You might have seen your dog playfully cocking their head to the side; usually when listening intently to a sound in the distance, or a voice command, or sometimes a learned response when looking for treats.
However, there are a number of health conditions that may cause your dog to involuntarily tilt their head to the side, ranging from easily treatable problems to illnesses that could potentially be more severe and permanent.
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What is a Head Tilt
A head tilt is when your dog cannot hold their head up straight and they tip their head to one side without the ability to correct it. A head tilt may be associated with other signs depending on the inciting cause such as shaking the head, scratching, turning the head, circling, falling over. Head tilts can be caused by a range of diseases affecting the structures of the external and inner ear, vestibular (balance) centre, and the brain. These anatomical structures are very closely linked to one another and so diseases that affect any part may cause a range of very similar clinical signs
Ear problems
Ear problems are more common in some breeds than others, but can affect any dog at any stage of life. A dogs external ear canal is made up of a vertical portion (which is visible when you look down your dogs ear) and a horizontal portion, (not visible without a scope). At the end of the canal is the ear drum (tympanic membrane). On the other side of this are the structures of the Middle ear and Inner ear – the tympanic bulla, cochlea, and tiny ear bones.
Otitis Externa
Otitis is an inflammatory condition affecting the ear canal. This can be caused by increased bacteria or yeasts within the ear, too much hair, or sometimes a reaction to an underlying allergy. The tissues can become red, inflamed, uncomfortable and itchy. Sometimes there is an increased production of wax which becomes thicker and darker. In more severe or chronic cases the ear canal can become narrowed which then perpetuates the problem.
Occasionally foreign material, something small such as a grass seed, may work its way inside the external ear canal and become lodged. This usually causes extreme discomfort and irritation and does require a vet visit to remove the object. In rarer cases a foreign object may damage or puncture the eardrum which can lead to Otitis media/interna.
Otitis Media/Interna
The middle and inner ear structures can become inflamed and infected which can lead to a head tilt, and may be accompanied by other signs such as head shaking, rubbing, or wobbliness. Your dog may also display a condition called nystagmus when the eyes involuntarily flick from side to side. This is most commonly due to a descending issue from the external ear canal, such as chronic inflammation or a ruptured eardrum.
Aural Haematoma
Aural Haematoma is a condition which affects the pinna (the flap of the ear). An initial trauma causes a small haemorrhage in the blood vessels under the skin. This then causes the space between the skin and the cartilage to fill up with blood. This forms what looks like a pocket or a bubble on the flap of the ear and usually results in a head tilt due to the associated discomfort. This condition can also be associated with Otitis Externa as the inflammation inside the ear will cause your dog to flap and shake their head. And this can result in injury which is what causes the haematoma.
Vestibular Syndrome
The Vestibular System is a closely linked relationship between the inner ear and balance centre of the brain. This system, along with information from the eyes, is what controls balance and posture and keeps the dog upright. Vestibular syndrome or disease usually presents fairly suddenly, and tends to affect older dogs. They commonly develop a head tilt which is often accompanied by other signs such as circling, wobbliness, falling over, vomiting, and nystagmus (the eyes flicker from side to side).
Vestibular Syndrome may be classed as peripheral (affecting mainly the middle or inner ear) or central (affecting the brain). Peripheral vestibular syndrome is more common and tends to be associated with a better prognosis.
There can be other causes such as infection, inflammation, or tumours affecting any part of the inner ear or brain. Additionally, certain medications can be toxic to the middle and inner ear (ototoxic) and can cause signs of vestibular disease. Such ototoxic medications may also cause deafness in your dog.
Brain Lesions
A head tilt may develop as a result of a central brain lesion; which is any damage to the tissue of the brain caused by injuries or various diseases. Dogs can develop brain tumours in any part of the brain and these can be benign or malignant. The most common type of brain tumour in dogs being a meningioma, which is a benign growth of the meninges (the layers of tissue wrapped around the brain) .
Signs of a brain tumour commonly include a head tilt; which may be accompanied by other signs such as seizures, wobbling, circling or turning the head, and altered behaviour.
Other types of brain lesion include stroke or an ischaemic event where an area of tissue becomes starved of blood supply. Generally acute in onset and tending to affect older dogs, they can often make a full recovery.
The brain can also be affected by inflammatory conditions such as Granulomatous meningoencephalitis. The cause is often not known and tends to affect younger dogs, of smaller breed sizes and the lesions can affect any part of the central nervous system.
Metabolic Disease
Hypothyroidism is a condition very similar to humans where the thyroid gland is underactive and not producing enough thyroid hormone. Hypothyroidism has a vast range of clinical signs but has been seen to be a cause of peripheral vestibular syndrome. The dog may develop a head tilt along with ataxia (wobbliness) and nystagmus.
Diagnosis & Treatment
It’s always best to book an appointment with your vet so that they can perform a full physical exam and to identify the underlying cause. In some cases, further investigation will be required; such as blood samples, examination under sedation, radiographic imaging (x-rays), or swabs to check for infection. Central brain lesions need more advanced imaging to diagnose (such as MRI) and may need to be referred to a nearby neurology department.
Depending upon the diagnosis, there will be a wide variety of treatment options and potential outcomes.
Conclusion
A wide range of conditions can cause a similar set of clinical signs when it comes to a head tilt. First and foremost, do not panic as the likelihood is that it is something that can be treated. As soon as you see a head tilt or any of the associated signs it is advisable to book an appointment within 24-48 hours so your pet has the best chance of recovery.
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