I first learned about Geriatric Vestibular Disease when my poodle dog, Max, woke up one night in distress. He stood up, his body curved into a "C" shape towards the side, and continually moved his head to one side. He could only walk in circles, and he had an eye twitch. When his symptoms did not resolve after about fifteen minutes, I rushed him off to the emergency veterinary clinic, fearing a brain tumor or other life-threatening disorder.
The veterinarians at the emergency clinic quickly checked him over and presented me with a diagnosis of vestibular disease, akin to vertigo in humans. In vestibular disease, something affects the vestibular apparatus, defined by marvistavet.com as the "neurological equipment responsible for perceiving one's body's orientation relative to the earth...and informing one's eyes and extremities how they should move accordingly. This vestibular apparatus is what allow us to walk, or even run, on very uneven ground without falling, helps us know when we need to right ourselves and allows our eyes to focus on moving objects without becoming dizzy".
Symptoms of the vestibular disease can include lack of coordination, nausea or motion sickness, back and forth or rotational eye movement, circling, head tilt, falling to one side and/or trouble with nerves controlling the head and face. The most common causes are the middle ear infection, brain lesion or tumor, or "idiopathic" (i.e. sudden onset of unknown cause). The veterinarian will look for certain clues in a dog's symptoms to determine whether something in the brain is causing the problem. For example, if the eye twitches are up and down or only occur when the dog is placed in certain positions, then brain involvement is suspected. Vestibular disease can result from a brain tumor, some sort of vascular accident or from an infection such as Rocky Mountain Spotted Fever.
On the other hand, if the dog has a history of chronic ear infections, veterinarians will most likely explore middle or inner ear problems as a first line diagnosis. Similarly, idiopathic vestibular disease (usually seen in geriatric dogs) can be suspected if the onset is acute. Only your veterinarian can determine if your dog's symptoms are related to vestibular disease or some other cause, and can then recommend any additional tests (such as checking the ears or diagnostic imaging of the brain) to pinpoint the source.
Treatment is generally straightforward and can include anti-nausea and anti-motion sickness medication such as metoclopramide. If the infection is suspected, antibiotics may also be prescribed. Assuming there is no brain tumor or another more serious brain lesion, improvement can be seen in as little as a few days and most dogs are back to normal within one or two weeks.
Geriatric vestibular disease is frightening in its symptoms, but barring any serious cause such as a tumor, is readily treatable. In Tiny's case, with a history of chronic ear infections, he was easily treated and back to his old self within a few days.