I don’t often get to inform my clients of good news. As some of you may already be aware, my veterinary practice primarily deals with issues related to end-of-life care, primarily hospice and in-home euthanasia. Therefore, I get very excited when I see a consultation appointment set up for an older dog whose owner is describing a head tilt, difficulty walking, and “moving funny” eyes.
Why? Because these are signs of a condition that appears extremely serious—owners frequently mistake it for a stroke—but usually goes away on its own with little to no treatment. Idiopathic vestibular disease is very common, but veterinarians are unsure of what exactly causes it (“idiopathic” means arising from an unknown cause, or the pathologist is a fool, as one of my professors said in veterinary school).
The vestibular system, which is made up of parts of the brain and ear, is in charge of preserving our sense of balance. The world appears to be spinning when the vestibular system is compromised.
These clinical signs are not unique to idiopathic vestibular disease. A thorough physical examination is required because a dog’s vestibular system can be adversely impacted by infections, tumors, inflammatory diseases, and other conditions. But idiopathic vestibular disease is typically to blame when symptoms in an older dog seem to develop out of nowhere and then start to get better over the course of a few days to weeks.
When I have a suspicion that one of my patients has idiopathic vestibular disease, I typically advise a wait-and-see strategy and symptomatic treatment. For instance, owners must keep the dog safe from falls, assist with his urination and feces outside, and provide hand feeding and watering if necessary.
Sometimes I’ll prescribe anti-nausea pet meds. Additional diagnostic testing is not required if the dog begins to improve within a few days and is essentially back to normal within a few weeks. If that is not the case (i. e. the dog’s vestibular disease symptoms are not subsiding) or if the idiopathic vestibular disease is not fully supported by the initial physical examination, blood work, X-rays, CT scans, MRIs, and other tests may be required to make a conclusive diagnosis.
Most dogs with idiopathic vestibular disease recover fully. Others have mild but persistent neurologic deficits (e. g. When they shake their heads, they have a slight head tilt or wobble, but these are rarely severe enough to negatively impact their quality of life. As they age, dogs can experience multiple episodes of idiopathic vestibular disease, but since the symptoms are familiar to their owners, they typically don’t become alarmed the second or third time.
Idiopathic vestibular disease isn’t always benign. There have been a few instances where we’ve had to put dogs to sleep because they were severely injured and couldn’t fully recover, but these are the exception rather than the rule. Take heart, then, if your dog has been identified as having idiopathic vestibular disease. There is every reason to be hopeful.
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Keeping old dogs with vestibular disease away from other pets and children
You don’t have to be concerned that they will infect humans or pets because this disease is not contagious. Concerns exist regarding the possibility that they might harm family members or pets.
They may nip or bite if they are agitated and anxious. They might also strike a child or a small pet. Children and pets who are unaware that the dog is unable to play normally or defend itself in the same way as before risk injuring the animal.
It may be beneficial for them to spend time with their family in a manner as normal as you can manage; just make sure you or another responsible adult is present at all times to ensure that nothing gets out of hand.
It doesn’t necessarily mean that everyone in your home with the same symptoms—be they pets or family members—has contracted it from someone else. It simply means that numerous people and animals living in the house have inner ear issues. If an allergen or a change in barometric pressure is aggravating the condition, you are likely to all experience episodes at the same time. It’s also possible that all those affected were exposed to a toxin.
Any dog that has experienced vestibular disease symptoms before is likely to do so once more. Older dogs are more likely to have recurrences. Though it doesn’t have to be, don’t be shocked if your dog fully recovers only to have another episode that might even be worse than the one before.
Simply put, this just means that under certain circumstances, the inner ear is still vulnerable to developing this issue. It is still advisable to take them to the veterinarian to rule out any new causes or other possible similar causes, but vestibular disease is likely rearing its ugly head once more. We don’t know how frequently or severely the recurrences will occur because there are too many variables. Just take what you can from each experience to better your dog’s care.
Idiopathic vestibular syndrome (IVS), to our knowledge the most prevalent condition describing this condition, was the most frequent cause of peripheral vestibular disease in dogs in our study. The only prior study [9] describing a population similar to this one found otitis media/interna to be the most common cause. Because advanced imaging techniques were not used in this study, it is likely that the results differed.
It has previously been mentioned that dogs with FVNUO can develop IVS-related clinical signs again [19]. Similar to this, 26 dogs (17 long-term follow-up in our population) had relapsed. 6%). No recurrence-related variables could be found in the current study, but this might be because there were so few instances of it. The underlying causes of acute vestibular syndrome in humans are typically divided into single or recurrent conditions. Relapse of vestibular neuritis is rare (1. 9%), whereas benign paroxysmal positional vertigo, Ménière’s disease, and vestibular migraine frequently recur, with respective prevalences of 30–50%, 47–79%, and up to 81% [31–33]. It appears likely that dogs with IVS may in fact have multiple underlying causes for these symptoms, which would account for the variety of presentations (mostly related to acute or chronic onset, progression or lack thereof of clinical signs, and concurrent facial nerve deficits or not), MRI findings (enhancement or lack thereof of cranial nerves VII and/or VIII), outcome, and recurrence of clinical signs, among other factors). The use of terms like IVS, peripheral vestibular syndrome, and FVNUO to refer to the same group of conditions raises the question of whether a review of the nomenclature currently in use is necessary. It is likely that these conditions are not just one single entity but rather a number of different conditions that share a common benign peripheral vestibular and/or facial dysfunction syndrome. To better understand the various pathologies and enhance the capacity to identify and diagnose each distinct condition, additional research into each subgroup is necessary. This will enable a better capacity to prognosticate the likelihood of resolution of the clinical signs and recurrence.
