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Vestibular Disease in Dogs

Picture of a labrador retriever in the forest

The vestibular system is in charge of giving mammals balance, as well as a sense of spatial orientation. That’s why vestibular disease affects a dog’s body balance system. There are two forms of this condition — peripheral vestibular disease (more common of the two) and central vestibular disease (less common). 

In this article, we’ll look at some of the causes of vestibular disease in our canine friends, its symptoms, its diagnosis, as well as how it can be treated. 

Peripheral vs. central vestibular disease

Peripheral vestibular disease happens when there is irritation caused to the nerves that connect the inner ear brain with the brain. Central vestibular disease, on the other hand, is the less common form, and it is a more serious type of condition as it originates inside the central nervous system.

The peripheral form can feel rather dramatic, especially to the dog parent, particularly when it occurs for the first time. Fortunately, you’ll be glad to know that most cases can improve in a timely fashion, so long as the dog receives the right treatment and supportive care. 

Causes

Why does peripheral vestibular disease occur? Some of its causes include overzealous cleaning of the dog’s ear (which can result in a perforated eardrum), tumors, polyps, hypothyroidism, stroke, trauma from a head injury, as well as recurrent or chronic inner and middle ear infections. There are also some types of drugs that can cause the condition, most of them being antibiotics — neomycin, gentamicin, tobramycin, and amikacin.

All of these can damage or irritate the nerves of the inner ear. This leads to inflammation. However, the disease can also be idiopathic (meaning that the cause can’t be identified), which mostly happens in older dogs. An infection of the middle ear is one of the typical reasons that lead to the development of this disease, at least in younger dogs. 

Some dogs can be born with vestibular disease as a congenital defect. 

As for central vestibular disease, some of its causes range from infections and traumas to inflammatory disease, loss of blood flow, bleeding in the brain, or cancer. 

Clinical signs

The typical symptoms of vestibular disease are represented by balance-related issues. As such, pet parents whose dogs have it might notice that their canine friends start to experience staggering, head tilting, circling and stumbling, a loss of coordination, and falling and rolling. Jerking eye movements from side to side are also common. 

Loss of balance combined with dizziness can lead to other types of symptoms, which consist of nausea, excessive drooling, and even vomiting. Head tilting and circling in the direction of the affected ear can also be noticed. Nystagmus (abnormal eye movement) is only present in one eye if just one of the ears is affected. 

Congenital vestibular disease can be seen between the dog’s birth and 3 months of age. Some of the breeds that are most predisposed to it are Doberman Pinscher, Akita, German Shepherd, English Cocker Spaniel, as well as Beagles. 

In geriatric dogs, this disease can be mistaken for a stroke. Vertigo can be intense, with dogs experiencing symptoms such as the ones we’ve already discussed, but also a difficulty or a total inability to stand up. In old dogs, the condition can make it very challenging, if not impossible, for the dog to pee or poop in the right place. 

How is vestibular disease diagnosed?

A physical examination which includes a neurological assessment can determine the specific form of vestibular disease. An otoscope can be utilized to look into your dog’s ears, and x-rays might be required in some cases, as well. The vet will also recommend blood tests, but also cytology to eliminate any potential causes of the symptoms. 

A biopsy is used for polyps and tumors. MRI and CT scans can provide valuable information, as well, especially when it is more difficult to discover the root cause. 

Performing a thorough neurologic examination is required for determining a specific neuroanatomic localization, which is the critical factor in distinguishing between the two forms of vestibular disease, but also in making a difference between ischemic stroke and idiopathic vestibular disease (in older dogs). The recurrence of clinical signs is another important factor to consider.

Idiopathic disease can recur in dogs even after they’ve improved, but that happens more rarely compared to strokes and the interval between the episodes is also longer in idiopathic vestibular disease (it can even take months for it to come back). With a stroke, the period between the episodes is days to weeks.

Puppies that are born with congenital vestibular disease are capable of adapting, and that’s why they are typically less affected by the condition as they grow up. In old dogs, the condition can resolve in one to two weeks, but the tendency to tilt their head can sometimes remain for the rest of their life. 

How can it be treated?

If medication is at the root of the problem, discontinuing it might bring a complete resolution. Sometimes, there can be residual hearing loss following these medical issues. If there are cancerous tumors present in the dog’s ear, the prognosis is less optimistic. Polyps can be removed surgically. 

Compared to its peripheral counterpart, central vestibular disease has a somewhat poor prognosis, mostly because the brain stem suffers damage. 

Since peripheral vestibular disease can also be caused by an infection, the dog could undergo treatment with antibiotics and anti-inflammatories. Luckily, cases of the peripheral form improve fast, so long as the underlying cause is addressed and the vertigo symptoms are managed with the appropriate supportive care.  

Given that dizziness can make it very difficult for a dog to walk normally, food and water need to be as close to him/her as possible, or even brought to the canine patient so as to encourage him or her to drink and eat. There are also patients that have to be hand-fed until they get better. Last, but not least, many dogs will require assistance in getting back and forth from where they go potty. 

Improvement over time

In idiopathic vestibular disease, the form that’s most commonly encountered is the peripheral one. As such, improvement begins after just two to three days and continues over a time span of up to two weeks. 

Peripheral vestibular disease also shows up in cases of otitis media or interna, in which case the improvement can be static or progressive. If the dog suffered an ischemic stroke, the improvement is variable, and stroke episodes can recur. In most cases of neoplasia, the dog suffers from central vestibular disease and the improvement can be static or progressive. 

The clinical signs that are associated with vestibular disease are usually more severe during the first 24 to 48 hours. There are many pets that experience improvement within just 72 hours. The head tilt and stumbling improves over a 7 to 10 day period. Most of the patients are considered completely recovered within two to three weeks. Some might have residual symptoms such as mild wobbling or a head tilt for the remainder of their life. If the patient doesn’t improve or his/her condition gets more severe, there could be a more serious underlying disorder that should call for advanced diagnostic testing. 

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