When your dog tilts their head it’s usually an incredibly adorable sign that your dog is listening to you, trying to understand what you’re communicating to them. They will also most likely tilt their head to the side if you say some of their favourite words, for instance, W-A-L-K-I-E-S, or, D-I-N-N-E-R.
However, have you noticed that your dog is tilting their head more than usual, for no apparent reason? Head tilting is actually one of the most common symptoms of vestibular disease.
Commonly referred to as ‘old dog syndrome’ due to its frequent occurrence in senior pooches, vestibular disease is a disturbance of your dog’s normal balance, causing them to feel disorientated, dizzy and unstable.
We’re going to explain what exactly vestibular disease is, why it happens, the symptoms to look out for and how to treat this peculiar disorder.
Vestibular disease is a non-progressive neurological disorder that is triggered by an anomaly in the vestibular system, which is the system that manages balance, mainly situated in your dog’s ears up to their brain. Luckily, it’s a fairly common disease that many dogs experience, despite being significantly frequent in older dogs, and your dog should recover and regain their balance fairly quickly.
The disorder definitely sounds and looks a lot more serious than it is - vestibular disease will thankfully not cause your dog any pain, just probably a bit of discomfort and dizziness. Essentially, the disease will make your dog feel like their world is spinning, think of it like when us humans experience vertigo.
To totally understand what vestibular disease is, it’s vital to understand what the vestibular system is and how it works. The vestibular system is a sensory system situated within the ear and brain, it regulates balance, allows animals to walk without falling over and permits the animal’s eyes to follow moving objects around without feeling dizzy.
Your dog’s ears are made up of the pinna (the visible part of the outer ear), the external ear canal, middle ear and the inner ear. The vestibular system is heavily focused inside the middle and inner parts of the ear. Multiple components and sensors are located deep inside these two sections of the ear, alongside a specialised control centre at the back of the brain.
Within the middle ear, there are two main receptors involved to control your dog’s balance, one to identify rotational acceleration and one for linear acceleration and gravity. Rotational acceleration allows your pooch to maintain and regain balance when they’re turning around or tumbling over during playtime with their pals, and linear acceleration tells your pup which direction is up and which is down to prevent them from falling over randomly.
These sensors in the middle ear are incredibly important and are constantly put to work. To keep the balance, they identify the position of your dog’s head and eyes and send electrical signals to the balance control centre in the brain, letting the brain know what tiny changes in position are required to keep your pooch upright. These messages are also delivered to the muscles which operate eye movement, so the eyes can shift in accordance with the position of the head.
Even though it operates within such a tiny space - the ears - the vestibular system is key, detecting tiny changes every single time your dog moves a muscle.
Multiple triggers can spark vestibular disease, however, the most common will be a middle or inner ear infection such as otitis, which is the inflammation and swelling of the middle ear.
Any tiny abnormality in the ear can trigger vestibular disease, due to their integral role in maintaining balance, so ear tumours, polyps (peculiar tissue growth) and even if your dog takes a medication that is toxic to the ear are all things that can cause the disorder. When your dog develops a hearing or balance problem due to their medication it’s referred to as ototoxicity. Injury and trauma can also be significant to the onset of vestibular disease. Even endocrine (hormonal) diseases such as hypothyroidism can be a trigger.
Although there are many factors that can cause the disease, sometimes dogs just experience it for no apparent reason. When no underlying cause for the disorder can be found, it’s referred to as idiopathic vestibular syndrome, and this is the type that frequently occurs in senior dogs.
Idiopathic is the word for a disease that arises suddenly and has no evident cause. This type of vestibular syndrome is often suspected to be because of some inflammation or swelling, but it can be comparable to humans and vertigo, in that we don’t know why it happens but accept that it does.
Typically, the symptoms of vestibular disease are quite distinct, so you should be able to notice it pretty quickly. Also, there isn’t ever a slow progression of the disorder, it happens almost overnight and will normally be pretty severe in appearance but only have a short duration.
The main symptoms to look out for are:
Loss of balance
Dog drifting from side to side
Head tilt, your dog may start to lean their entire body in the direction of the head tilt and eventually fall over
Walking around in circles
Ataxia, which refers to a loss of muscle control which might make your dog reluctant to stand up or walk, even to go to the toilet or get food. If your dog experiences this, it’ll depend on the seriousness and localisation of the disease
The vestibular system is situated very close to the part of the brain that controls vomiting and sickness, so it’s likely your dog will feel motion sickness and they may even be sick
Difficulty eating and drinking
Erratic eye movements, eyes moving back and forth or rotating
If your dog’s eyes are moving in a strange manner, whether they’re going from side to side or going round in a loop, the action is called nystagmus. Regularly, the eye movements could be slower in one direction, and this is often the side where the neurological issue is based. However, nystagmus is typically labelled in relation to whichever direction the eyes are moving faster. For example, your dog could be experiencing ‘right nystagmus’, but the neurological problem is likely to be on the right side of the balance centre.
