After 14 years of working as a vet, I can diagnose some client concerns in an instant. When a client calls and says their dog is choking, the dog probably has kennel cough. When a client suspects their dog is constipated (because the dog is straining to have a bowel movement), I will probably treat a case of diarrhea caused by colitis.
Those initial guesses aren’t always accurate, so it’s important to perform a thorough physical exam and testing. Still, many conditions can be identified by how clients erroneously “diagnose” them.
When a client suspects a stroke, what do I think? It’s probably vestibular disease causing a sudden onset of stumbling and loss of balance. A physical exam is important because it could be a stroke.
What is vestibular disease?
Vestibular disease is a relatively common condition, accounting for nearly 1 in 1,000 veterinary visits seen by primary care veterinarians. Any condition that affects the vestibular system, which handles balance can cause it.
The most common form of vestibular disease is “idiopathic vestibular disease,” also known as “old dog vestibular disease.” We don’t know why idiopathic vestibular disease occurs, but it causes a sudden non-progressive onset of vestibular signs in older dogs. In one 2020 study, researchers found that 68% of dogs with vestibular disease were ultimately diagnosed with idiopathic vestibular disease. Less common causes of vestibular disease in that study included internal/middle ear infection (26%), hypothyroidism (4%), hereditary vestibular disease (1%), and cancer (1%).
Vestibular disease affects a dog’s balance. Affected dogs may struggle to stand or walk, acting uncoordinated and falling to one side. In severe cases, dogs may roll uncontrollably even while lying on the ground. The head is often tilted to one side and some dogs have rapid back-and-forth eye movements (nystagmus).
Typical recovery & survival rate for dogs with vestibular disease
Vestibular disease in dogs is often a treatable condition, with most dogs making a full recovery within 2-3 weeks. Assuming that the cause of vestibular disease is relatively benign (for example, with idiopathic vestibular disease or middle/internal ear infection), clinical signs such as a head tilt and incoordination will often disappear in the first 7-14 days. Many dogs make a full recovery, with no significant changes in life expectancy
Dogs initially diagnosed with vestibular disease may show worrying clinical signs possibly associated with cancer. Other neurologic signs and dramatic behavior changes might make a cancer diagnosis more likely. However, you shouldn’t euthanize these dogs unless they have received a thorough veterinary workup to determine a definitive diagnosis and possible treatment.
Are there cases when dogs with vestibular disease should be euthanized?
Recurrence of vestibular disease or persistence of chronic vestibular signs can occur. According to a 2020 study, 1 in 2 dogs experience persistent signs of vestibular disease, such as a head tilt. (See our article “What to do if your dog is not recovering from vestibular disease“). In most cases, recurrent or persistent signs are mild and do not affect the dog’s quality of life. However, if the cause of vestibular disease involves cancer or another serious underlying disease, life expectancy may vary significantly.
We may consider euthanasia if a dog has a poor prognosis for returning to a good quality of life. With idiopathic vestibular disease, your dog may be uncomfortable for a couple of weeks, but will probably be “back to normal” within a few weeks.
Dogs with ear infections and hypothyroidism usually respond well to medication. Therefore, the only situation in which we typically recommend euthanasia is a dog with vestibular disease caused by a cancerous mass. Your veterinarian may recommend euthanasia if your dog’s vestibular disease is cancer-related, depending on the type of cancer and its ability to be treated.
Can vestibular disease kill a dog?
Vestibular disease itself cannot kill a dog. However, some causes of vestibular disease, such as brain tumors, might be fatal.
WATCH: 3 Important Tips To Care For an Old Dog [VET VIDEO]
How do you know when it is the right time to euthanize your dog?
Euthanasia timing is a deeply personal decision and not always an easy one. If your dog’s condition is rapidly declining and that decline is attributable to a life-threatening condition with a poor prognosis, your veterinarian may recommend euthanasia.
However, the “right time” for euthanasia is less straightforward. Many dogs experience a gradual decline in quality of life as they age and there is no one right or wrong time to consider euthanasia. In these cases, you will need to evaluate your dog’s quality of life and the likelihood of their condition improving. Your veterinarian and their support staff can help you think through these decisions.
Can vestibular disease create permanent damages? (neural damages, etc.)
Research shows that approximately half of dogs with idiopathic vestibular disease still have residual neurologic signs present months or even years later. The most common residual sign is a head tilt. Fortunately, residual effects are typically mild and don’t affect a dog’s quality of life.
Treatments and prognosis for dogs with vestibular disease
The treatment of vestibular disease depends on its underlying cause.
Idiopathic vestibular disease comprises most cases of vestibular disease. Treatment won’t speed resolution of the condition because there is no cure. Instead, treatment focuses on providing supportive care to keep your dog comfortable and ensure that they are eating and drinking. Based on the severity of your dog’s signs, you can expect to spend anywhere from $20 (for anti-nausea medications) to $500 (for hospitalization and intravenous fluids, in severe cases) to treat idiopathic vestibular disease.
