vestibular apparatus and the cranial nerves associated with it. This disruption can lead to the characteristic symptoms of vestibular disease.

Toxins can also contribute to vestibular disease in dogs. Certain toxins, such as some medications, chemicals, or ingested substances, can have neurotoxic effects on the vestibular system. 

These substances can interfere with the normal functioning of the nerves and structures involved in balance and coordination, leading to vestibular dysfunction and the associated symptoms.

Injury, specifically to the inner ear, whether from infection, trauma, or other causes, can disrupt the functioning of these structures, resulting in vestibular dysfunction.

7. Tumors/Cancers

Tumors or cancers in the brainstem or cerebellum can be benign or malignant and can grow and spread quickly. 

Types of tumors, cancers, and lesions related to vestibular disease in dogs:

Acoustic Neuroma (Vestibular Schwannoma) 

Acoustic Neuroma, also known as Vestibular Schwannoma, is a non-cancerous growth that occurs on the eighth cranial nerve, which connects the inner ear with the brain. 

This nerve has two divisions: 

  • the cochlear division, responsible for transmitting sound 
  • vestibular division, which sends balance information from the inner ear to the brain 

When an Acoustic Neuroma develops on the vestibular division of the eighth cranial nerve, it can disrupt the normal function of the vestibular system and lead to vestibular disease symptoms in dogs. 

The tumor presses on the vestibular nerves, causing a disturbance in balance and coordination.

Symptoms of vestibular disease caused by Acoustic Neuroma may include:

  • Head tilt: The dog may tilt its head to one side, as the tumor affects the balance signals.
  • Loss of balance: Dogs with Acoustic Neuroma may have difficulty maintaining their balance and may stumble or fall.
  • Unsteady gait: Dogs may have a wobbly or uncoordinated gait, often walking in circles or leaning to one side.
  • Nystagmus: Nystagmus refers to involuntary eye movements, where the eyes rapidly move back and forth or up and down. It is a common symptom of vestibular disease.
  • Hearing loss: Since Acoustic Neuroma affects the vestibular division of the eighth cranial nerve, it can also impact hearing. 

The diagnosis of Acoustic Neuroma as the cause of vestibular disease in dogs is typically confirmed through diagnostic imaging, such as magnetic resonance imaging (MRI). This imaging technique allows veterinarians to visualize the tumor and its effects on the vestibular structures.

The treatment options for Acoustic Neuroma in dogs can vary depending on factors such as the size and location of the tumor, as well as the overall health of the dog. 

Treatment may include observation, radiation therapy, or surgery, depending on the specific case. 

Surgical removal of the tumor may be recommended in some cases, especially if the tumor is causing significant symptoms or affecting the dog’s quality of life. 

However, it’s important to note that not all Acoustic Neuromas require treatment, and some small tumors may be safely monitored over time

Meningioma

Meningiomas are the most common primary brain tumors in dogs and cats. 

They are generally considered benign tumors; however, they can still cause significant clinical signs and affect the normal function of the brain.

In dogs, seizures are the most common sign of meningiomas

When a meningioma develops in the brain, it can potentially affect the structures involved in the vestibular system, leading to vestibular signs and contributing to vestibular disease in dogs. 

The tumor’s location and size determine the specific vestibular symptoms that may be observed.

A comprehensive diagnostic workup, including neurological examination, imaging (such as MRI), and other tests, is necessary to determine the underlying cause of vestibular disease in a dog suspected of having a meningioma.

Treatment options for meningiomas in dogs may include surgical removal of the tumor, radiation therapy, or a combination of both, depending on factors such as the tumor’s location, size, and the dog’s overall health. 

Ceruminous Gland Adenocarcinoma 

Ceruminous Gland Adenocarcinoma is a rare malignant tumor that originates from the sweat glands found in the external auditory canal of a dog’s ear. 

The ceruminous glands in dogs are responsible for producing ear wax or cerumen. While this type of tumor is specific to a dog’s ears and its surrounding area, it can have implications beyond the ear itself.

When Ceruminous Gland Adenocarcinoma develops in a dog’s ear, it can potentially affect the vestibular system due to its proximity to the inner ear structures. 

The tumor’s presence and its growth can interfere with the normal function of the vestibular receptors, leading to vestibular signs and contributing to vestibular disease in dogs.

A comprehensive diagnostic workup, including a thorough examination of the ear, imaging (such as CT scan or MRI), and possibly a biopsy, is necessary to confirm the presence of Ceruminous Gland Adenocarcinoma and determine the extent of its impact on the vestibular system.

Treatment options for Ceruminous Gland Adenocarcinoma in dogs may involve a combination of surgery, radiation therapy, and chemotherapy, depending on factors such as the tumor’s size, location, and overall health of the dog. 

Metastatic Tumors 

Metastatic tumors refer to cancerous cells that have spread from their original location to a different body part. 

Cancer cells can enter the bloodstream or lymphatic system, allowing them to travel to distant sites and establish secondary tumors. 

Once these metastatic tumors develop in the brain or inner ear, they can disrupt the normal function of the vestibular system and contribute to vestibular disease symptoms.

