Head Tilt in Dogs: Causes and Treatment

If you notice your dog tilting their head, you may think it’s a cute gesture or them trying to get your attention.  

However, this could be a sign of an underlying medical condition that needs to be addressed by a veterinarian.  

Dog head tilts can be caused by a variety of conditions, ranging from infections to neurological issues.  

If you notice a head tilt in your dog, contact your veterinarian.  

What Is Dog Head Tilt?

A head tilt in dogs occurs when instead of holding their head straight and upright, dogs point one of their ears toward the ground.  

It’s like how dogs hold their head when they are curious or looking at you in confusion, but a head tilt caused by an underlying medical concern is persistent or sudden.  

Because persistent head tilts are caused by underlying health issues, a veterinary exam and treatment is necessary.  

Head Tilt Causes

Many cases of dog head tilt can be traced back to the vestibular system in the middle ear. This system is responsible for helping your dog maintain their balance, posture, and head position, and influences eye movement. However, there may be other underlying issues that are making a dog’s head tilt.  

Let’s look at some of the most common causes:  

• Punctured/ruptured eardrum  

• Antibiotic use (such as gentamicin) if an eardrum is ruptured 

• Ear washes (typically containing chlorhexidine) 

• Ear infections (bacterial, parasitic)  

• Cancer 

• Stroke 

• Inflammation or infection of the brain (encephalitis)  

• Hypothyroidism 

• Nutritional deficiency, notably thiamine  

Sometimes, head tilt in dogs is idiopathic, meaning the exact cause is unknown. This is common in senior dogs and involves the middle or inner ear. 

Signs That Dog Head Tilt Requires Immediate Veterinary Care

If your dog is tilting their head with the following symptoms, bring them to the vet immediately:  

• Avoiding walking or standing  

• Leaning in the same direction of the tilt 

• Vomiting 

• Disorientation, leaning, and/or circling 

• Confusion 

• Fatigue/lethargy 

• Loss of balance, poor coordination, stumbling, falling over 

• Eye shifting from side to side 

• Deafness or difficulty hearing 

How Vets Diagnose Dog Head Tilt

To diagnose the cause of dog head tilt, your veterinarian will do a physical exam, paying particular attention to your dog’s ears.  

Depending on the suspected underlying cause, your vet may recommend several tests, including: 

• Blood work, complete blood count (CBC) 

• Urinalysis and electrolyte panel 

• Nutritional status 

• Imaging tests, such as X-rays, computed tomography (CT), and magnetic resonance (MRI), to determine issues within the middle ear 

• Cerebrospinal fluid test if inflammation or infection is suspected within the brain. CSF is the watery liquid that surrounds and cushions the brain and spinal cord. This is collected through spinal tap under anesthesia. 

• Bone biopsy if a tumor or infection of the bone is suspected 

Dog Head Tilt Treatment

Dog head tilt is sometimes temporary and resolves on its own. However, in most cases, it may require treatment.  

Treating head tilt in dogs depends on the underlying cause, including: 

• Antibiotics, such as topical Animax for an ear infection 

• Hormone or nutritional support for hypothyroidism or poor nutrition 

• If the cause is unknown, supportive care is recommended 

Supportive treatment depends on the severity of head tilting and its related symptoms: 

• Hospitalization with IV fluids until head tilting and related symptoms (such as disorientation or poor coordination) subside 

• Sedatives 

• Anti-nausea medication and medications to counteract motion sickness, especially in mild to moderate cases (such as Cerenia) 

A dog with a more serious underlying disorder may not improve, or symptoms may worsen.  

Advanced testing will then be recommended with individual treatment plans formulated for the dog’s specific needs. 

Dog Head Tilt Recovery and Management

Recovery for a dog head tilt depends on the underlying cause. Typically, ear infections resolve within 10–14 days following treatment.  

Sometimes, if the ear infection is severe, it may take a month or two to resolve.  

Dogs with head tilts due to underlying neurological issues—such as cancer or stroke—may experience an intermittent head tilt long-term that can only be managed with supportive care, rather than resolving completely.  

Dogs who experience head tilts due to hypothyroidism generally experience resolution if the condition is managed with appropriate medications. These dogs will require lifelong medication management to keep their symptoms at bay.