Vestibular Syndrome in Dogs: Treatment Options, Palliative Care, and How to Know When It’s Time for Euthanasia

Vestibular syndrome in dogs refers to a sudden onset of balance problems caused by dysfunction of the vestibular system, which controls coordination and equilibrium. They often have a head tilt, are falling to the side, have eye movements (nystagmus) and are dizzy and disoriented. Pet parents often think their dog is having a stroke.

The good news is most cases of vestibular syndrome are temporary and most dogs recover in a few days with supportive care alone. However, depending on the underlying cause, in some cases dogs do not recover, and you may find yourself considering euthanasia.

This guide will walk you through what vestibular syndrome is, available treatment options, how to provide comfort, and when euthanasia might be the most compassionate decision. If you are in the NYC area and find yourself facing the decision for euthanasia, Paws at Peace provides peaceful in-home euthanasia in all five boroughs (Manhattan, Bronx, Brooklyn, Queens, and Staten Island), 7 days a week.

🧠 What Is Vestibular Syndrome in Dogs?

The vestibular system is responsible for balance and spatial orientation. It involves parts of the inner ear and brain. When something disrupts this system, dogs may experience sudden symptoms such as:

• Loss of balance
• Falling or rolling to one side
• Head tilt
• Rapid eye movement (nystagmus)
• Nausea or vomiting
• Reluctance to eat or walk
• Confusion or anxiety

🧪 Common Causes of Vestibular Syndrome

• Idiopathic (Old Dog Vestibular Disease) – the most common and benign form of vestibular syndrome, often resolving on its own in senior dogs
• Inner or middle ear infections
• Hyperthyroidism
• Tick-borne diseases
• Brain tumors or cancer
• Reaction to ear medications
• Stroke
• Metronidazole toxicity

🔍 Diagnosing the cause of vestibular syndrome

In most cases of vestibular syndrome, we don’t do any testing beyond a physical exam because most cases are due to idiopathic vestibular syndrome (old dog vestibular disease) and most dogs recover within a few days without any treatment!

If your dog develops vestibular syndrome and it is not starting to improve within a few days, your veterinarian may recommend the following tests:

• Blood testing (for hyperthyroidism or tick-borne diseases)
• MRI/CT (to check for tumors/cancer/stroke)
• Chest x-rays (to check for tumors/cancer)

🩺 Treatment Options for Vestibular Syndrome

The mainstay of treatment in most cases of vestibular disease is supportive and palliative care. What that means is medications that help your dog with nausea and dizziness and nursing care to help them move about, urinate and defecate, and feel comfortable while their body recovers. The majority of dogs recover with supportive care alone in a few days to weeks, although some have mild lingering symptoms such as a mild head tilt.

🐶 Supportive care for vestibular syndrome

• Anti-nausea medications: medications like Cerenia (maropitant) or Zofran (ondansetron) can help with dizziness and vomiting associated with vestibular syndrome
• Motion sickness medications: Bonine (meclizine) can be helpful in some cases of vestibular syndrome
• Mobility assistance: Some dogs with vestibular syndrome are unable to walk without some assistance and some cannot walk at all, depending on how severely they are affected. Using a harness like a Help-Em-Up harness. In large dogs with family members are unable to physically assist them, hospitalization for the first few days can sometimes help.
• Hydration support: some severely affected dogs are unable to drink so subcutaneous fluids (or intravenous fluids in a hospital setting) can sometimes be helpful.
• Assistance with eating: Dogs with vestibular syndrome sometimes have trouble holding their head still enough to eat, or walking to the bowl so using hand-feeding or soft, aromatic foods can be helpful.
• Comfortable bedding and fall-proof spaces to avoid injury from losing balance and falling
• Calm, quiet environment to reduce sensory overload
• Antibiotics may be used in cases of vestibular syndrome where an ear infection or a tick-borne disease is suspected
• Steroids may be used in cases of vestibular syndrome where a brain tumor is suspected. Patients with brain tumors are unlikely to make a recovery.

🕊️ When it might be time to consider euthanasia

The good news is: most cases of vestibular syndrome – especially idiopathic – do not require euthanasia, and most dogs recover well! However, there are rare situations where euthanasia may be the kindest option, particularly when:

• The condition is caused by an untreatable brain tumor or severe neurological disease
• The dog is non-ambulatory and declining, with no signs of improvement after several days to a week.
• The dog is not eating, drinking, or engaging, and remains distressed for more than a few days.
• There are other underlying illnesses (e.g., cancer, heart failure) impacting quality of life.
• There have been multiple relapses with worsening outcomes

💭 Things to Consider:

• Can your dog walk safely without constant assistance?
• Are they eating and drinking on their own?
• Do they seem confused or frightened most of the time?
• Are other medical conditions making recovery more difficult?
• Are there potential human factors (work, size of humans compared to the dog, etc) that make it difficult or impossible to care for a dog with vestibular disease?

📓 Daily Journaling Can Help

Use a simple journal to track your dog’s quality of life. Each day, record:

• A 😊 for a good day
• A 😞 for a bad day

You can also use this space to write down meaningful memories or small joys. Over time, the pattern can help guide your decision and provide peace of mind.

Our Quality of Life Scale (https://pawsatpeace.com/quality-of-life-scale/) is another helpful tool to help you assess your cat’s quality of life. This quiz can be taken once to give you a snapshot or taken multiple times to assess trends over time.

🏡 Why In-Home Euthanasia May Be the Best Option

If euthanasia becomes necessary, in-home euthanasia in NYC allows your dog to pass peacefully, surrounded by familiar people and scents—without a stressful trip to the hospital.

At Paws at Peace, we offer compassionate home visits throughout Manhattan, Brooklyn, Queens, the Bronx, and Staten Island to provide a gentle transition in the comfort of home.

💬 Final Thoughts

Vestibular syndrome can be frightening, but many dogs recover beautifully with time, patience, and supportive care. If the symptoms are caused by something more serious, your veterinarian can help guide you toward the right next step—whether that’s treatment, palliative care, or planning for a peaceful goodbye.

If you’re unsure what to do next, consider scheduling a teleconsult with one of our compassionate veterinarians. We can review your dog’s medical records, talk through your options, and help you plan the most peaceful and loving path forward.

And if the time comes to say goodbye, our in-home euthanasia team is here to make that transition peaceful and dignified, right at home—where your dog feels safest. We serve all five boroughs of New York City seven days a week.