Vestibular disease / Vestibular syndrome

Vestibular disease in cats is a condition affecting the vestibular system, which is responsible for maintaining balance, coordinating head and eye movements, and providing the sense of spatial orientation. This intricate system consists of components in the inner ear and connections to the brainstem that work together to keep cats balanced and oriented in space. When this system malfunctions, cats experience dramatic symptoms including loss of balance, head tilting, abnormal eye movements, and severe disorientation that can be extremely alarming to owners. Vestibular disease can occur in cats of any age but is most commonly seen in middle-aged to older cats, and may result from various underlying causes or occur without identifiable cause in the idiopathic form.

The causes of vestibular disease in cats fall into two main categories based on the location of the problem. Peripheral vestibular disease involves the inner ear vestibular apparatus and the nerve connecting it to the brain, with common causes including inner ear infections, middle ear infections that extend to the inner ear, inflammatory polyps, and tumors affecting the ear structures. Central vestibular disease involves the brainstem vestibular centers and typically results from more serious conditions including brain tumors, infectious diseases affecting the brain, stroke, and inflammatory brain diseases. Idiopathic vestibular disease, where no underlying cause can be identified, is common in cats and typically carries a better prognosis than cases with identifiable pathology.

The impact of vestibular disease on affected cats is dramatic and immediately obvious to owners. The sudden onset of severe imbalance, often accompanied by rolling or falling, creates an extremely distressing situation for both cats and their families. Affected cats may be unable to stand, walk, eat, or drink normally due to their profound disorientation. Nausea and vomiting commonly accompany the vestibular symptoms, further compromising the cat's wellbeing and ability to maintain nutrition and hydration. While the appearance of vestibular disease is alarming and the acute episode can be quite severe, many cats with peripheral or idiopathic vestibular disease recover substantially over time, though recovery may take several weeks and some residual symptoms may persist.

Treatment and prognosis for vestibular disease depend heavily on the underlying cause when one can be identified. Idiopathic vestibular disease typically improves significantly within a few days and resolves substantially within one to three weeks, with supportive care being the primary treatment. Cases caused by ear infections respond well to appropriate antimicrobial therapy, though treatment may be prolonged. Central vestibular disease caused by brain tumors or serious brain conditions carries a more guarded prognosis and requires treatment directed at the specific underlying cause. Veterinary evaluation is essential for any cat showing vestibular signs to differentiate between peripheral and central causes, identify treatable underlying conditions, and provide appropriate supportive care during the recovery period.

Idiopathic vestibular disease, also called feline idiopathic vestibular syndrome, is the most common form of vestibular dysfunction in cats and occurs without identifiable underlying cause. This condition typically affects older cats and causes sudden onset of severe vestibular symptoms that resolve spontaneously over several weeks. While the exact mechanism is unknown, the condition may involve temporary dysfunction of the vestibular apparatus or nerve, possibly related to circulatory changes, viral inflammation, or other transient factors. Despite its dramatic presentation, idiopathic vestibular disease carries an excellent prognosis, with most cats recovering substantially though some may retain a mild head tilt or occasional balance disturbance permanently.

Inner and middle ear infections represent the most common identifiable cause of peripheral vestibular disease in cats. Otitis media and otitis interna, infections of the middle and inner ear respectively, can directly damage the vestibular apparatus or compress the vestibular nerve, causing dysfunction of the balance system. These infections typically develop as extensions of outer ear infections or may reach the middle ear through the Eustachian tube from the throat. Common causative organisms include bacteria such as Staphylococcus, Streptococcus, and Pseudomonas, as well as yeast. The vestibular symptoms typically develop gradually as infection progresses, though sudden worsening can occur when infection reaches a critical threshold of inner ear involvement.

