Vestibular Disease
“Luther’s
Strange Problem: A Case of Vestibular
Disease"
Luther is a nine year-old Beagle cross that came
into Capitol Illini Veterinary Services on a hot July day last summer. Luther
was in a foul mood. He could not
walk straight and when he attempted to do so, he turned in a tight circle to
the left. He couldn’t feel the left-side
of his face or blink his left eye. His
nausea was so profound that he vomited numerous times. Luther’s owners were concerned that he may
have had a “stroke?”
We
often see geriatric K9 patients that are examined for what owners believe to be
a “stroke.” Fortunately, not all of
these patients have suffered a true vascular accident (“stroke”). Vestibular disease looks similar to some of
the same abnormalities that we see with vascular accidents. The vestibular apparatus is located within
the inner ear. The function of the
apparatus is to provide spatial awareness and aids in keeping a patient
oriented and coordinated in movement.
The inner ear is a highly complex space with many nerves and nerve roots
in close proximity. The health of the
middle and external ear canals can have a direct influence on vestibular
function because all of these structures are linked together. With this in mind, let’s take a look at some
of the other things that were noted during Luther’s initial exam.
Luther
had extremely painful ears. The external
ear canals were very red and irritated.
Ear cytology (looks at different cell populations contained within the
ear canals) was performed and it revealed that a very large amount of bacteria
was present. The left and right tympanic
membranes (ear drum) appeared to have large amount of debris behind them (this
debris was most likely pus). So how
could an ear infection lead to Luther’s condition? Luther’s ear infection was so severe that it
involved all parts of his ear (external/middle/inner). Not only were the canals affected but a very
important nerve, the facial nerve, and his vestibular apparatus were as
well. The facial nerve helps to
coordinate movement of the eyelids and other associated facial movements. The damage to the facial nerve was severe
enough to produce Luther’s inability to blink the left eye. His inability to walk in a coordinated
fashion (ataxia) and vomiting (result of motion sickness) was produced by the
disruption of the vestibular apparatus by the infection.
Luther
was placed on many types of antibiotics (systemic and topical) for several
weeks. His head-tilt and ataxia resolved
relatively quickly. However, at this
writing, his left eye is only able to partially blink. His owners medicate that eye so that he does
not develop a condition known as “dry eye.”
Luther has not had any other complications since the treatment.
Luther’s
vestibular disease had a direct cause- a severe middle/inner ear
infection. There are some cases of
vestibular disease that have no discernible cause. This condition is known as idiopathic
vestibular disease (aka “old dog vestibular syndrome). Idiopathic vestibular disease can begin
acutely with clinical signs such as:
ataxia, vomiting, nystagmus (irregular eye movements), circling and a
head-tilt. With appropriate treatment,
the condition can resolve within a few hours to weeks. The bottom-line is this; If your dog or cat
(cats can suffer from vestibular disease
too) exhibits any type of neurologic dysfunction bring them in for veterinary
care as soon as possible!
Thanks for reading,
Tom Antonini, DVM
Capitol Illini Veterinary Services
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