‘Old Dog’ Vestibular Disease and Treatment

When an old dog suddenly starts walking like a drunken sailor with their head tilted, many pet parents assume it’s due to a stroke or seizure. Some even think it’s a brain tumour. While it’s natural to think the worst when these symptoms arise, they – along with some other disturbing signs – can also indicate a much less serious condition called idiopathic vestibular disease in dogs. It looks really bad, but it often improves on its own with little or no treatment.

What is vestibular disease in dogs?

Vestibular disease in dogs is a balance disorder of the inner ear that affects the vestibular system. Common symptoms include a head tilt, vertigo, nausea and difficulty walking (or even standing). Another name for this condition is ‘old dog’ vestibular disease because older dogs are more likely to experience this condition, with the average age of a dog diagnosed with vestibular disease being 12–13 years old.

Idiopathic vestibular disease is the most commonly diagnosed form of vestibular disease in pets. With idiopathic vestibular disease the cause is typically unknown, and treatment isn’t required as it often resolves by itself with supportive care. Other causes of vestibular disease in dogs include ear infection, hypothyroidism, tumours, other diseases and trauma.

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Are some breeds more at risk?

Some dog breed types, such as spaniels and brachycephalic breeds, may have a higher predisposition for vestibular disease in dogs. According to one study, French Bulldogs, Bulldogs, King Charles Spaniels, Springer Spaniels, Boxers, Cocker Spaniels and Golden Retrievers are some breeds with the highest odds of vestibular disease, but the condition can affect any dog breed including mixed breeds.

How is vestibular disease in dogs diagnosed?

For a dog showing the symptoms of vestibular disease, veterinarians will first review the possible causes, check for infection and may advise the use of an MRI. However, pet parents are often advised to wait and watch their pet’s progression to determine the best course of action.

Rule out common diseases

While the cause is most often idiopathic (aka unknown), there may be other potential sources for your pup’s vestibular disease symptoms. Your veterinarian may recommend blood work and a blood pressure check to make sure there is no ‘obvious’ condition causing these clinical signs.

Check for ear infections

Moving forwards, both ear canals are examined and if an infection is suspected, antibiotic medication will be discussed as inner ear disease is a possible cause of vestibular signs. Technically, you can’t see the inner ear during an exam because the eardrum obscures the view, however a nasty-looking outer ear and an inflamed eardrum may indicate that inner ear disease is present.

Use diagnostic imaging tools

Your vet may discuss the availability of an MRI to evaluate the inner ear and brain. (An MRI allows for the best evaluation of disease, but it’s often not pursued due to cost – an average of £2,500 across the UK).

Wait-and-see approach

There’s a very loose rule of thumb: if there is gradual or complete improvement within 72 hours, it’s likely the dog has idiopathic vestibular disease and additional testing is not necessary. If there is no improvement or progression of signs, it is likely something much more serious like a tumour, and an MRI would then be recommended to reach a definitive diagnosis.

What are the symptoms of vestibular disease in dogs?

A dog’s vestibular system is composed of portions of the brain and ear and is responsible for maintaining balance. When something goes wrong within this system, it’s like being drunk on a rocky boat. Dogs with idiopathic vestibular disease typically show some combination of the following signs:

• a head tilt

• an unsteady gait, loss of balance, or falling over (ataxia)

• circling in one direction

• eyes rapidly moving from side to side (nystagmus)

• sudden vomiting

• standing with legs spread wide

• changes in eating or drinking habits

Now for the caveat: these clinical signs are unfortunately not unique or diagnostic for vestibular disease. These symptoms are also very similar to signs of a canine stroke, which is caused by a blockage in the blood vessels reducing oxygen in the brain.

Other things can cause these same symptoms such as a brain tumour, an inner ear infection, inflammatory disease or sudden brain bleeds – to name a few. The sudden onset of vestibular disease and a seizure can also be hard to tell apart. If your dog is experiencing these symptoms and the diagnosis is unclear, do your best to record the episode and show it to your vet so they can closely examine the signs.

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Treatment for vestibular disease in dogs

The best course of treatment for vestibular disease will depend on the cause, but generally veterinarians will recommend supportive care. If clinical signs are mild, dogs can often be managed at home with vet-prescribed treatments for motion sickness.

However, if they’re unable to walk, IV fluids and injectable anti-nausea medications are recommended. Urinary catheters are also sometimes placed for hygienic reasons and instructions for general nursing care are provided, including how to prevent falls.

Often dogs show signs of improvement from an episode of vestibular disease within 72 hours, and recovery should happen within one to two weeks. After recovery, most dogs live a long life with vestibular disease, despite some persistent symptoms such as a head tilt and nausea.

Home remedies for vestibular disease in dogs

Once your dog is at home recovering, there are several things you can do to ease their transition back home and help ensure they feel comfortable.

• Make sure your dog’s bed is nearby and easily accessible.

• Prevent further injury by ensuring your home is easily walkable – you may want to add rugs or a non-slip mat if you have wood or tiles.

• Keep their water and food bowls close so they don’t need to walk far.

• Encourage their appetite by adding tasty food toppers.

• Use a body harness with a handle to help hold your dog steady.

Should you put a dog down with vestibular disease?

Vestibular disease is not fatal, so it is unnecessary to immediately consider putting your dog down if they are diagnosed. Idiopathic vestibular disease in dogs is also not a painful condition, which is why as a pet palliative care practitioner I recommend waiting to see if conditions improve before making the permanent decision to euthanise. Why not wait and see? Again, improvement is very likely and the difficult decision of euthanasia can always be made at a later date if there’s a change in your dog’s quality of life.

Personally, I feel there’s reason to hold out hope and be cautiously optimistic, as idiopathic vestibular disease is the most common form of vestibular disease in dogs. It is the direction I would take if it were my own pup.

How long can dogs live with vestibular disease

How long a dog can live with vestibular disease depends on a variety of factors, including the cause, the dog’s overall health and age. Idiopathic vestibular disease itself does not typically shorten a dog’s life expectancy. After recovery, many dogs with vestibular disease continue to live normal lives though they may have residual symptoms like a head tilt and nausea. But in some cases, particularly if the vestibular disease is caused by an underlying condition such as cancer or infection, the prognosis may be more uncertain. As always, it’s important to consult with a veterinarian who can provide an appropriate diagnosis and guidance for managing the vestibular disease and your dog’s specific needs.

Can old dog vestibular disease be prevented?

Idiopathic vestibular disease cannot be prevented because its exact cause is unknown. But you can help your dog by maintaining a healthy lifestyle and keeping your vet aware of any changes in their health.

References:

• Cornell.edu - Senior Dog Dementia

• Vestibular Disease in Dogs and Cats

• VCA - Vestibular Disease in Dogs

• Clinical signs, MRI findings and outcome in dogs with peripheral vestibular disease: a retrospective study

• Vestibular disease in dogs under UK primary veterinary care: Epidemiology and clinical management

• Clinical reasoning in canine vestibular syndrome: Which presenting factors are important?

• Acute Vestibular Disease in Old Dogs

• Successful Therapeutic Management of Geriatric Vestibular Syndrome in Dogs