Inflammatory polyps are benign growths that commonly occur in the middle ear, external ear canal, and nasopharynx of cats, particularly young cats. When polyps grow within the middle ear or extend to affect the inner ear, they can cause vestibular dysfunction through direct pressure on vestibular structures or by predisposing to secondary infection. Polyps represent one of the most common causes of vestibular disease in young cats, as opposed to the idiopathic form that predominantly affects older cats. Surgical removal of polyps typically resolves the vestibular symptoms, though regrowth is possible and may require additional treatment.

Central vestibular disease results from conditions affecting the brainstem vestibular centers rather than the peripheral ear structures. Brain tumors, including primary brain tumors and tumors that have metastasized from elsewhere, can cause vestibular dysfunction when they involve the brainstem. Infectious diseases including feline infectious peritonitis, toxoplasmosis, and cryptococcosis can cause brain inflammation affecting vestibular centers. Stroke or other vascular events affecting brainstem blood supply can cause sudden vestibular dysfunction. Inflammatory brain diseases such as meningoencephalitis cause vestibular symptoms along with other neurological signs. These central causes are generally more serious than peripheral causes and require specific diagnostic evaluation and treatment.

Several other factors can cause or contribute to vestibular disease in cats. Certain medications, particularly some antibiotics including aminoglycosides, are toxic to the vestibular apparatus and can cause permanent damage if administered inappropriately. Trauma to the head or ear can damage vestibular structures. Tumors of the ear canal or skull base can affect vestibular function through direct invasion or compression. Metabolic disturbances, while less commonly causing vestibular signs in cats than in other species, can occasionally contribute. Understanding the range of potential causes helps guide appropriate diagnostic workup and treatment selection for individual cats presenting with vestibular symptoms.

The early warning signs of vestibular disease are often subtle or absent, as many cases present with sudden onset of severe symptoms without premonitory signs. In cases where vestibular disease develops secondary to ear infection, owners may notice signs of ear discomfort such as head shaking, scratching at ears, or ear discharge in the days or weeks before vestibular symptoms appear. Cats may show mild balance disturbance or occasional stumbling before the full syndrome develops. Some cats become quieter or show mild changes in behavior before acute vestibular crisis. However, in idiopathic vestibular disease and many other causes, the onset is typically sudden and dramatic, with cats appearing completely normal one moment and severely affected the next.

The hallmark symptoms of vestibular disease are dramatic and immediately recognizable. Head tilt is almost universally present, with the cat holding its head rotated so that one ear is lower than the other, typically tilting toward the side of a peripheral lesion. Loss of balance causes affected cats to stagger, fall, or roll toward the affected side, and some cats are unable to stand at all during severe episodes. Circling behavior, walking in circles usually toward the affected side, is common in cats that are able to ambulate. Nystagmus, an involuntary rhythmic movement of the eyes, is characteristic, with the eyes moving rapidly back and forth or in rotational patterns. The direction and characteristics of nystagmus provide important clues about whether the lesion is peripheral or central.

Behavioral and systemic symptoms accompany the vestibular disturbance and contribute significantly to the cat's distress. Severe nausea and vomiting result from the vestibular dysfunction, similar to motion sickness, and can lead to dehydration and electrolyte imbalances if persistent. Affected cats typically refuse to eat due to nausea and disorientation. Extreme distress and vocalization may occur, particularly in the acute phase, as cats are unable to understand or compensate for their sudden loss of balance. Some cats become very still, reluctant to move at all because any movement worsens their disorientation. Others thrash or roll repeatedly, which can cause self-injury.

Physical examination findings help characterize vestibular disease and differentiate peripheral from central causes. In peripheral vestibular disease, the head tilt and circling are toward the affected side, and nystagmus typically has a horizontal or rotational character with the fast phase away from the lesion. Examination may reveal concurrent ear disease such as discharge, pain, or visible abnormalities. In central vestibular disease, additional neurological abnormalities beyond vestibular signs are usually present, including changes in mentation, cranial nerve deficits, weakness on one side of the body, or abnormal postural reactions. The presence of these additional signs suggests brain involvement and warrants more extensive diagnostic evaluation.

