Vestibular Syndrome (“Dog Vertigo”)

Our guide has been authored by qualified veterinarians, but should not be taken as substitute for medical advice or professional veterinary consultation. If your pet displays any unusual symptoms, we strongly advise seeking guidance from a veterinarian

Understanding Vestibular Syndrome (“Dog Vertigo”) in dogs

The vestibular system is a sensory system responsible for balance. It includes several structures: spatial awareness and balance signals originate in the inner ear, and are then transmitted via the vestibular nerve to the brainstem and the cerebellum, which are responsible for stabilizing movement and orientation. Damage to any part of the system might disrupt balance to varying degrees, causing symptoms like dizziness or “vertigo”. This is common in dogs and may stem from various causes, some harmless and others more severe.

Donna's story

Donna is a large 2-year-old shepherd dog. One day, her owner, Micha, noticed she was pacing around uneasily while clinging to the walls, refusing to eat, and vomiting every time she drank water. Micha took Donna to the vet, where she was diagnosed with vestibular disease. During the exam, Donna showed signs of pain and even attempted to bite when her ear base was touched. She had a fever and a high white blood cell count and was sent for neurological evaluation. The neurologists performed an MRI, which revealed severe inflammation deep in her inner ear. Donna started an antibiotic treatment along with pain relievers and anti-nausea medication. She was discharged the next day. Within two weeks, she had fully recovered, aside from a slight, endearing head tilt.

Vestibular Syndrome (“Dog Vertigo”)'s Causes: Uncovering Triggers

Idiopathic: This is the most common cause of vestibular disease and is seen mostly in senior dogs. For this reason, this form is nicknamed “old dog vestibular syndrome”. As the name suggests, it primarily affects older dogs, appearing suddenly and resolving within a few days to weeks without a known cause.
Severe outer ear infections can damage the eardrum, allowing bacteria to penetrate deeper into the middle and inner ear. Infections may sometimes reach the inner ear directly through the bloodstream and are undetectable using standard exam methods.
Nervous system inflammation (meningitis) caused by viruses, bacteria, or one-celled parasites like Toxoplasma or Neospora. Autoimmune inflammation may also occur without an infectious cause.
Vascular damage (stroke) impacting the brain’s balance centers.
Tumors, benign and malignant, in the inner ear, brainstem, or cerebellum.
Thyroid gland disorder (Hypothyroidism)
Head trauma
Toxins or certain medications

Recognizing Vestibular Syndrome (“Dog Vertigo”): Signs and Symptoms

Difficulty walking (ataxia): The dog struggles to stand or walk, leans to one side, clings to walls, stumbles, falls, and stands with their legs wide apart. Some will walk in a tight circle. Their steps may be smaller or bigger than usual, resembling an intoxicated person’s walk.
Head tilt to one side
Eye flickering (nystagmus): The eyes move rapidly from side to side, making it difficult to focus.
Head and body tremors: particularly when trying to move toward something.
Nausea with excessive drooling, loss of appetite, and vomiting

Vestibular Syndrome (“Dog Vertigo”) Diagnosis: How it's Identified

The first step is observing the characteristic symptoms indicating a balance issue and conducting a comprehensive physical examination focusing on the nervous system. Reflexes and spatial awareness are tested to distinguish between a “high” cause (stemming from the cerebellum or brainstem) and a “low” or peripheral cause (in which the vestibular nerve or ear canal are the origin).
An ear canal otoscopy may reveal infection, polyps, or even tumors. If the dog is in pain or the examination is difficult, anesthesia may be necessary.
Comprehensive blood tests are performed to look for infections or thyroid hormone imbalances.
After gathering all the relevant information, symptomatic treatment is often recommended to ease the dog’s discomfort and nausea, with close monitoring- particularly in older dogs prone to idiopathic “old dog vestibular syndrome”.
In cases involving younger dogs, severe or worsening symptoms, or additional neurological signs, a more thorough neurological evaluation may be necessary, with CT or MRI scans focusing on the brain and inner ear. Cerebrospinal fluid (CSF) sampling can check for inflammation or infections in the nervous system.

Treating Vestibular Syndrome (“Dog Vertigo”): Options and Approaches

Vestibular impairment can be caused by multiple possible conditions, so treatment depends on the underlying cause. In many cases, there isn’t a specific cure, and treatment focuses on managing symptoms until spontaneous recovery occurs.

- Antihistamines: Typically used for allergic reactions, these medications can also reduce vestibular symptoms, namely nausea.
- Fluids: Given to dogs unable to eat or drink, or those who are vomiting due to dizziness.
- Anti-nausea and anti-vomiting medications: To address these common symptoms.
- Pain and fever relief: In cases where inflammation or infection causes pain or fever.
- Sedatives: For anxious dogs struggling with symptoms like movement difficulty or dizziness.
- Antibiotics: To treat ear canal or nervous system infections, sometimes requiring long-term treatment over weeks or months.
- Hormonal supplements: Thyroid hormone supplementation for hypothyroidism.
- Blood thinners: For cases of vascular damage (stroke).
- Steroids: For swelling in the ear canal, nerve tissue, or for autoimmune conditions. Please note that they should only be given when there’s a clear indication and no significant infection.

Surgical procedures:

- Ear-related: Removing tumors from the ear canal, removing severely and chronically inflamed ear canals, or draining fluid in the middle ear.
- Brain-related: Removing tumors from the cerebellum or brainstem.

Vestibular Syndrome (“Dog Vertigo”): Surprising Facts

A comprehensive U.K. study found that nearly 0.1% of dogs (1 in 1,000) experience vestibular impairment each year.

Idiopathic vestibular syndrome was given the somewhat offensive nickname “old dog vestibular syndrome” for a reason, as the average age of affected dogs is 12-13 years. Luckily, the condition typically resolves quickly, with around 50% of dogs recovering within 5 days and only 10% suffering from mild symptoms a month later.

Stroke, a familiar term associated with these symptoms, is unfortunately a leading cause of death for humans worldwide (ranked third globally). However, in dogs, strokes are extremely rare and are usually not the cause of vestibular symptoms.

Vet's Tip: Dealing with Vestibular Syndrome (“Dog Vertigo”)

This condition can be extremely alarming for pet owners, as symptoms like dizziness, stumbling, and vomiting make it seem like the worst is about to happen, especially with older dogs. In the past, this condition was frequently misinterpreted as terminal issues like brain tumors or severe strokes, leading to unnecessary euthanasia.

Nowadays, we know that in most cases, particularly in senior dogs, the condition resolves on its own in a matter of days or weeks. While the symptoms are indeed alarming, it’s important to remember that they’re often reversible. That’s why your vet may appear less worried. They understand that most dogs recover fully and quickly with the proper treatment.

Price Tag

Veterinary consultation

$60-$180

Comprehensive blood work

$200-$600

Advanced imaging (CT/MRI)

$1,000-$4,000

Supportive oral medication

$20-$50 per month

Latest in Research and Treatments

Humans suffering from vertigo caused by inner ear problems often turn to physiotherapy manipulations that help move inner ear fluids, providing significant and rapid relief. Studies show that these methods can be relevant to dogs as well. Further research can make these treatments available to dogs, especially in the common idiopathic cases.