Few things unsettle pet parents more than seeing their dog suddenly lose balance—leaning or falling to one side and struggling to hold its head upright. Many pet parents rush to Google the symptoms and quickly find the term vestibular disease in dogs. But what does that actually mean, and is it as serious as it looks?
As veterinary neurologists, we see dogs with vestibular signs almost every day. The good news is that many of these dogs recover. The challenge is that not every case is the same. Understanding what’s really going on and acting quickly can make a meaningful difference in your dog’s prognosis. Here are seven things every pet parent should know about vestibular disease in dogs.
1. Vestibular disease in dogs isn't a disease—it's a symptom.
What Is Vestibular Disease in Dogs?
The term “vestibular disease” can be misleading because it doesn’t refer to a single illness. Instead, it describes a group of symptoms caused by problems affecting the body’s balance system.
The balance system, or vestibular system, has two main parts:
- The peripheral vestibular system includes the inner ear and the nerves that send balance signals to the brain.
- The central vestibular system includes the brainstem and cerebellum, which coordinate movement.
Problems affecting the central vestibular system are generally more serious than those in the peripheral vestibular system.
What are signs of vestibular disease in dogs?
When the vestibular system is disrupted, dogs may suddenly:
- Lean, fall, or roll to one side
- Hold their heads in a constant tilt
- Show rapid abnormal eye movements, or nystagmus
- Become nauseated or vomit
Saying a dog has vestibular disease simply means that something is disrupting these balance pathways—it doesn’t tell us where the problem is or what is causing it. Determining whether the issue is peripheral or central is key to guiding treatment and understanding the likely outcome.
2. Eye movement patterns help pinpoint the cause of vestibular disease in dogs.
What is nystagmus?
Nystagmus is rapid, involuntary eye movement and is one of the most telling symptoms of vestibular disease in dogs. Its direction provides valuable information about the cause.
- Horizontal or rotary nystagmus are commonly seen with peripheral problems, but can also occur with central disease.
- Vertical nystagmus, positional nystagmus triggered by changing head or body positions, or nystagmus that changes direction often signal a central (brain-based) problem.
These patterns might look like small quirks to the untrained eye, but they provide critical information. Combined with other neurological findings, they help veterinarians prioritize likely causes.
3. A normal ear exam doesn't rule out an ear problem.
This is one of the most misunderstood aspects of vestibular disease in dogs. Even when your veterinarian looks in your dog’s ear and says it appears clean, there could still be a problem deeper inside.
The middle and inner ear, where the vestibular structures live, aren’t visible with a simple otoscope. An ear canal can look clean while deeper structures are affected by:
- Middle or inner ear infections
- Polyps or tumors
- Chronic inflammation
- Trauma
These hidden problems can cause severe balance problems while leaving the visible ear canal looking perfectly normal. That’s why advanced imaging, such as MRI, is sometimes the only way to find the true source of the issue.
4. Imaging can reveal what clinical exams can't.
How is vestibular disease in dogs diagnosed?
Because vestibular disease can stem from many causes, advanced imaging is often recommended. MRI allows neurologists to see details of the brain and inner ear that no physical exam can reveal.
What causes vestibular disease in dogs?
Vestibular signs can arise from problems in the inner ear (peripheral vestibular disease) or within the brain itself (central vestibular disease).
Peripheral causes are usually less serious and resolve with treatment or even natural compensation:
- Middle or inner ear infections
- Inner ear tumors
- Hypothyroidism
- Ear Trauma
- Idiopathic vestibular syndrome (no known cause)
Central causes are more serious and usually require specialized treatment:
- Strokes
- Brain tumors
- Brain inflammation or infection
- Bleeding in the brain
- Severe ear infections
Why is MRI so important for diagnosing vestibular disease in dogs?
MRI doesn’t just reveal which underlying cause is responsible, but also how serious it is. Knowing the exact cause and severity allows veterinarians to choose the most appropriate therapy and provide a more accurate prognosis.
Neurologists don’t call a case “idiopathic” until more serious causes have been ruled out, ensuring that your dog isn’t sent home with a “wait and see” plan when there’s actually a treatable—or dangerous—condition.
5. Some dogs have both ear and brain involvement.
In certain cases, the problem isn’t just in one spot. A severe or chronic ear infection can erode bone and extend into the brain, leading to both peripheral and central vestibular disease at the same time.
These complex cases can cause additional symptoms such as:
- Mentation changes
- Uneven pupils
- Severe pain
Treatment might include ear surgery to remove infected tissue, long-term antibiotics, and medications to control inflammation in the brain. Recovery can take weeks to months, but many dogs do well once the infection is fully resolved.
6. Many cases of vestibular disease in dogs improve on their own.
What is idiopathic vestibular syndrome or "old dog vestibular disease"?
One of the most common and fortunately least serious types of vestibular disease in dogs is canine idiopathic vestibular syndrome, also known as “old dog vestibular disease.” This condition tends to affect senior dogs suddenly, often overnight, with a dramatic head tilt and staggering walk.
Despite the severity of the onset, many dogs begin improving within three days, even without specific treatment. The improvement over time is actually one of the biggest clues that it’s idiopathic.
Supportive care is still important: anti-nausea medication, good hydration, and safe, padded rest areas can help your dog feel better while the body’s natural compensation process takes over. Most dogs recover fully within two to three weeks, although a small head tilt may persist.
Is it safe to assume an older dog has "old dog vestibular disease?"
It’s important not to assume that vestibular disease in older dogs is always idiopathic. There are a lot of other conditions affecting older dogs that can cause vestibular symptoms, and idiopathic vestibular disease is a diagnosis of exclusion, meaning it can only be confirmed after ruling out more serious conditions.
7. Recurrence of vestibular disease in dogs isn't normal.
True idiopathic vestibular disease usually only happens once. If your dog experiences repeated episodes, it’s a sign that something else may be at play.
What does recurrent vestibular disease in dogs suggest?
Recurrent or progressive symptoms raise concern for conditions such as:
- Chronic ear infections
- Inflammatory brain disease
- Vestibular nerve tumors
- Cerebellar or brainstem strokes
Any recurrence warrants evaluation by a veterinary neurologist.
What should pet parents know about vestibular disease in dogs?
For most dogs, especially those with idiopathic or peripheral causes, the prognosis is excellent. Central (brain-based) causes can carry a more guarded outlook, but early diagnosis and treatment make a meaningful difference.
The key takeaway? While the sudden onset of vestibular signs can be frightening, many dogs recover when they receive an accurate diagnosis and proper treatment. If your dog is showing any signs of vestibular disease, contacting Southeast Veterinary Neurology (SEVN) ensures a thorough evaluation, proper diagnosis, and the best possible treatment plan for your pet. Reach out right now to one of our Florida hospitals in Miami, Boynton Beach, and Jupiter, or to our Virginia Beach, VA location!
FAQ for Pet Parents
Can vestibular disease in dogs go away on its own?
Yes, especially with the idiopathic form, which is most common.
Is vestibular disease painful for dogs?
No. While it’s disorienting, it’s not typically painful.
Can vestibular disease in dogs come back?
Recurrence is uncommon, but can happen depending on the cause. Always have your dog rechecked if signs return.
Is vestibular disease in dogs the same as a stroke?
While strokes can cause vestibular symptoms depending on the area of the brain affected, vestibular symptoms can be secondary to many other causes apart from stroke.