Head Tilt in Dogs

Head tilting is more of a symptom than a condition and can indicate many different illnesses, some of them life threatening. If you notice that your dog is tilting his head to one side (either side), you should watch for other symptoms such as:

Peripheral Vestibular Disease

• Circling, leaning
• Eyeball moving around or up and down rapidly
• Not being able to focus
• Unusual clumsiness (falls, stumbles, lack of coordination)
• Vomiting
• Nausea
• Loss of appetite

Central Vestibular Disease

• Abnormal eye movements (jerking side to side, up and down, or around)
• Weakness of the body
• Rolling around on the ground
• Strange behavior
• Head tremors
• Depression
• Facial paralysis

Types

There are two types of vestibular disease, but peripheral vestibular disease is the most common in dogs.

• Peripheral vestibular disease is caused by a condition in the middle or inner ear such as ear infection, perforated eardrum, and ear mites
• Central vestibular disease is due to a disturbance in the brain such as inflammation, infection, tumors, cancer, or head trauma

The cause of either vestibular disease is idiopathic (unknown), but veterinary professionals believe it may be due to one of these causes:

Peripheral Vestibular Disease

• Middle or inner ear infection
• Reactions from certain antibiotics such as metronidazole
• Head trauma
• Hypothyroidism

Central Vestibular Disease

• Infections
• Tumor
• Inflammatory disease such as encephalitis or granulomatous meningoencephalitis (most common in Maltese and Yorkshire Terrier)
• Hyperadrenocorticism
• Metronidazole toxicity

To diagnose your dog, the veterinarian will need to perform a physical examination and conduct several diagnostic and laboratory tests. Some of the most important tests include a head x-ray, CT scans, MRI, spinal fluid analysis, urine and blood tests. One of the specialized tests for diagnosing vestibular disease is an otoscope examination. This is done by sedating your dog while the veterinarian uses a magnifying tool called an otoscope to look at the eardrum and the ossicles in the middle ear.

Also, a myringotomy may be done if the veterinarian thinks it is needed. This is done by making a tiny incision in the eardrum to collect a sample of fluid from the inner ear for a culture. If an inner ear problem is ruled out, the veterinarian will most likely suspect that your dog has central vestibular disease. The veterinarian may take a sample of spinal fluid to analyze as well.

Initial treatment of nausea and vomiting can be treated with motion sickness medication. There is no cure for vestibular disease except to treat the condition that is causing the condition. These treatments depend on which type of vestibular disease your dog has and what is causing it.

Ear Infection

Antibiotic or antifungal cream or ear drops will be used and a steroid injection to relieve the swelling and pain. It usually takes about four to six weeks to heal.

Tumor

If the tumor is benign (not cancerous), the veterinarian may just remove it to fix the problem. However, if the tumor is malignant (cancerous), other treatments like radiation and chemotherapy have to be done after removal.

Hyperadrenocorticism

To treat hyperadrenocorticism, there are several choices, which are medical, surgical, and radiation. It depends on the cause and severity of the condition.

Metronidazole Toxicity

The effects of metronidazole toxicity should go away within one to two weeks after stopping the medication.

Brain Infections

Infections of the brain such as toxoplasmosis and encephalitis, will be treated by intravenous (IV) antibiotics or antifungals. Your dog will likely be kept overnight for observation.