Symptom progression varies depending on the underlying cause and whether treatment is provided. In idiopathic vestibular disease, symptoms are most severe at onset and gradually improve over several days to weeks, with most improvement occurring in the first three to five days. Vestibular symptoms caused by ear infection may worsen if infection progresses, or improve with appropriate treatment. Central vestibular disease may be stable, progressive, or fluctuating depending on the underlying cause. Without treatment of underlying causes, symptoms persist or worsen rather than resolving. Monitoring symptom progression provides important information about the likely cause and response to treatment.

Certain symptoms associated with vestibular disease indicate potentially serious underlying conditions requiring urgent evaluation. Signs suggesting central rather than peripheral disease, including altered mental status, seizures, weakness affecting the limbs, or other neurological abnormalities beyond vestibular signs, warrant immediate veterinary attention. Severe, uncontrolled vomiting leading to dehydration requires urgent supportive care. Complete inability to eat or drink for more than twenty-four hours risks serious complications. Symptoms that continue to worsen despite treatment suggest inadequate treatment of the underlying cause or a more serious condition. Any vestibular signs in a young cat warrant investigation for ear polyps or other treatable conditions.

The diagnostic process for vestibular disease begins with a comprehensive neurological examination to characterize the vestibular dysfunction and differentiate peripheral from central disease. The veterinarian assesses the direction and character of the head tilt, the pattern of nystagmus, the cat's gait and balance, and postural reactions. Cranial nerve function is tested to identify deficits beyond the vestibular nerve that would suggest central involvement. The examination determines whether additional neurological signs suggesting brain disease are present. This neurological assessment guides subsequent diagnostic testing by indicating whether the problem likely lies in the peripheral vestibular system or the central nervous system.

Otoscopic examination and evaluation of the ears is essential in any cat with vestibular disease, as ear disease is a common and treatable cause. The external ear canals are examined for evidence of infection, inflammation, discharge, masses, or foreign material. The tympanic membranes are assessed for integrity, appearance, and any bulging that might suggest middle ear effusion. Ear cytology evaluates for bacterial or yeast organisms. However, normal otoscopic examination does not rule out middle or inner ear disease, as these deeper structures are not visible on routine examination. Any evidence of ear disease in a cat with vestibular signs strongly suggests the ear as the source of vestibular dysfunction.

Imaging studies provide crucial information for diagnosing the cause of vestibular disease. Skull radiographs can sometimes reveal changes in the tympanic bullae consistent with middle ear infection or masses, but have significant limitations in sensitivity and detail. Advanced imaging with computed tomography or magnetic resonance imaging provides much more detailed evaluation and is recommended for most cases of vestibular disease. CT excels at evaluating bony structures and can identify middle ear changes, bulla destruction, and masses affecting the ear. MRI provides superior soft tissue detail and is the gold standard for evaluating the brain and inner ear, essential when central vestibular disease is suspected. These imaging studies help identify or rule out ear infections, polyps, tumors, brain lesions, and other structural causes of vestibular dysfunction.

Additional diagnostic tests may be indicated based on clinical findings and imaging results. Blood work including complete blood count and chemistry panel assesses overall health and may reveal evidence of infection or systemic disease. Testing for infectious diseases such as feline leukemia virus, feline immunodeficiency virus, toxoplasmosis, and cryptococcosis may be recommended when central nervous system infection is suspected. Cerebrospinal fluid analysis provides information about inflammatory or infectious conditions affecting the brain and is obtained through a procedure requiring anesthesia. Biopsy of masses identified on imaging may be necessary for definitive diagnosis. In cases where extensive testing reveals no underlying cause, a diagnosis of idiopathic vestibular disease is made by exclusion, meaning other causes have been adequately ruled out.