Many of the symptoms listed above can often be mistaken by owners to be something much more severe, such as a stroke or tumour, due to the similar ways in which they present themselves.
It’s suggested that there’s around a 0.08% prevalence of vestibular disease in the UK’s canine pup-ulation, but the most commonly affected dogs are the older pooches.
For some unknown reason, Doberman Pinschers seem to be by far the most impacted breed, it’s suspected that it’s due to some kind of genetic anomaly. Cavalier King Charles Spaniels, Cocker Spaniels, German Shepherds, French Bulldogs and Boxers are also commonly affected dog breeds.
Vestibular disease diagnosis will mostly be based off your description of your pet’s symptoms, as the signs of the illness are so distinctive. Where possible, a short video of your dog can speed up diagnosis even more. So, if you notice any changes in your pooch’s balance and their head and eye movements, try to capture some footage for the vet.
Even though your vet should be able to quickly recognise vestibular disease based on the symptoms your dog is experiencing, further tests will still be essential in case there is another underlying problem causing vestibular disease. Blood and urine tests will be required, maybe even alongside blood pressure tests, x-rays of the head and assessments of the ears. Sometimes, an MRI or CT scan may be performed to search for any further problems.
Despite this, sometimes a cause just can’t be found, which is when the vet will likely diagnose your dog with idiopathic vestibular disease. The diagnosis for this type of vestibular disease will be based off these criteria:
A cause can’t be found (no signs of ear infection, trauma, infectious diseases, hypothyroidism)
Your dog is a senior
The symptoms started seemingly out of nowhere
The signs begin to resolve pretty quickly
Vestibular disease has a great prognosis and will typically clear up all by itself with little to no treatment. However, if you notice any signs of the disorder, you must take your dog to the vet to determine if an underlying cause is triggering it.
Treatment for vestibular disease will depend on what is causing, if anything, the change in balance. One of the most common causes is an ear infection, which will likely necessitate a course of antibiotics to clear it up. Occasionally, curing an inner ear infection can take several months, so you’ll have to persevere with treatment.
Medication that helps combat sickness and nausea can sometimes be prescribed, and depending on how severe the disorientation is, sedatives may be given to encourage your dog to relax. These will often be prescribed if your pet is suffering from idiopathic vestibular disease, just to help your dog begin to feel themselves again.
Again, depending on the severity of the illness, additional help may be needed, such as intravenous fluids and overnight stays at the vet to aid your dog with eating and walking on their own if the illness has advanced to an extreme level.
However, most dogs will do just fine recovering in the comfort of their own home.
There are a few things you can do at home to help your dog during their recovery from vestibular disease. Essentially, as an owner, you need to do everything you can to make things easier for your dog and minimise their discomfort.
As your dog will be feeling a little wobbly and might struggle to stand up, it’s best to try and keep their living area relatively confined so that there is less chance of a stumble. Ideally, keep your dog on soft floorings, such as the carpet, so that they don’t slip or slide on the floor. It’s also a good idea to move some furniture out of the way in case they walk or fall into anything and cause themselves an injury. Similarly, keep your dog away from the staircase in case they trip. Generally, you need to be doing everything you can to try and prevent any painful falls and injuries.
Your dog may struggle to get up and walk when they need to go outside to the toilet, so you might need to assist them. This also applies to them trying to get to their food and water bowls. Being constantly dizzy will make your dog feel nauseous, and as a result, they’ll probably be uninterested in their food. Consequently, you might need to bring their bowls to wherever they are and even hand feed your dog. It’s recommended to try and let your dog navigate around the house themselves to recalibrate the senses, but if the symptoms are so severe that they can’t walk properly, a little extra help may be necessary in the initial stages.
It’s crucial that you do take your dog to the vet when symptoms begin to develop, but the vet is likely to just recommend taking a ‘wait and see’ approach, alongside anti-sickness medication. You just need to keep your pooch comfortable and wait for them to recover at home. Usually, the symptoms will be the most severe during the first 2 days and then most dogs will begin to improve in the few days after. However, the head tilt and wobbling will take slightly longer, potentially even taking over 10 days to subside. A full recovery will usually take up to 3 weeks, but occasionally some dogs keep some of their symptoms such as the wobbly stance and tilting head for life.
If you notice that the symptoms of vestibular disease are not improving, or they’re worsening, you’ll need to take them for another in-depth examination at the vets, as this may indicate there is another condition triggering the symptoms that was missed the first time round which will need to be addressed.
If you notice your dog acting peculiar, stumbling around and tilting their head for no reason, you must take them to the vets immediately to determine what’s going on.
Luckily, vestibular disease won’t cause your dog too much hassle, and will clear up relatively quickly, however, something much more serious could be causing this loss of balance, which must be worked out quickly.
Written by: Dr Andrew Miller MRCVS
Andy graduated from Bristol University in 2010 and sees nutrition as a foundation for our pet's wellbeing and takes a common-sense approach. We are what we eat, and it shouldn't be any different for our pets.