Head Tilt in Dogs

Head tilt is more of a symptom than a condition. It could be seen prominently in older dogs but if it accompanies any of the following symptoms in an otherwise healthy dog, then one must take their dog to the vet as soon as possible.

• Abnormal head posture (frequent head tilt)
• Strange behaviour like rolling around on the ground 
• Unusual clumsiness 
• Lack of coordination (ataxia)
• Constantly stumbling and falling over
• Nausea and vomiting
• Circling (constant turning in circles)
• Not being able to focus 
• Abnormal eye movements called nystagmus (jerking side to side, up and down, or around)
• Weakness of the body 
• Head tremors 
• Loss of appetite
• Depression 
• Facial paralysis (in severe cases)

If your dog presents with a head tilt along with any of the above-mentioned symptoms, then your dog might be suffering from a vestibular disorder. 

Depending upon the area of infection, vestibular diseases have been divided into three types, peripheral, central and paradoxical.

Peripheral vestibular disease is generally caused by an inflammation or infection in the middle or inner ear which could lead to ear infections like ear mites. In peripheral vestibular syndrome, you may notice that your dog is tilting his/her head towards the infected ear. You may further notice that the abnormal eye movements would be towards the healthy ear, that means if your dog has left vestibular disease, then he/she may show fast eye movement towards the right. Your dog would not present with any postural abnormality in this type.

Central vestibular disease is due to a disturbance in the brainstem, specifically the medulla. In central vestibular syndrome, you may notice that your dog is tilting his/her head towards the infected side. You may further notice that the abnormal eye movements would be towards the healthy side of the dog. Your dog may present with a postural abnormality towards the infected side, that means he/she may not be able to stand or maintain an upright position along the infected side.

Paradoxical vestibular disease occurs due to any disease in the cerebellum, the part of the brain which is responsible for position and movement of the body even in an unconscious state. Since there is damage to the cerebellum, your dog may present with postural abnormalities towards the infected side.

In paradoxical vestibular syndrome, you may notice that your dog is tilting his/her head towards the healthy side. You may further notice that the abnormal eye movements would be towards the infected side.

Causes of peripheral vestibular disease could be:

• Ototoxicity (damage to the ear due to some chemical exposure)
• Middle or inner ear infection like otitis media and otitis interna
• Allergic reactions from certain antibiotics such as metronidazole 
• Traumatic brain injury
• Hypothyroidism (decreased levels of thyroxine hormone in the body)

The causes of the central and paradoxical vestibular syndrome could be:

• Infections 
• Tumours like a trigeminal nerve sheath tumour, lipoma and melanomas in dogs
• Inflammatory diseases such as encephalitis or granulomatous meningoencephalitis of unknown aetiology 
• Hyperadrenocorticism (excessive cortisol hormone production in the body)
• Cerebrovascular diseases like stroke
• Toxicity from medication like Metronidazole

For diagnosing the root cause of head tilt in dogs, apart from clinical symptoms, your veterinarian may recommend tests like complete blood count, urine analysis and blood chemistry to look for infection markers in the blood.

The vet may also recommend an otoscope examination for your dog. This test is done by sedating the dog while the veterinarian uses a magnifying tool called an otoscope to look at the eardrum and the ossicles (present in the middle ear) to find the infection.

Further tests like X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) could be done to confirm any damage or infection in the middle ear as well as the brain.

Cerebrospinal fluid (CSF) analysis could be done by your vet to find out inflammation and/or infection within the brain of your dog. CSF is a clear, watery liquid that surrounds and protects the brain and spinal cord.

There is no specific treatment for vestibular diseases in dogs, so the treatment is directed at the underlying cause. 

• Ear infections could be treated with the help of antibiotic and antifungal medications, including ear drops and tablets. In some cases, steroid injections could be given by your vet to relieve pain and swelling in your dog’s ear. 
• If there are non-cancerous (benign) tumour growths, they could be removed by your vet to fix the problem. 
• In case of a malignant tumour, radiotherapies and chemotherapies could be given to the dog after the tumour removal. 
• Once the medication is stopped, the toxicity from metronidazole relieves on its own after two weeks.
• In the case of brain Infections such as encephalitis, your vet may hospitalize your dog for intravenous (IV) delivery of antibiotics or antifungals.
• Sedatives could be given to the dog to make him/her relax, if they are severely stumbling, unable to stand or walk. 
• Anti-emetics could be given to manage nausea and vomiting.
• If the dog is unable to eat or walk on its own, the vet may hospitalize the dog for delivering intravenous fluids.

Barring major health issues like tumours and encephalitis, most dogs begin to improve within seventy-two hours. The clinical symptoms like head tilt and stumbling often improve over a seven to ten-day period. 

Most dogs are completely recovered within two to three weeks.

Despite getting treated, some dogs may retain mild ‘wobble’ or tilt for life, but that is harmless if it doesn’t progress.

If the dog fails to improve or worsens instead, then your vet may recommend advanced diagnostic testing to find out the more severe underlying disorder.