Can Dogs Get Vestibular Disease More Than Once? Our Vet Explains Signs, Diagnosis & Treatment

Vestibular Disease in Dogs: Can It Come Back or Be Fatal?

Have you ever noticed your dog suddenly develop a pronounced head tilt, walk in circles, or have trouble keeping their balance? These may be signs that your pup is experiencing vestibular disease. While the symptoms can be alarming to witness as a dog owner, the good news is that vestibular disease is often temporary and non-life-threatening. However, it is possible for vestibular episodes to recur in some cases. Let‘s take a closer look at this balance disorder, including what causes it, how it‘s diagnosed and treated, and what a vestibular disease prognosis looks like for dogs.

What Is Vestibular Disease?

First, a quick anatomy lesson. The vestibular system is what allows your dog to have a sense of balance and spatial orientation. It‘s made up of components in the inner ear and brain that provide information about the position of a dog‘s head and body in relation to the ground. The inner ear contains fluid-filled semicircular canals that sense rotation of the head. There are also small crystals called otoliths that detect linear acceleration, like when a dog is walking in a straight line or going up and down.

Information from the vestibular system is sent to the brain and coordinates with visual cues and proprioception (a sense of where the body and limbs are in space) from the muscles and joints. This allows a dog to make the subtle adjustments needed to maintain balance and move around gracefully. When there is a problem with the vestibular system, a dog will experience dizziness, loss of balance, and disorientation.

Vestibular disease simply refers to a sudden, non-progressive disturbance in a dog‘s balance due to a problem with the vestibular system. It can occur in the peripheral components in the inner ear or the central components in the brain. Most of the time, vestibular disease seems to come out of nowhere in older dogs and is considered idiopathic, meaning it has no identifiable underlying cause. Less commonly, vestibular disease may be caused by:

Inner or middle ear infections
Inflammatory diseases
Tumors of the brain or ear
Head trauma
Stroke
Hypothyroidism
Certain antibiotics or other medications that are toxic to the ear

Signs of Vestibular Disease in Dogs

A dog can develop vestibular disease quite suddenly, often with a cluster of very distinct symptoms. The most common signs of vestibular disease in dogs include:

Head tilt, usually to one side
Circling in one direction
Nystagmus (irregular jerking eye movements, either side to side or up and down)
Staggering, loss of balance, and incoordination
Falling or rolling to one side
Motion sickness, nausea, and/or vomiting

These symptoms occur because the brain is receiving abnormal information from the vestibular system about the position of the head and body. In most cases, the clinical signs are most severe for the first 24-48 hours and then start to gradually improve. Many dogs will be reluctant to eat, drink, or go to the bathroom because they feel so dizzy and disoriented.

Diagnosing Vestibular Disease

If you notice any signs of vestibular disease in your dog, it‘s important to have them examined by a veterinarian right away. While vestibular symptoms are distinctive, they can also have very serious underlying causes that need to be ruled out or treated, such as a brain tumor. Your vet will start by getting a thorough history and doing a complete physical exam. They will pay close attention to your dog‘s ears, eyes, and neurological status.

In older dogs with classic vestibular signs, idiopathic vestibular disease may be the presumed diagnosis as long as there are no other red flags on the exam. However, additional testing is often still recommended. Routine bloodwork and urinalysis can help rule out a systemic problem like an infection or thyroid disease. If an ear infection is suspected, your vet may take a sample from the ears to examine under the microscope. In some cases, advanced imaging like a CT scan or MRI may be advised to check for problems like tumors or inflammatory brain disease.

Treating and Managing Vestibular Episodes

The treatment for vestibular disease depends on the underlying cause, if one can be identified. Inner ear infections are treated with antibiotics and anti-inflammatory medications. If a brain or ear tumor is found, surgery may be an option. Thyroid supplements can help resolve signs if hypothyroidism is diagnosed. In dogs with idiopathic vestibular disease, the main focus is on supportive care and nursing them through the episode until it passes.

For dogs experiencing motion sickness and vomiting, anti-nausea medications like maropitant or ondansetron can help them feel better and keep food and water down. If a dog becomes dehydrated, they may need to stay at the vet clinic for IV fluid therapy. Keeping a dog confined to a small, padded, and non-slip area can help prevent injury while they are having trouble with their balance. They may need to be carried outside for bathroom breaks or have a sling placed under their belly for support.

Most dogs with idiopathic vestibular disease will see a noticeable improvement in their symptoms within 72 hours, although some may have a residual head tilt for a week or two. The majority of dogs recover fully within 2-3 weeks, although it‘s not uncommon for them to have a slight occasional head tilt for the rest of their life. This generally doesn‘t impact their quality of life. Early and intensive supportive care can speed recovery. Physical rehabilitation exercises may help strengthen the other parts of the balance system to compensate.

Can Vestibular Disease Come Back?

A frustrating aspect of idiopathic vestibular disease is that it can potentially recur, and we don‘t fully understand why. Some dogs may have multiple episodes throughout their life, although they can often go months to years without any signs in between episodes. Dogs that experience recurrent bouts of vestibular disease may have an underlying health issue that has not been discovered, so it‘s important to keep working with your vet to investigate possible causes.

While any dog can develop vestibular disease, there are some breeds thought to be at higher risk. These include German Shepherds, Doberman Pinschers, Beagles, Golden Retrievers, Labs, and Aussies. Older dogs in general are more prone to vestibular episodes. If you have a dog that is predisposed to vestibular dysfunction, there are a few steps you can take to help support them and keep them safe:

Use a harness with a handle when out on walks in case you need to assist them
Consider adding carpet, rugs, yoga mats, or interlocking foam tiles to slippery floors in the home
Use baby gates to block off stairs
Keep living areas clutter-free and move any furniture with sharp corners to avoid injury if your dog becomes disoriented
Ask your vet about supplements that may support inner ear and brain health, like antioxidants or omega-3 fatty acids

Is Vestibular Disease Life-Threatening?

The good news is that the prognosis for dogs with vestibular disease is generally very good. The condition itself is not fatal, and most dogs will recover even without treatment. However, vestibular dysfunction can be life-threatening in some situations. A dog that is extremely disoriented may not be able to eat or drink and can become dehydrated. Some dogs may even aspirate food or water if they are vomiting and off-balance. Dogs can also seriously injure themselves falling down stairs or hitting objects if they are stumbling around.

Rarely, vestibular signs may be the first indication of a more serious underlying problem, such as a rapidly growing brain tumor. This is why it is so important to have any dog with vestibular signs evaluated by a vet as soon as possible. The sooner an underlying cause can be identified and addressed, the better the chances of a full recovery. Even if no specific cause is found, supportive care may be needed to get a dog through the episode safely.

The Mystery of Idiopathic Vestibular Disease

Idiopathic vestibular disease may be scary for dog owners to witness, but the acute phase is generally short-lived. The majority of dogs recover fully, although some may have future episodes. While vestibular disease is not usually life-threatening on its own, it can lead to complications in some cases. Any dog showing signs of vestibular dysfunction should be evaluated by a veterinarian to rule out underlying issues like ear infections, hypothyroidism, or tumors.

More research is still needed to fully understand why some dogs develop idiopathic vestibular disease and why recurrence is possible. In the meantime, dog owners can take heart that the prognosis is very good for vestibular dogs with appropriate care and support. If your dog is prone to vestibular episodes, work with your vet to come up with a plan to keep your dog safe and comfortable and contact them at the first sign of a problem. Remember that your dog may be very frightened and disoriented during an episode, so provide lots of reassurance, love, and a safe space for them to recover.