Initial treatment for vestibular disease focuses on supportive care and managing the distressing symptoms while diagnostic evaluation proceeds or while waiting for spontaneous improvement in idiopathic cases. Anti-nausea medications provide relief from the motion sickness-like symptoms that accompany vestibular dysfunction, improving comfort and enabling cats to eat and drink. Intravenous or subcutaneous fluids correct dehydration that develops from vomiting and inability to drink. Sedation may be necessary for severely affected cats that are thrashing or rolling dangerously. Hospitalization allows close monitoring and intensive supportive care during the acute phase when symptoms are most severe and cats are unable to care for themselves.

Treatment of underlying causes is essential when an identifiable cause of vestibular disease is found. Ear infections causing vestibular symptoms require aggressive, prolonged antibiotic therapy, typically for a minimum of four to six weeks and often longer, to clear infection from the middle and inner ear. Antibiotic selection is ideally based on culture and sensitivity testing, with medications chosen for their ability to penetrate into the ear structures. Anti-inflammatory medications may be used alongside antibiotics to reduce swelling and improve drainage. Surgical intervention, including bulla osteotomy to drain and clean the middle ear, may be necessary for severe or refractory infections.

Surgical treatment is indicated for specific causes of vestibular disease. Inflammatory polyps causing vestibular dysfunction require surgical removal, with techniques ranging from traction avulsion to ventral bulla osteotomy depending on the polyp location and extent. Tumors of the ear canal or skull base may be amenable to surgical excision if they have not invaded critical structures. For central vestibular disease caused by accessible brain tumors, surgical removal may be possible at specialized centers, though many brain tumors are not surgically treatable. The decision to pursue surgery depends on the specific diagnosis, location and extent of the lesion, the cat's overall health, and owner preferences and resources.

Medical management for central vestibular disease targets the underlying cause when possible. Brain tumors may respond to radiation therapy, chemotherapy, or palliative corticosteroid treatment to reduce tumor-associated swelling. Infectious causes require appropriate antimicrobial therapy directed at the specific pathogen, which may include antibiotics, antifungal medications, or antiprotozoal drugs depending on the organism identified. Inflammatory brain diseases may respond to immunosuppressive therapy. Supportive care including anti-nausea medication and physical assistance remains important while primary treatment takes effect.

Physical therapy and rehabilitation can aid recovery from vestibular disease once the acute phase has passed. Encouraging gradual return to activity helps the brain adapt to altered vestibular input and develop compensatory mechanisms. Controlled exercise in safe environments prevents falls while promoting recovery. Environmental modifications such as ramps instead of stairs and raised food and water bowls accommodate residual balance deficits. Most cats with peripheral or idiopathic vestibular disease improve substantially with time and supportive care alone, though the timeline varies and some residual head tilt may persist permanently.

Treatment decisions for vestibular disease involve weighing multiple factors in consultation with the veterinary team. The suspected or confirmed underlying cause largely determines treatment options and expected outcomes. The cat's age, overall health status, and severity of symptoms affect treatment feasibility and prognosis. Owner factors including goals of care, ability to provide necessary nursing care at home, and financial considerations influence treatment choices. For idiopathic vestibular disease, the primary treatment is supportive care with an expectation of substantial improvement over one to three weeks. For other causes, treatment is directed at the underlying condition, with outcomes depending on the specific diagnosis and response to therapy.

Recovery timeline for vestibular disease varies considerably depending on the underlying cause. In idiopathic vestibular disease, improvement typically begins within the first two to three days, with the most dramatic improvement occurring in the first week. Most cats show substantial recovery by two to three weeks, though some take longer. Residual head tilt may persist indefinitely in some cats, representing incomplete compensation rather than ongoing disease. Recovery from vestibular disease caused by ear infection depends on successful treatment of the infection, with vestibular symptoms typically improving as infection resolves, though this may take several weeks of antibiotic therapy. Recovery from polyp-associated vestibular disease is typically rapid following successful surgical removal, though some cats require time for full compensation.

