Head tilts and loss of balance is not uncommon in older dogs but can be quite worrisome for owners. Sometimes these changes can occur overnight or gradually worsen over the course of a few days.  There are several reasons that an older dog may have these symptoms:

The most common cause of a head tilt and loss of balance is due to something called ‘old dog vestibular syndrome.’  This problem is sometimes called a ‘doggie stroke’ even though the dog may or may not have actually had a true stroke or vascular accident.

The exact cause of old dog vestibular syndrome is unknown. Regardless of the cause, the brain’s “balance center” – the vestibular apparatus- is affected and these dogs cannot properly sense their body’s orientation.  People who experience vestibular syndromes liken it to ‘vertigo.’  Most of these dogs show symptoms very quickly and will improve quickly over the course of days or a few weeks. Some may seem ‘dizzy’ and their eyes may dart from side to side. Others vomit due to nausea or need assistance walking. Most of these dogs make full recoveries and function well but may have a slight head tilt or ‘wobble’ when they walk for the rest of their days.

A middle ear infection (otitis media) is also a common cause of a head tilt and loss of balance. Middle ear infections may also cause dogs to have a “drooping” of their face on the side of the head tilt. Middle ear infections are most common in dogs with a history of outer ear infections (otitis externa), allergies or skin infections.

A brain tumor is a more uncommon cause of head tilt and loss of balance, but this possibility should not be overlooked. Generally speaking, older dogs are more likely to develop cancer than younger dogs.  Unfortunately, unlike old dog vestibular syndrome, dogs with brain tumors tend to worsen instead of improve over time.

I recommend that any dog with a head tilt and loss of balance be evaluated by their veterinarian as soon as possible.  Middle ear infections need prompt medical treatment to prevent permanent nerve damage and often the associated head tilt will disappear with time.  If your dog is diagnosed with old dog vestibular syndrome, your vet may recommend medications to combat nausea. Some dogs seem to panic due to their loss of balance and sedatives may make recovery easier for them.  If your vet suspects a possible brain tumor or other lesion, MRI (magnetic resonance imaging) or CT (computed tomography) may be necessary for a diagnosis and treatment plan.