Dizziness or vestibular disease in dogs and cats
What is the vestibular system?
The vestibular system controls balance, posture and coordinated eye movement. It includes structures within the inner ear, the nerve connecting the ear to the brain, and areas of the brainstem and cerebellum.
When this system is disrupted, the brain receives incorrect information about the body’s position. Affected pets may feel as though the room is spinning, similar to severe vertigo in people.
What signs might I see?
• A sudden head tilt
• Wobbliness, stumbling, circling, falling or rolling to one side
• Rapid, repetitive eye movements called nystagmus
• Nausea, drooling, reduced appetite or vomiting
• Reluctance or inability to stand and walk
• Loss of balance that appears worse when the pet moves
• Facial droop, reduced blinking or difficulty keeping the tongue in the mouth in some cases
Vestibular disease is often mistaken for a stroke. A stroke is possible in dogs and cats, but it is only one of several causes and it may not be the most common explanation.
Peripheral and central vestibular disease
Veterinarians first determine whether the problem is peripheral, involving the inner ear or vestibular nerve, or central, involving the brain. This distinction is important because the likely causes, tests and prognosis differ.
• Peripheral causes include idiopathic vestibular disease, middle or inner ear infection, inflammation, trauma, certain medications or toxins, and less commonly tumours.
• Central causes include inflammation or infection within the brain, stroke, cancer, trauma and other neurological disease. Altered awareness, marked weakness, abnormal limb positioning, seizures, or other widespread neurological abnormalities increase concern for central disease.
What is idiopathic vestibular disease?
Idiopathic vestibular disease means that no underlying cause is identified. It is common in older dogs and can also occur in cats. Signs usually begin suddenly and may be severe, even though the condition itself is often self-limiting.
Many affected pets begin to improve within 48-72 hours and continue recovering over one to two weeks. Some take longer, and a mild head tilt or occasional unsteadiness may remain.
Idiopathic vestibular disease is a diagnosis made after considering the history, neurological examination and expected pattern of recovery. It should not be assumed solely because a pet is older.
How is vestibular disease diagnosed?
Your veterinarian will perform a full physical and neurological examination, including assessment of eye movements, balance, limb responses, facial function and the ears.
Depending on the findings, recommended tests may include:
• Blood and urine tests to identify metabolic illness or other contributing disease
• Ear examination and sampling when infection is suspected
• Blood pressure measurement
• Imaging of the middle and inner ears
• CT or MRI of the ears and brain when central disease, cancer or a deep ear problem is suspected
• Testing of cerebrospinal fluid in selected neurological cases
If signs are typical of idiopathic peripheral vestibular disease and the patient is otherwise well, supportive care and close monitoring may be reasonable before advanced imaging. Failure to improve as expected should prompt reassessment.
How is it treated?
Treatment depends on the underlying cause. Idiopathic vestibular disease has no specific cure and is managed with supportive care while the nervous system compensates.
• Anti-nausea medication for motion sickness, vomiting and reduced appetite
• Intravenous fluids or hospitalisation if the pet cannot safely eat, drink, stand or toilet
• Assistance with walking, positioning and nursing care to prevent falls, pressure sores and urine scald
• Eye lubrication if blinking is reduced
• Antibiotics or other targeted treatment when middle or inner ear infection is confirmed or strongly suspected
• Specific treatment for inflammatory disease, stroke, toxins or tumours when identified
Repositioning manoeuvres used for benign positional vertigo in people have only limited veterinary evidence and are not routine treatment for most dogs or cats with vestibular disease.
Helping your pet at home
• Keep your pet indoors in a quiet, well-lit, confined area.
• Block access to stairs, pools and furniture, and cover slippery floors.
• Use a harness or towel sling to provide support during short toilet trips.
• Keep food and water within easy reach and use non-slip bowls.
• Offer small meals only when your pet is alert and able to swallow safely.
• Turn and reposition a pet that cannot move independently, following your veterinary team’s instructions.
• Give all medications exactly as directed and monitor for improvement each day.
Seek urgent veterinary care if:
• Your pet is difficult to wake, collapses or develops seizures
• Breathing becomes difficult or repeated vomiting prevents hydration
• Your pet cannot swallow safely, repeatedly coughs or appears to inhale food or water
• Weakness develops rather than loss of balance alone, or the limbs seem unable to support weight
• Signs continue to worsen, new neurological signs appear, or there is no improvement within the timeframe advised
• Your pet becomes painful, develops ear discharge or has a history of toxin exposure or recent trauma
What is the outlook?
The outlook depends on the cause. Idiopathic peripheral vestibular disease usually has a good prognosis, despite its dramatic appearance. Ear infections often improve with appropriate treatment, although recovery can be prolonged.
Central vestibular disease has a more variable prognosis because it may be caused by inflammation, stroke or cancer. Your veterinarian will discuss the most likely diagnosis, whether referral or advanced imaging is recommended, and what recovery may look like for your pet.
Clinically reviewed and approved by Dr Giulia Agostini, Pet Emergency Senior Veterinarian and Clinical Manager, DVM MANZCVS (ECC) August 2026