At the time of presentation, more than half of the dogs in the current study had facial nerve dysfunction. The internal acoustic meatus serves as the entry point for the facial and vestibulocochlear nerves, which are both protected by a common dural sheath. This shared pathway continues into the facial nerve canal’s proximal region, where the nerves are in close proximity [3]. This close proximity explains how a lesion affecting the vestibulocochlear nerve can cause facial paresis or paralysis (FP), and vice versa [1]. In the past, it was believed that a concurrent vestibular and facial nerve dysfunction was more often indicative of middle ear disease [9, 17], but in our study, about two thirds of dogs with PVD and FP were diagnosed with the idiopathic form of the disease and had no middle ear abnormalities. Dogs have been reported to have concurrent facial and vestibular neuropathy of unknown origin (FVNUO) in recent studies [18, 19]. The term “idiopathic syndrome” has historically been used to describe patients with peripheral vestibular dysfunction alone. However, recent research and cases diagnosed with FVNUO [18, 19] support the idea that many patients with no findings on diagnostic investigation who are given this diagnosis also have concurrent facial nerve dysfunction. A 69% albuminocytological dissociation in CSF in a study with 16 dogs with FVNUO suggested an underlying inflammatory process [19]. Surprisingly, in the current study’s cerebrospinal analysis of 79 dogs with suspected IVS, only 2 dogs had mild mixed pleocytosis, and 4 dogs had albuminocytological dissociation. 15% of human patients with acute facial neuropathy also report having dizziness [20] and Bell’s palsy, a peripheral-type facial nerve paralysis that is most frequently brought on by type 1 herpes simplex virus reactivation, also causes about one-third of patients to experience spontaneous nystagmus [21]. Herpes zoster oticus, a virus that commonly results in severe hearing loss and is not typically treated with corticosteroids or antiviral medications, is the most frequent cause of vestibular and concurrent facial nerve impairment in people [22].
The patients had to have undergone magnetic resonance imaging (MRI) of the brain and have all of the records that are available for review in order to be included in this study. The inclusion criteria also included a final diagnosis of peripheral vestibular disease. In order to diagnose peripheral vestibular dysfunction, one or more of the following clinical symptoms must be present: head tilt, nystagmus, positional strabismus, and vestibular ataxia (asymmetric leaning and falling). Dogs with concurrent Horner syndrome were still considered (i Since these abnormalities have been linked to PVD [6, 17], e miosis, enophthalmos, protrusion of the third eyelid, and/or ptosis) or facial nerve dysfunction may be present. Dogs were excluded if they displayed the previously listed clinical signs in addition to altered mental status, proprioceptive deficits, and/or additional cranial nerve deficits (except for cranial nerve VII) and were therefore diagnosed with suspected central vestibular dysfunction. Patients who were initially thought to have PVD but later discovered to have central vestibular system lesions on MRI were not included in the study.
Retrospective examination of the medical records of canines with peripheral vestibular disease who received a diagnosis at the two contributing facilities between January 2013 and June 2019 Breed, age, sex, the length and speed of the onset of the clinical signs, the results of the neurological examination, the results of the MRI, and the final diagnosis were among the information gathered. The local Ethics Committee, VREC274, gave its blessing to this study, and all participants provided written consent.
Recurrence or Persistence of Clinical Signs with Vestibular Disease
The recurrence or persistence of symptoms can be fairly common: a study of clinical signs and MRI findings in dogs with peripheral vestibular disease found that after a median follow-up time of 12 months:
In total, these neurological deficits persisted in 52% of dogs. The study included 188 dogs, with a median age of 6 years. 9 years.
Recurrence of vestibular disease was noted in 17. 6% of dogs in the first 12 months.
In our related article about dogs who don’t recover from vestibular disease, we go into more detail about the recurrence of vestibular disease in dogs:
FAQ
Why does my dog keep getting vestibular disease?
Infections of the middle or inner ear, toxic medications, trauma or injury, tumors, and hypothyroidism are some of the causes of vestibular disease. Idiopathic vestibular syndrome is the name given to the condition when no identifiable cause can be found.
How often does vestibular disease occur in dogs?
Dogs are relatively susceptible to vestibular dysfunction, with a prevalence of 0. 08% reported in primary veterinary care in the UK.
Do dogs always recover from vestibular disease?
Most dogs with idiopathic vestibular disease recover fully. Others have mild but persistent neurologic deficits (e. g. When they shake their heads, they have a slight head tilt or wobble, but these are rarely severe enough to negatively impact their quality of life.
Can vestibular problems come and go?
Vestibular neuritis usually improves after a few days. However, the symptoms can take about three weeks to subside. Additionally, you might experience periodic episodes of vertigo and wooziness for several months.