Vestibular Disease

Dizziness or being unsteady on your feet can be one of the most unsettling sensations. Anyone who has been on a boat in rough water or has spun around in a circle too fast can attest to this. But there is a medical condition that can also create this feeling, and when it happens, it can be very unpleasant, especially if we do not expect it or know why it is happening.

Many people have likely had the misfortune of experiencing vertigo, the sensation of spinning. Vertigo is a symptom of a vestibular disorder and it can occur in many animals in addition to humans, including our pets and livestock.

The vestibular center is located in the inner ear and sends information from the middle ear to the cerebellum and brain stem. It is responsible for maintaining our balance and orientation. It’s how we know if we are upside-down, how we can correct ourselves if we are falling or walking on uneven ground, and allows our eyes to follow objects without becoming dizzy.

If this area is compromised, you could become uncoordinated and even nauseated, and it’s no different for our pets. They may look like they are falling down drunk or may even roll over on the ground. They often have their head tilted to one side and their eyes may dart back and forth (this is known as nystagmus). They may vomit as well. In mild cases, it may just feel like the room is spinning, but in more severe cases, they literally cannot tell which way is up.

There are several reasons that the vestibular system can be affected and they are typically divided into two main categories – central lesions (in the brain) and peripheral lesions (in the ear). Central lesions include tumors, infections such as Rocky Mountain Spotted Fever in dogs or Toxoplasmosis in cats, trauma, toxins, and in very rare cases, vascular accidents. Peripheral causes include middle ear infections and polyps or tumors in the ear canal, but the most common cause of vestibular issues in our dogs and cats is actually idiopathic (meaning, we cannot identify a cause). Rabbits are more likely to have vestibular problems due to ear infections or a parasitic infection from E. cuniculi.

In order to try to determine the cause and confirm it is indeed a vestibular issue (and not a seizure or heart condition), a physical exam and medical history are indicated. The exam includes an otoscopic exam and a neurologic exam and can often determine if the problem is central or peripheral. If an exam cannot make this determination, imaging such as CT or MRI is indicated.

Treatment, of course, depends on the cause. If there is an infection, antibiotics or antiparasitics can be indicated. If there is a growth, removal is considered. Thankfully, if the problem is idiopathic, it will typically resolve without treatment. Most dogs improve within 2-3 days and are normal within 2 weeks. Cats can take a bit longer (2-3 weeks) but also tend to resolve without treatment. Supportive care such as fluids and antinausea medication are given if the pet is not eating/drinking or if they are vomiting. They must be kept in a safe environment away from any stairs or sharp surfaces they could fall on to. Sometimes, a head tilt can remain, but this does not impact their health or quality of life.

While seeing your pet have a vestibular episode can be terrifying, many times it is self limiting or treatable. However, because there are scarier causes out there, it is very important to have your pet evaluated as soon as possible.