These tumors may originate from various primary cancer sites, such as the lungs, mammary glands, prostate, kidney cancer, thyroid cancer, and melanoma, among others.

Cancer cells can enter the bloodstream or lymphatic system, allowing them to travel to distant sites and establish secondary tumors. 

Once these metastatic tumors develop in the brain or inner ear, they can disrupt the normal function of the vestibular system and contribute to vestibular disease symptoms.

8. Age: Old Dog Vestibular Disease/ Canine Idiopathic Vestibular Disease

Age-related degenerative changes in the vestibular system are believed to play a role in the development of vestibular disease in dogs.

Age-related degenerative changes that can potentially cause vestibular disease in dogs:

  • The decline in the Semicircular Canals
  • Sensory Degeneration in the Vestibular System 

The decline in the Semicircular Canals

The semicircular canals are crucial components of the vestibular system responsible for sensing rotational movements of the head and maintaining balance and stability. 

When there is a decline in the function of these canals, it can lead to various vestibular disorders in dogs. 

Here is some information on how the decline in the semicircular canals can cause vestibular disease:

  • Dysfunction of Semicircular Canals: If the semicircular canals in dogs experience dysfunction or damage, it can disrupt the normal functioning of the vestibular system. This can result in symptoms such as loss of balance, disorientation, head tilt, abnormal eye movements (nystagmus), and difficulty walking or standing.
  • Age-Related Decline: Studies have shown that the function of the semicircular canals may decline with age in dogs. 

Sensory Degeneration in the Vestibular System 

Similar to presbycusis for hearing, the term “presbyvertigo” has been used to describe age-related changes within the vestibular system.

In dogs, sensory degeneration in the vestibular system can manifest as: 

  • Vestibular Disease: disorders affecting the vestibular system in dogs. It can include peripheral vestibular disorders, central vestibular disorders, or a combination of both. 
  • Age-Related Vestibular Degeneration: degeneration of the vestibular system that occurs with aging in dogs. It is associated with the natural aging process and can result in a decline in balance and coordination.
  • Neurodegenerative Vestibular Disease: In some cases, sensory degeneration in the vestibular system can be associated with neurodegenerative disorders in dogs. Neurodegenerative diseases are progressive conditions that result in the loss of structure and function of neurons. They can lead to the degeneration and death of nerve cells, including those in the vestibular system.
  • Vestibular dysfunction in dogs is characterized by a sudden loss of balance, which can be caused by various factors such as inner or middle ear infections, ear injuries, tumors, inflammation in the central nervous system, cancer, stroke, seizures, hypothyroidism, trauma, or other underlying conditions. 
Vestibular Disease in Dogs video

What dogs are at higher risk of developing Vestibular disease?

Vestibular Disease is most commonly seen in dogs over the age of 8, but it can affect dogs of any age. 

Larger breeds of dogs: such as the Doberman Pinscher, Rottweiler, and Boxer are at a higher risk for the disease. 

Age: Older dogs, particularly geriatric dogs, are more commonly affected age-related degenerative changes in the vestibular system are believed to play a role in the development of vestibular disease in older dogs.

Breeds: Breeds that have been reported to be more commonly affected by vestibular disease include Cocker Spaniels, Beagles, Doberman Pinschers, German Shepherds, and Boxers.

Underlying Health Conditions: dogs with hypothyroidism (low thyroid function), ear infections, trauma, tumors, or metabolic disorders, can also contribute to the development of vestibular disease

Symptoms of  Vestibular Disease in Dogs

The signs of vestibular disease in dogs can include: 

  • a sudden onset of head tilting 
  • nystagmus (irregular eye movement)
  • strabismus (irregular eye position) 
  • ataxia (loss of balance/coordination) 
  • disorientation 
  • leaning to one side 
  • circling 
  • difficulty standing or walking 
  • nausea and vomiting 

Loss of Balance and Coordination

Dogs may struggle to balance on their feet or walk in a straight line. 

They may also fall over or stumble frequently. This can be a scary symptom to watch, but it is important to remain calm and provide support to your dog. 

You can help your dog by providing a stable surface to walk on or by using a supportive harness to assist with walking.

Nystagmus (Involuntary Eye Movement)

Dogs with the disease may exhibit rapid eye movement or jerking of the eyes, which can be accompanied by dizziness or vertigo. 

This symptom can be distressing for your dog and may cause them to feel disoriented or confused. It is important to keep your dog in a quiet and calm environment to help them feel more secure.

Head Tilt

A head tilt to one side is a common symptom of the disease, where your dog may appear to be leaning or tilting in one direction. 

This can be caused by a loss of balance or a problem with the inner ear. Your veterinarian may recommend medication or other treatments to help alleviate this symptom.

Nausea and Vomiting

Dogs with the disease may experience vomiting or loss of appetite due to motion sickness or dizziness. 

It is important to monitor your dog’s food and water intake and seek veterinary care if they are not eating or drinking normally. Your veterinarian may recommend medication or other treatments to help alleviate nausea and vomiting.

