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Head Tilt in Dogs (Vestibular Signs)

By: Dr. John McDonnell

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Diagnosis In-depth

A head tilt is a symptom of a potentially serious medical condition. The cause of the head tilt should be investigated thoroughly by your veterinarian. Diagnostic tests are needed to determine the presence of an underlying disease or cause for the head tilt. Your veterinarian may investigate your pet's head with a variety of means, including a complete medical history. Be able to answer the following questions:

  • When did the symptoms first occur?
  • Was it a gradual onset or did your pet suddenly have the head tilt?
  • Has a similar episode occurred?
  • Does your pet have a disease that could be contributing to the symptom such as long-standing ear infections, hearing loss or deafness, or metabolic diseases such as heart disease or diabetes?
  • Is your pet on any medicines?
  • Is there any potential for exposure to toxic substances?

    Additional tests may include:

  • A complete physical examination including an otoscopic exam (looking into the ear canal) will help to determine if an ear infection could be causing the head tilt. The ear canal and tympanic membrane can be examined with an otoscope for ear wax accumulation, foreign bodies, infections or inflammation

  • Cultures of ear discharge may be taken to help determine the best antibiotic to use in cases of ear infections

  • A neurologic evaluation will be needed to determine if the head tilt and any other signs are due to peripheral vestibular disease or central vestibular disease. This evaluation will help guide your veterinarian to the appropriate tests needed to determine quickly what is causing the head tilt, and more importantly, what is the best treatment for the signs

  • Laboratory work such as a complete blood count, serum chemistry analysis, and urinalysis will help to detect other conditions your pet may have that can contribute to the disease. As anesthesia is needed for some of the more advanced tests, baseline laboratory work may be needed to assess your pet's health

  • Blood screening tests for endocrine dysfunction such as hypothyroidism

  • Measurement of blood pressure

    Tests listed below may require general anesthesia. In general, modern veterinary anesthesia is very safe and well tolerated by pets. However, animals with vestibular dysfunction may show worse signs after waking up from anesthesia. The more severe signs usually resolve over 48 to 96 hours.

  • Bulla radiograph series (X-rays of the skull) are needed to determine if there is significant disease in the middle ear as well as the inner ear. This test examines the normally fluid filled bulla or middle ear. Middle ear disease is the most common cause of head tilt and severe disease may need to be surgically treated. Anesthesia is required for diagnostic bulla radiograph series.

  • CT (computed tomography) scan or MRI (magnetic resonance imaging) of the head are more sensitive tests than bulla series for detecting middle ear disease. Although both CT and MRI tests can detect disease in the brain, MRI is more sensitive than CT. These tests require anesthesia and may require referral to a specialist.

  • Brainstem auditory evoked response (BAER) test may be needed to assess associated damage to hearing and the brainstem. Sound is transmitted to your pet's ears and the brainstem electrical responses are recorded on a special machine called an electrodiagnostic machine. These tests require specialized equipment, which may require referral to a specialist.

  • Cerebrospinal (spinal) tap is needed to determine if there is disease within the brain. This test allows examination of the cerebrospinal fluid (fluid that surrounds the brain and spinal cord). Abnormalities detected in the cerebrospinal fluid indicate severe disease that may require special medications. This test requires anesthesia and may require referral to a specialist.

    Therapy In-depth

    Your veterinarian may recommend one or more of the diagnostic tests described above. In the meantime, treatment of the symptoms might be needed, especially if the problem is severe. The following symptomatic treatments may be applicable to some but not all pets with vestibular signs. These treatments may reduce severity of symptoms or provide relief for your pet. However, nonspecific therapy is not a substitute for definitive treatment of the underlying disease responsible for your pet's condition.

  • If nausea is causing your pet to vomit or refuse food, your veterinarian may use intravenous or subcutaneous fluids to prevent dehydration.

  • Antiemetic drugs usually act on the area of the brain that is involved in the vomiting reflex. These medications may be given by injection if your pet is vomiting or refusing food.

  • Antivertigo medications can decrease the vestibular signs but should not be used long term.

  • If otitis is causing your pet's vestibular signs, your veterinarian may prescribe an oral and topical antibiotic based on clinical judgment while awaiting results of the culture and sensitivity.         

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