Ettinger & Feldman — Textbook of Veterinary Internal Medicine
Client Information Sheet
Old Dog Vestibular Disease
|What is a vestibular disease?In the body, balance is controlled by the ears (vestibular receptors of the inner ear) working together with specific areas of the brain. Together they represent the vestibular system. A problem affecting the vestibular system will cause loss of balance manifested by a head tilt, a large base stance, and a tendency to fall to the side or to roll or to walk in tight circles. An abnormal, rapid, side-to-side movement of the eyes can also be seen, called nystagmus. Therefore vestibular disease is a general term indicating a disease in the balance system.
What are the symptoms of old dog vestibular disease?
Many diseases can cause loss of balance, the most common being ear infection, a tumor in the brain or the inner ear, a vascular problem, toxicity to chronic drug administration (e.g., metronidazole), and old dog vestibular disease. Old dog vestibular disease is a condition with an acute onset of severe vestibular signs in an older dog. The clinical signs happen extremely rapidly, sometimes over a few minutes, and will cause severe incapacitation of the dog. It is not unusual for a dog to be unable to get up and walk because the loss of balance is so severe. Nystagmus is commonly seen. We assume that your dog feels dizzy and nauseous. Vomiting will sometimes occur. You may also notice that your dog will only lie on one side and will roll on the floor when attempting to move or when you try to turn him on to the other side.
What is the cause of old dog vestibular disease and how can it be diagnosed?
The cause of old dog vestibular disease is unknown. The diagnosis is made by the history (i.e., acute onset of loss of balance in an old dog), by the neurologic examination (i.e., no other neurologic signs, no weakness, and no signs of brain problem), and by ruling out other diseases (no sign of ear infection, tumor) The history is important in the diagnosis and it is important for you to try to recall any changes in your dog’s behavior or health in the previous days or weeks. Was your pet more depressed or lethargic lately? Did you notice more scratching of the ears or shaking of the head that could indicate ear infection? Did your pet seem to be getting old or dragging behind during walks recently? These can indicate that something more is going on. If there is a suspicion that something else is going on, your veterinarian might recommend further tests for your dog. Otherwise, only a good physical and neurologic examination is needed. Because it can be difficult to perform a complete neurologic examination the first day in a dog severely affected and obviously anxious, your veterinarian might recommend that your pet be hospitalized for the first few days or that you come back for a recheck examination after 1 to 3 days to complete the evaluation.
What is the treatment?
There is no specific treatment for old dog vestibular disease. Only time and supportive therapy is needed. If your dog seems nauseous or is vomiting, motion-sickness medication should be administered. Hospitalization and fluid administration might also be needed if the vomiting is pronounced.
Your dog will need help to walk and possibly even just to stand. It is easier to provide help by using a sling or a towel underneath the abdomen and a harness to support the front part of the body. Your dog will learn to use walls and your legs to help keep its balance. Try to avoid slippery surfaces!
In the event of a possible ear infection, it is wise to start antibiotic therapy. However, antibiotics are not needed for old dog vestibular disease.
Will my dog be normal again?
Although initial clinical signs are often dramatic, improvement is also dramatic. Your dog might improve as quickly as 2 to 3 days after the beginning of the problem. However, it will usually take weeks before your dog is almost back to normal. A complete recovery is expected; although in some dogs, a slight head tilt will persist for the rest of their life.
Relapses are not common but can sometimes occur.
Despite the severity of the clinical signs and the normal anxiety of your pet (and yourself!), the chance of recovery is excellent. All your dog needs is some time and your help.