The vestibular system maintains normal balance and contains central components in the brain, as well as peripheral components in the inner and middle ear, stated Malcolm Weir, DVM, MSc, MPH and Ernest Ward, DVM, of VCA, an operator of over 1,000 animal hospitals in the US and Canada.
Vestibular disease occurs due to a “sudden, non-progressive disturbance of balance.” This condition is more common in older dogs, hence it is also called “old dog vestibular syndrome” and “canine idiopathic vestibular syndrome.” In neurological Vestibular disease is one of the most common and most challenging presentations in veterinary neurology, explained Fitz Patrick Referrals, which was founded by Professor Noel Fitzpatrick in 2005.
Clinical Signs, MRI Findings, and Outcomes In Dogs With Peripheral Vestibular Disease (May 2020)
Rocio Orlandi and colleagues of BMC Veterinary Research, an open-access, peer-reviewed journal, found that Cavalier King Charles spaniel (20%), Boxer (12%), Cocker spaniel (11%), Labrador (6%), French bulldog (5%) and English springer spaniel (4%) were the breeds that were most affected by peripheral vestibular disease. 85.1% of dogs had an acute onset of clinical signs. Previous episodes of vestibular dysfunction were observed in 12.7% of dogs. All of the dogs had acute-onset symptoms.
73.4% of canines were non-progressive and 123 of them showed an acute onset of vestibular signs. Some of the clinical signs included head tilt (98.4%), ataxia (65.4%), facial paralysis (54.7%), nystagmus (51.6%), and position strabismus (49.5%). Of those with facial paralysis, 12.2% were bilaterally affected while Horner syndrome was found in 3.7%.
45.2% of dogs had no abnormalities after magnetic imaging was performed in all patients. The most common abnormalities were facial and/or vestibulocochlear nerve enhancement after contrast administration (40.4% of dogs). These affected the facial nerve in 49 dogs, the vestibulocochlear nerve only in 10 dogs, and both nerves simultaneously in 49 canines. 63.3% of dogs were assessed for thyroid function, which was consistent with hypothyroidism in seven dogs (3.7%). Two patients had contrast enhancement of the facial nerve on MRI. Cerebrospinal fluid analysis was performed in 53.7% of dogs and was reported to be abnormal in 17 patients.
The most common final diagnosis with idiopathic vestibular syndrome (IVS), which was observed in 128 patients. 26% were diagnosed with otitis media and/or interna while others were diagnosed with hypothyroidism (4%), congenital vestibular disease (1%), neoplasia (malignant peripheral nerve sheath tumor of the facial nerve; one dog= 0.5%), and cholesteatoma (one dog= 0.5%). Outcome data was available in 148 patients (78.7%) and the median follow-up time was 12 months. 52% of dogs (77/148) showed persistence of neurological deficits such as head tilt (34.5%), facial paresis (28.5%), and ataxia (4.1%). 17.6% had a recurrence of the clinical signs at least once over the following 12 months.
How Do I Know If My Dog Has Vestibular Disease?
Signs can include loss of balance, disorientation, head tilt, and irregular jerking eye movements or nystagmus. Many, but not all dogs, will be hesitant or unable to stand or walk and depending on the severity and localization of the condition. Standing or walking may be a struggle for your dog, which can be distressing for the both of you. Most dogs with vestibular disease will lean or fall in the direction of their head tilt. When your dog’s vestibular system is damaged, it can lead in some, but not all, of the signs: asymmetric ataxia or drunken gait, abnormal posture such as leaning or head tilt, circling or deviating, wide-based stance, and vomiting due to motion sickness.
Why Does My Dog Have Vestibular Disease?
Causes include middle or inner infections, drugs that are toxic to the ear, hypothyroidism, trauma or injury, and tumors. If the specific cause is unknown, it will be called idiopathic vestibular syndrome. Your dog can have vestibular disease due to aging.
How Will the Veterinarian Diagnose and Treat Vestibular Disease?
Diagnosis involves knowing your dog’s medical history, clinical signs, and the results of blood and urine tests. Some cases might involve other diagnostic testing methods like blood pressure measurement or radiographs of the head to evaluate the condition of the middle and inner ears and the tympanic bullae. MRI or computed tomography (CT) scans are helpful in looking for tumors or other abnormalities, at least on some occasions. Undergoing MRI scanning will require your dog to remain completely still, which is only possible with general anesthesia. For CT scans, your dog may need to be sedated to “achieve optimal stillness and positioning.”
Brainstem auditory evoked response (BAER) may also be done in some dogs. Overall, the criteria for diagnosis are: your dog is older, has a sudden onset of peripheral vestibular signs, has no detectable cause (i.e. no signs of trauma, etc.), exhibits signs that resolve over several weeks. Treatment will address the underlying cause of the condition, if it can be identified. In severe cases, supportive therapy like intravenous fluids and hospitalization may be needed until your dog can eat and walk by itself. If your dog has ataxia, sedatives may be administered to help it relax. Drugs that address nausea or motion sickness may also be helpful in treating vestibular disease.
If your dog is suspected to have middle or inner ear infections, antibiotics may be prescribed to treat it. In the past, corticosteroids have been used to aid in vestibular disease treatment, there is little scientific evidence to support their use. Generally speaking, corticosteroids are not recommended. Physiotherapy aids in the recovery of dogs with vestibular disease as inactivity and recumbency results in decreased joint movement, stiffness, and muscle weakness and contracture. These factors hinder your dog from completely recovering from vestibular disease.
How Do I Nurse My Dog?
Keep your dog safe by letting it stay on a small padded area to prevent them from walking into things, fall over, or injure themselves, advised PDSA, the UK’s leading vet charity. Ensure that your pet eats and drinks regularly. For the few days of recovery, you may have to hand-feed your dog. Further, you will need to help your dog to go the potty by carrying or supporting them while it walks. If you own a large dog, you will need another person to assist it.
Older dogs are more likely to have vestibular disease, so owners need to watch out for ataxia, loss of balance, or nausea. Nursing your dog involves helping it relieve itself and letting it stay in a padded area to prevent injuries. If vestibular disease escalates, owners may consult a veterinary neurologist for treatment and diagnosis.