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“Old Dog” Vestibular Disease and Treatment

If you have an older dog, they could have a condition called idiopathic “old dog” vestibular disease. Here's everything you need to know.

by Dr. Shea Cox, DVM, CVPP, CHPV
Updated August 18, 2021
Two brown senior pointer dogs
Studio Porto Sabbia / Adobe Stock

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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 tumor. And 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.

Most pets are diagnosed with idiopathic vestibular disease because the cause is typically unknown, but other causes include ear infection, hypothyroidism, tumors, other diseases, and trauma. Idiopathic vestibular disease doesn’t require treatment; it typically resolves by itself with supportive care.

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 (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 forward, 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 — about $1,500 here in the Bay Area.)

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, such as a tumor, 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 tumor, 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.

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 over-the-counter Meclizine for “motion sickness.”

However, if they’re unable to walk, then 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 tile.

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

  • Encourage their appetite by adding tasty food toppers like bone broth to their meals.

  • 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 I recommend waiting to see if conditions improve before making the permanent decision to euthanize. Why not wait and see, giving time a chance? 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.

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Dr. Shea Cox, DVM, CVPP, CHPV

Dr. Shea Cox is the founder of BluePearl Pet Hospice and is a global leader in animal hospice and palliative care. With a focus on technology, innovation and education, her efforts are changing the end-of-life landscape in veterinary medicine.