You treat an inner or middle ear infection from vestibular disease with antibiotics. Your dog will require 6-8 weeks of oral antibiotics and may also need supportive care (hospitalization). However, the treatment of a middle or inner infection can cost between $500-1,000.
Oral thyroid hormone supplementation treats hypothyroidism, for the rest of your dog’s life. Thyroid medication and monitoring cost less than $50 per month.
If cancer causes your dog’s vestibular disease, treatment will depend on the type of tumor involved. Your veterinarian will give you information regarding the treatment of your dog’s tumor, along with expected costs and prognosis.
What can you do at home to help a dog with vestibular disease?
Dogs with vestibular disease, regardless of the underlying cause, will probably need supportive care at home. Dizziness can be extremely disorienting and disruptive, but you can help.
Help your dog find a comfortable place to rest. Using blankets or towels to create a small nest for your dog can help them feel more supported and settled.
Keep your dog away from areas where they could become injured. Dogs with the disease can fall down stairs or hurt themselves jumping on furniture. They are also more inclined to trip over large objects on the floor. Close doors or use baby gates to confine your dog to a small, safe area that is free of obstacles and fall risks.
Finally, help your dog with eating, drinking, and potty breaks. You may need to bring food and water to your dog, at least for a few days. If your dog isn’t eating well, entice them by adding some tasty, canned food to their normal dog food. You may also need to help your dog outside, using a harness. In most cases, you should only need to provide this level of assistance for a few days before your dog shows gradual signs of improvement.
Visiting a vet
If your dog is showing signs of vestibular disease, it’s time to schedule a visit with your veterinarian. While the sudden onset of vestibular disease can be scary and may prompt you to rush to the emergency vet, take a deep breath. In most cases, vestibular disease can wait one to two days to be seen by a veterinarian. Contact your dog’s regular veterinarian to determine whether they have an open appointment and what course of action they recommend.
A veterinarian will begin by performing a full physical exam, paying close attention to your dog’s ears and nervous system. Your veterinarian may also recommend blood tests to look for evidence of hypothyroidism or other illnesses that may complicate the treatment of your dog’s vestibular disease.
If your dog is determined to be suffering from idiopathic vestibular disease, your veterinarian will prescribe medication to help ease your dog’s dizziness. Vestibular disease and dizziness can cause nausea, so your veterinarian may also prescribe an anti-nausea medication. Finally, your veterinarian will talk to you about what you can do at home to support your pet’s recovery.
If your veterinarian suspects your dog has another underlying cause for their vestibular disease, such as an ear infection, hypothyroidism, or cancer, further testing may be recommended.
Preventing recurrence of vestibular disease
While most dogs will recover rapidly from an episode of vestibular disease, signs may persist and recurrence of vestibular disease may also occur. Unfortunately, there is no effective way to prevent the recurrence of idiopathic vestibular disease.
When to put a dog down
In most cases, euthanasia is unnecessary for vestibular disease. However, there are two rare exceptions. If untreatable cancer causes your dog’s vestibular disease, your veterinarian may recommend euthanasia. If your dog is very ill because of other serious medical conditions, you and your veterinarian may jointly decide that euthanasia is a better option for your pet than addressing the vestibular disease. Fortunately, both circumstances are rare. The overwhelming majority of canine vestibular disease patients respond well to treatment; therefore, euthanasia is rarely recommended or appropriate.
Why does my dog keep showing signs of vestibular disease?
Nearly half of dogs diagnosed with idiopathic vestibular disease will have signs that persist for months to even years. In most cases, this doesn’t negatively affect the dog’s quality of life.
Is vestibular damage permanent?
Most dogs with vestibular disease recover rapidly with treatment. Some dogs will have mild changes that persist, such as a subtle head tilt, but the initial period of dizziness and falling over typically resolves within one to two weeks.
Can a dog get vestibular disease twice?
Recurrent vestibular disease is not very common, but it can occur. Recurrent disease can be associated with any of the potential causes of vestibular disease—idiopathic vestibular disease, ear infection, hypothyroidism, or cancer. A recurrence of signs does not make any cause of vestibular disease more or less likely.
Do dogs with the vestibular disease have seizures?
Seizures are not typically seen with vestibular disease. If your dog is having seizures accompanied by vestibular signs, seek veterinary attention immediately to rule out issues such as toxins, head trauma, and encephalitis.
Can vestibular disease cause deafness in dogs?
Vestibular disease and deafness are not typically related; two separate nerves control hearing and balance. However, approximately 25% of dogs with vestibular disease have an inner or middle ear infection. Inner and middle ear infections may contribute to hearing loss.
Does CBD help with vestibular disease?
Some pet owners feel CBD helps control their dog’s vestibular disease. However, veterinarians recommend against the use of CBD because of a lack of quality control testing associated with most CBD products.
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