Vestibular disease in dogs

Recognise the signs

• Sudden, dramatic onset — fine one moment, severely affected the next
• Head tilt — consistent tilt to one side
• Loss of balance — stumbling, falling, rolling to one side
• Inability to stand or walk in a straight line
• Nystagmus — rapid involuntary flickering or jerking of the eyes (horizontal, vertical, or rotary)
• Nausea — lip licking, retching, vomiting
• Extreme distress in some dogs from the disorienting sensation
• Refusing to eat or drink
• Some dogs show positional discomfort and cry when moved
• In ear infection cases: scratching at the ear, head shaking, or ear discharge may precede or accompany vestibular signs

First aid steps

1. 1. Stay calm — your dog needs your calm presence. Despite looking terrifying, vestibular disease is usually not life-threatening.
2. 2. Keep your dog away from stairs, swimming pools, decking, and any fall hazards immediately.
3. 3. Create a safe, confined, comfortable space — a padded area on the floor with no obstacles.
4. 4. Do not put your dog in a bath or try to wash them — they cannot balance and could drown.
5. 5. Phone your vet and describe the symptoms — they will advise whether to come in urgently or as an emergency. Most will want to see the dog today.
6. 6. Do not leave your dog unattended on a raised surface (sofa, bed) as they may fall and injure themselves.
7. 7. If your dog is vomiting frequently, gently clear the mouth area and keep the airway clear. Avoid giving food or water until the acute vomiting phase passes.
8. 8. You may need to support your dog to help them eat, drink, and go to the toilet — use a towel sling under the belly for support if needed.
9. 9. Video the symptoms on your phone if possible — the type and direction of nystagmus helps the vet with diagnosis.
10. 10. Reassure your dog with gentle, calm voice and stroking — it is frightened and disoriented.

While transporting to the vet

• Use a padded crate or box lined with towels to prevent rolling and injury during the journey.
• Keep the journey as smooth as possible — sharp corners and sudden stops worsen nausea.
• Have someone sit with the dog in the back if possible, offering calm reassurance.
• Phone ahead so the vet can prepare a suitable waiting area — a dog that cannot stand should not be left in a busy waiting room.
• If alone, use a carry crate rather than allowing the dog to move freely in the car.

When it can usually wait

• Known previously diagnosed idiopathic vestibular disease showing the same pattern as before, with mild signs only, and the dog is comfortable — discuss with your vet
• Very mild intermittent wobbliness in an older dog with no nystagmus or head tilt — warrants a check-up but not an emergency

Common causes

• Idiopathic vestibular disease ('old dog vestibular syndrome') — most common, cause unknown
• Otitis media/interna (middle or inner ear infection — most common treatable cause)
• Hypothyroidism (underactive thyroid affecting vestibular function)
• Brainstem or cerebellar tumour
• Ischaemic stroke (cerebrovascular accident)
• Haemorrhagic stroke
• Toxin exposure (metronidazole toxicity, certain other drugs)
• Head trauma
• Nasopharyngeal polyp (less common)

What the vet will need to know

• What time did symptoms start, and how rapidly did they develop?
• Is the head tilt consistent or does it change sides?
• Direction and type of eye movement (nystagmus) if you can observe it
• Any ear problems — scratching, shaking head, smell, or discharge recently?
• Any medication changes recently (particularly metronidazole)?
• Any known toxin exposure or head injury?
• Any limb weakness or paralysis in addition to balance problems?
• Dog's age, breed, and any previous similar episodes
• Any recent changes in appetite, thirst, or behaviour prior to this event?

Aftercare

• Administer any anti-nausea medication (maropitant — Cerenia) as prescribed by the vet for the first 3–5 days.
• Assist the dog with eating and drinking — elevated bowls may help; hand-feeding small amounts frequently is often better tolerated than large meals.
• Use a rolled towel or purchased mobility harness to support the dog during toilet trips.
• Protect the dog from stairs, slippery floors (use non-slip mats), and drop hazards at all times during recovery.
• Encourage gentle movement as tolerated — some mobility aids vestibular compensation.
• Most dogs show dramatic improvement in the first 72 hours; full recovery typically occurs in 2–4 weeks.
• A residual mild head tilt often remains permanently — this is cosmetic only and does not affect quality of life.
• Attend follow-up appointments — if a treatable cause (ear infection, hypothyroidism) was identified, ensure treatment is completed and effective.

Prevention

• Idiopathic vestibular disease cannot be reliably prevented.
• Manage and treat ear infections promptly to prevent progression to inner ear involvement.
• Annual thyroid screening in older dogs, especially those showing non-specific signs of slowing down.
• Avoid unapproved doses of metronidazole (Flagyl) — metronidazole toxicity causes vestibular signs.
• Annual senior health checks from age 7–8 to detect conditions that could contribute to vestibular episodes.

Breed-specific notes

• German Shepherds: higher incidence of idiopathic vestibular disease reported.
• Dobermanns: increased risk of cerebellar abnormalities which can mimic vestibular disease.
• Bulldogs and Cocker Spaniels: prone to ear disease which can progress to inner ear involvement.
• Rough Collies: congenital vestibular disorders reported in the breed.
• Large and giant breeds: higher risk of neurological conditions including brain tumours in older dogs.

Frequently asked questions