Difficulty Walking or Standing

Dogs with Old Dog Vestibular Disease may struggle to stand or walk due to the loss of balance or dizziness. 

They may also exhibit a wide stance or sway when standing. It is important to provide a safe and comfortable environment for your dog, with plenty of soft surfaces to rest on. Your veterinarian may recommend physical therapy or other treatments to help improve your dog’s mobility.

Vestibular Disease Treatment 

Specific treatment approaches may vary depending on the underlying cause and severity of the condition. 

Note: do not medicate your dog without the vet’s consent and advice. 

Medical treatment options and specific medications that may be used in the management of vestibular disease in dogs:

Symptomatic and Supportive Care: In cases of idiopathic vestibular disease or peripheral vestibular disease, the primary focus of treatment is on providing symptomatic and supportive care to manage the associated clinical signs. 

This may include measures such as providing a safe and comfortable environment, minimizing environmental stressors, and assisting the dog with balance and mobility.

Medications: Medications may be prescribed to alleviate specific symptoms and promote recovery. These medications aim to control nausea, vomiting, and reduce vestibular-related dizziness. 

The specific medications used can vary, and it is best to consult with a veterinarian for a proper diagnosis and appropriate medication selection. Some commonly used medications may include:

Antiemetics: Antiemetic medications such as maropitant (Cerenia) or ondansetron may be prescribed to control nausea and vomiting.

Sedatives: In cases where dogs experience severe anxiety or are unable to rest due to constant disorientation, sedatives such as diazepam (Valium) or trazodone may be used to promote relaxation and reduce anxiety.

Motion Sickness Medications: Medications like meclizine (Antivert) or dimenhydrinate (Dramamine) may be used to manage vestibular-related motion sickness in some cases].

Treatment of Underlying Causes: If the vestibular disease is secondary to an underlying condition such as an ear infection or tumor, the treatment will focus on addressing the underlying cause. Antibiotics, antifungals, or other specific treatments may be necessary based on the identified cause.

Rehabilitation and Physical Therapy: In some cases, rehabilitation exercises and physical therapy may be recommended to improve balance, coordination, and strength during the recovery phase. These exercises are often tailored to the individual needs of the dog and may include techniques such as balance exercises, range-of-motion exercises, and controlled walking.

Vet Q&A

Q: How long can a dog live with vestibular disease?

A: Most dogs recover from vestibular disease within a few weeks, but in some cases, the vestibular disease can become a chronic condition that requires ongoing treatment and management.

Vestibular Disease is not considered fatal, however, it is affecting older dogs that might have other medical issues. 

Q: What triggers a vestibular episode in dogs?

A: 

  • Ear infections
  • perforated eardrums
  • tumors
  • hypothyroidism
  • reactions to ear medication (ototoxicity) 
  • side effects from antibiotic
  • age-related degeneration of the vestibular system
  • brain issues

Q: What can I do if my dog has vestibular disease?

A:

  1. Consult a Veterinarian: The first step is to consult a veterinarian for a proper diagnosis and guidance. A veterinarian can assess your dog’s condition, determine the underlying cause if possible, and provide appropriate treatment options.
  1. Create a Safe Environment: Dogs with vestibular disease often experience balance problems and dizziness. To prevent accidents and injuries keep them away from hazards such as stairs, furniture, and electrical cords. Remove objects that could cause stumbling or tripping.
  1. Provide Supportive Care: Provide a comfortable and quiet space for them to rest. You can create a small room, a crate, or a partitioned section with stacked pillows or cushions.
  1. Assist with Mobility: To assist with mobility, consider using a harness or sling to support your dog’s weight when needed. This can provide stability and prevent falls.
  1. Adjust Food and Water bowls: Elevate the bowls to a comfortable height or consider hand-feeding if necessary.
  1. Minimize Stress and Anxiety: Vestibular disease can be distressing for dogs, and stress can worsen their symptoms. Create a calm and quiet environment to help reduce stress. Avoid sudden movements or loud noises that could startle your dog.
  1. Follow Veterinary Recommendations: veterinarian’s recommendations regarding medications, dietary changes, or any other specific instructions for your dog’s condition will provide you with the best course of action based on your dog’s individual needs.

Q: Do dogs with vestibular disease sleep a lot?

A: Dogs with vestibular disease may experience changes in their sleep patterns, but individual dogs may exhibit different behaviors. 

It is common for dogs with any illness or condition to sleep more than usual as their body focuses on healing and recovery – especially senior dogs.  Thats why dog beds should offer support, cushioning and help prevent further health issues such as infections, pain, or worsen joint issues.

Q: What makes Vestibular Disease in dogs worse?

Vestibular issues in dogs typically do not progress or worsen over time 

However, certain factors or underlying causes can contribute to the severity or persistence of symptoms. 

  • Underlying causes
  • Secondary complications: if the vestibular disease is caused by a problem within the brain, other areas of the brain can be affected, resulting in seizures, weakness, or loss of vision.
  • Concurrent health conditions: Dogs with pre-existing health conditions, such as hypothyroidism or other neurological disorders, may be more prone to experiencing severe or chronic vestibular issues.

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