I need an expert opionion on my 14 year old dog which i have…

-It appears you are offline. I am sorry we were not able to connect to discuss Marcus' signs.

-Based on the information you provided, I can offer some general advice.

-The vestibular apparatus allows us to walk, even run, on uneven ground without falling, helps us know when we need to right ourselves, and allows our eyes to follow moving objects without becoming dizzy. The vestibular system consists of the structures of the middle ear, the nerves that carry their messages to the brain/central nervous system, and the brain/central nervous system itself.

-There are two sets of receptors involved: one to detect rotational acceleration (tumbling or turning) and one to detect linear acceleration and gravity (falling and letting us know which direction is up and which is down). Both receptors are located in the middle ear.

-From these centers, instructions are carried by nerve cells to the legs, neck, and eye muscles so that we may orient ourselves immediately. The information about being upside down is also sent to an area of the brain so that we can become consciously aware of our position.

-The following are signs of vestibular disease:

Lack of coordination
Motion sickness.
Nystagmus (back and forth or rotational eye movements

-In order to determine prognosis and choose treatment, one needs to figure out what has happened to the vestibular system. The first step is to determine whether the lesion is central - in the brain - or peripheral (in the inner ear).

-Idiopathic vestibular disease is the most common form of vestibular disease in dogs and cats. For unknown reasons, cats are most commonly affected in the northeast U.S. in the late summer and early fall.

-Idiopathic vestibular disease, begin acutely and resolve acutely. Usually improvement is evident in 72 hours and the animal is normal in 7 to 14 days, although occasionally a head tilt will persist. When a case of vestibular disease begins, it may be a good idea to wait a few days to see if improvement occurs before doing diagnostics beyond a routine blood/urine database.

-Treatment of idiopathic vestibular disease generally involves control of nausea (motions sickness) while the condition runs its relatively short course.

-If the vestibular signs have a brain origin, there could be a tumor, vascular accident, infection (especially Rocky Mountain spotted fever) or other lesion in the brain. Imaging of the brain will be important in determining the nature of the lesion and what treatment makes the most sense. This means a CT scan or MRI to image the brain; most likely a referral will be needed for this type of procedure. General anesthesia is required for CT and MRI.

-Middle ear infection is a likely possibility for vestibular disease especially if the patient has a history of ear infections. Concurrent facial nerve paralysis, creating a slackened look to one side of the face, or Horner’s syndrome where there are some eye changes, often go together with middle ear infection.

-When an otoscope is used to visualize the external ear of an animal with vestibular disease and debris is seen, this would be a good hint that there is infection in the middle ear as well. However, just because debris is not seen in the external ear does not mean that a middle ear infection is unlikely. Imaging of the middle ear bones may be in order.

-The most accessible way to evaluate the middle ear is with a set of radiographs called a bulla series (so named because it focuses on an ear bone called the tympanic bulla). If the bulla appears abnormal, the ear may require surgical drainage. The problem is that radiography is often not sensitive enough to pick up damage in the middle ear and a normal set of films does not rule out disease. In these cases, imaging such as a CT scan or MRI is better, although rather expensive. These imaging techniques, however, allow imaging of the brain tissue itself (which radiology does not), thus allowing brain abnormalities to be evaluated as well.

-Treating a known middle ear infection can be difficult. Culture of the middle ear may be necessary and oral antibiotics are needed for 6 to 8 weeks to clear the infection from the tiny bones of the middle ear. Surgery may be needed to open the tympanic bullae and flush them out.

-Amoxicillin is not typically the most effective antibiotic for treating middle ear infections but could be helping if an infection is present.

-It is also possible that he has idiopathic vestibular syndrome and is starting to improve as most dogs do.

-Dramamine is not the most effective medication for controlling the motion sickness associated with vestibular signs. You may want to talk to your veterinarian about a medication called Cerenia to help with nausea and potentially improve his appetite.

-If this is a middle ear infection and is properly treated, it is possible he will recover.

-Idiopathic vestibular syndrome typically resolves within 7-10 days. Recurring episodes may occur in some dogs.

-With either condition, he may still have a head tilt, facial paralysis, or be a bit unsteady when walking permanently. However, most dogs recovery well enough to have a very normal quality of life.

-It sounds like he is improving, so it would be worthwhile to talk to his veterinarian about antibiotics for a possible middle ear infection and give him some more time to see how he does.

I hope this information was helpful and Marcus will feel better very soon. Thank you for trusting JustAnswer with your questions. It was my pleasure to help you today. If you need further information regarding this question or need clarification on the recommendations, please let me know. I am happy to help.

-Do you have any questions or need clarification on any of the information?