Vestibular Disease in Cats

What is vestibular disease?

Vestibular disease is a condition that affects the vestibular system, which helps a cat maintain balance and move normally. The vestibular system has central components in the brain and peripheral components in the inner ear and the nerves that connect it to the brain. Disease or damage in any of these areas can affect a cat’s balance and coordination.

What are the signs of vestibular disease?

Signs of vestibular disease usually develop suddenly, often in less than an hour. Signs include:

• Sudden loss of balance and coordination
• Disorientation
• Falling, rolling or circling to one side
• A head tilt
• Involuntary, darting eye movements called nystagmus
• Reluctance to stand or walk
• Nausea, vomiting, or reduced appetite

What causes vestibular disease?

Vestibular disease can affect cats of all ages. Common causes of vestibular disease include:

• Middle- and inner-ear infections
• Trauma or injury
• Tumors
• Certain medications or toxins that can damage the inner ear
• Cerebrovascular accident (stroke) 

In many cats, the exact cause is unknown; this is called idiopathic vestibular syndrome. A congenital (inherited) form has been reported in Siamese and Burmese cats, and many of these cats are also deaf. Idiopathic vestibular disease is not contagious to other animals or humans.

How is vestibular disease diagnosed?

Your veterinarian will diagnose vestibular disease based on your pet’s medical history and physical, neurological, and ear examinations. Additional tests may be recommended to identify the underlying cause or rule out more serious conditions. Tests may include:

• Blood and urine tests
• Blood pressure
• Magnetic resonance imaging (MRI)
• Skull radiographs (X-rays)
• Spinal fluid analysis
• Ear cultures
• Cytology (examination of any discharge or fluids found in the ear canal)

How is vestibular disease treated?

Treatment depends on the underlying cause. Antibiotics or anti-fungal medications may be used in middle- or inner-ear infection cases. For idiopathic vestibular disease, treatment focuses on reducing motion sickness, nausea, and vomiting and providing supportive care. During the initial stages, many cats need help eating, drinking, moving around, and using the litter box.

In severe cases, supportive therapy such as intravenous fluids and hospitalization may be required until the cat can eat and walk on their own. If the cat is seriously disoriented or ataxic (stumbling, unable to stand or walk), they may be given medication to help them relax.   

What is the prognosis for a cat diagnosed with vestibular disease?

The prognosis depends on the cause of the vestibular disease. Idiopathic vestibular disease is a short-term, self-resolving condition that rarely recurs. Signs are usually the most severe during the first 24 to 48 hours and then steadily improve. Nystagmus usually resolves within a few days. Some cats may retain a mild head tilt or slight unsteadiness. Other causes, such as tumors, have a much more guarded (uncertain) prognosis.

If your cat does not improve or gets worse, a more serious underlying disorder may be present. Your veterinarian may recommend advanced diagnostic testing or referral to a veterinary neurologist.