What could be causing a dog's symptoms of drifting to one side, difficulty balancing, and anorexia, and what treatment options are available?

Vestibular Disease: Immediate Veterinary Evaluation Required

Your dog is exhibiting classic signs of vestibular dysfunction—a disorder affecting the balance system—and requires immediate veterinary assessment to differentiate between peripheral (typically benign) and central (potentially life-threatening) causes.

Clinical Presentation Analysis

The triad of symptoms you describe—drifting to one side, difficulty balancing, and anorexia—represents the hallmark presentation of vestibular disease in dogs:

• Head tilt and circling (drifting to one side) indicate abnormal vestibular function, with the animal typically tilting and circling toward the side of the lesion 1
• Ataxia (difficulty balancing) occurs in approximately 65% of dogs with peripheral vestibular disease 1
• Anorexia commonly accompanies vestibular dysfunction due to severe nausea from vertigo 2

Additional signs to assess include nystagmus (abnormal eye movements), positional strabismus (abnormal eye position when head is moved), and facial nerve paralysis, which occurs in approximately 55% of cases 1.

Most Likely Diagnosis by Age

Idiopathic vestibular syndrome (IVS) is the most common cause of peripheral vestibular dysfunction, accounting for 68% of cases in one large study 1:

• Geriatric dogs are most commonly affected by idiopathic vestibular disease 2
• Younger dogs are more likely to have otitis media/interna as the underlying cause 1
• Increasing age is associated with higher likelihood of idiopathic vestibular syndrome rather than infectious causes (odds ratio 0.866) 1

Critical Differential Diagnoses to Rule Out

Your veterinarian must distinguish between peripheral and central vestibular disease, as central causes carry significantly worse prognosis:

Peripheral causes (better prognosis):

• Idiopathic vestibular syndrome (most common) 1, 2
• Otitis media/interna (second most common, 26% of cases) 1
• Hypothyroidism (4% of cases) 1

Central causes (require urgent intervention):

• Brain tumors
• Stroke
• Inflammatory brain disease

The absence of altered consciousness, proprioceptive deficits, or cranial nerve deficits beyond VII and VIII strongly suggests peripheral rather than central disease 3.

Recommended Diagnostic Workup

Essential initial diagnostics include 2:

• Complete neurological examination to localize the lesion
• Comprehensive blood work including thyroid function (hypothyroidism can cause vestibular signs) 1, 2
• Blood pressure measurement 2
• Otoscopic examination to identify middle/inner ear disease 2

Advanced imaging when indicated 2:

• MRI of the brain is the gold standard for ruling out central causes and identifying structural abnormalities
• Important prognostic finding: Contrast enhancement of cranial nerves VII and/or VIII on MRI is associated with decreased chance of complete recovery (odds ratio 0.432) 1

Treatment Protocol

Immediate symptomatic management 2:

• Maropitant (antiemetic) once daily is the preferred treatment among veterinary neurology specialists for controlling nausea and vomiting 2
• Intravenous fluid therapy for dogs unable to eat or drink due to severe nausea 2
• Supportive care with easy access to food and water 4

Physical therapy considerations 4:

• Modified vestibular repositioning maneuvers have shown success in 12 canine patients with vestibular dysfunction 4
• This approach is borrowed from human benign paroxysmal positional vertigo treatment protocols 4

Prognosis and Expected Recovery

For idiopathic vestibular syndrome (most likely diagnosis in geriatric dogs):

• Clinical signs typically begin improving within 72 hours 2
• Most dogs show significant improvement within 1-2 weeks 4, 2
• Incomplete recovery is common: 27% retain persistent head tilt, 22% have persistent facial paresis, and 3% have persistent ataxia 1
• Recurrence occurs in 14% of cases 1
• Better prognosis if: History of previous vestibular episodes (odds ratio 3.533 for complete resolution) 1

For otitis media/interna:

• Requires antibiotic therapy targeting middle/inner ear infection
• May require longer treatment duration and surgical intervention in severe cases

Critical Red Flags Requiring Emergency Care

Seek immediate emergency veterinary care if your dog develops:

• Altered consciousness or mental status changes (suggests central disease)
• Seizures
• Inability to stand or walk at all
• Complete refusal of food and water for more than 24 hours
• Worsening rather than improving symptoms after 72 hours

Common Pitfalls to Avoid

• Do not assume "old dog vestibular disease" without proper workup: While idiopathic vestibular syndrome is most common in geriatric dogs, treatable causes like hypothyroidism and otitis media must be excluded 1, 2
• Do not delay veterinary evaluation: Central vestibular disease can be life-threatening and requires immediate intervention 3
• Do not discontinue antiemetic therapy prematurely: Nausea control is essential for maintaining hydration and nutrition during recovery 2