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brown and white american foxhound dog tilting head outside

If your dog’s head tilt lasts longer than 24 hours or is accompanied by other symptoms, such as vomiting or falling over, they should be seen by a veterinarian immediately.

Dogs naturally tilt their heads when concentrating on sounds, such as your voice, or to hear sounds more clearly. It may also be a sign that your dog is interested in what they hear.

However, excessive head tilting can be a symptom of several issues that should be checked by a veterinarian. Head tilt in dogs is usually due to a condition in the peripheral vestibular system that’s located in the middle ear.

In many situations, head tilting in dogs is most serious within the first 48 hours, especially when the cause is unknown. If the underlying cause is not severe, dogs with head tilt and stumbling often improve over 7-10 days, though some symptoms, such as wobbling, may persist.

Here’s what you should look for and the possible causes and treatment of head tilting in dogs.

Other Signs to Watch For With Head Tilting in Dogs

Your dog may avoid walking or standing, and in many cases, will lean (or even drop) in the same direction as the head tilt. If you see any of the following signs along with head tilting, take your dog to the vet:

  • Vomiting

  • Disorientation, leaning, and/or circling

  • Confusion

  • Fatigue

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

  • Not wanting to or hesitating to stand or walk

  • Eye shifting from side to side

  • Deafness or difficulty hearing

Causes of Head Tilting in Dogs

Many cases of head tilt in dogs 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 it also influences eye movement.

Here are the most common causes of dog head tilt:

  • Vestibular disease:

    • Peripheral vestibular disease: If the ear is damaged, such as a punctured eardrum (tympanum), a dog may tilt their head. This can also be caused by some antibiotics (often containing aminoglycosides) and ear washes, such as those containing chlorhexidine, as well as infections that affect the middle and inner ear. The central and inner ear are inflamed due to bacterial, parasitic, or other types of infection.

    • Central vestibular disease: This is usually caused by cancer, stroke, inflammation, or infection to the brain.

    • Idiopathic peripheral vestibular disease: Idiopathic means that the exact cause is unknown. This is common in senior dogs (10-12 years old) and involves the middle or inner ear.

  • Hypothyroidism: The thyroid gland does not produce enough of the thyroid hormone, causing the metabolism to slow. Hypothyroidism can cause peripheral vestibular syndrome, accompanied by head tilting.

  • Nutritional deficiency: Deficiencies in nutrients such as thiamine can cause dogs to tilt their heads.

Diagnosing Head Tilting in Dogs

Your veterinarian will do a physical exam, paying particular attention to your dog’s ears. Depending on the suspected underlying cause, they may recommend several tests, including:

  • 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.

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

Treatment of Head Tilting in Dogs

Head tilting in dogs is sometimes temporary and resolves on its own. However, it can be caused by a serious underlying condition and result in injury due to falling. Have your dog examined as soon as possible.

Treating head tilting depends on the underlying cause, including:

  • Treatments for stroke, cancer, or serious injury

  • Antibiotics for an ear infection

  • Hormone or nutritional support for hypothyroidism or poor nutrition

  • If the cause is unknown, no treatment other than 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 drugs to counteract motion sickness, especially in mild to moderate cases.

A dog with a more serious underlying disorder may not improve, or symptoms may worsen, in which case, advanced testing will be recommended.

References

Carnes, M. “Head Tilt in Dogs: A Clinical Approach.” Today’s Veterinary Practice, June 2018.

What Causes Head Tilt in Dogs? Symptoms and Treatment,” Kingsdale Animal Hospital, January 2022.

Featured Image: iStock.com/John Marshall

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