Post-treatment care during recovery from vestibular disease requires attention to safety, nutrition, and gradual return to normal activity. Cats with significant balance deficits should be confined to a safe area where they cannot fall from heights or injure themselves on obstacles. Food and water should be easily accessible at appropriate heights, and hand-feeding or syringe-feeding may be necessary for cats too disoriented to eat independently. Litter boxes should be low-sided and easily accessible. Assistance with grooming helps maintain coat condition and comfort. As balance improves, gradually expanding the cat's environment and activity level encourages compensation while maintaining safety.

Prognosis for vestibular disease depends on the underlying cause. Idiopathic vestibular disease carries an excellent prognosis, with most cats returning to near-normal function, though some retain mild residual signs. Vestibular disease caused by ear infections has a good prognosis when infection is identified and treated appropriately, though severe infections with significant inner ear damage may result in permanent deficits. Polyp-associated vestibular disease typically resolves well with surgical removal, though polyp regrowth requiring additional treatment is possible. Central vestibular disease caused by brain tumors or serious brain conditions carries a more guarded prognosis, varying considerably based on the specific diagnosis, extent of disease, and available treatment options.

Long-term outlook for cats that have recovered from vestibular disease is generally positive, with most cats returning to good quality of life. Cats that retain mild residual head tilt or occasional balance disturbance typically adapt well and function normally in daily activities. Recurrence of idiopathic vestibular disease is possible but uncommon. Cats that had vestibular disease due to ear infections benefit from ongoing ear health monitoring to prevent recurrence. Those with underlying conditions predisposing to vestibular problems require continued management of those conditions. Regular veterinary follow-up enables early detection of any recurrence or new problems.

Primary prevention of vestibular disease focuses on addressing the underlying causes that can be prevented or managed before they lead to vestibular dysfunction. Prompt, thorough treatment of outer ear infections before they progress to involve the middle and inner ear is one of the most effective preventive measures. Cat owners should recognize the signs of ear discomfort, including head shaking, scratching at ears, and discharge, and seek veterinary attention early rather than waiting for symptoms to worsen. Regular ear examinations during routine veterinary visits allow early detection of ear problems before they become severe enough to threaten vestibular function.

Environmental prevention measures help reduce the risk of ear infections and other conditions that can lead to vestibular disease. Keeping cats indoors reduces exposure to ear mites, a common cause of ear infections that can progress to involve deeper structures. Avoiding introduction of water or irritating substances into the ear canal protects the ear's natural defenses. For cats prone to ear problems, regular preventive ear cleaning with appropriate products as directed by a veterinarian can help maintain ear health. Prompt treatment of upper respiratory infections may help prevent spread of infection through the Eustachian tube to the middle ear.

Maintaining overall health supports the body's ability to resist infections and recover from illness. High-quality nutrition provides the nutrients needed for immune function and tissue health. Keeping cats up to date on vaccinations prevents certain infections that could potentially affect the nervous system or predispose to secondary problems. Managing chronic conditions such as diabetes or immune-suppressing viral infections reduces susceptibility to infections that could lead to vestibular disease. Regular veterinary care enables early detection and management of developing health problems.

Early detection of ear problems and other conditions that could lead to vestibular disease enables intervention before vestibular damage occurs. Owners should monitor for signs of ear discomfort and seek prompt evaluation for any ear-related symptoms. Cats with a history of ear problems should receive regular monitoring. Any signs of balance disturbance, head tilting, or unusual eye movements warrant immediate veterinary attention, as early treatment of underlying causes can prevent progression and permanent damage. Young cats presenting with ear problems should be evaluated for polyps, which if removed early can prevent vestibular complications.

For idiopathic vestibular disease, which occurs without identifiable cause, prevention is not possible, but awareness of the condition helps owners respond appropriately. Understanding that sudden vestibular symptoms can occur in older cats and that idiopathic vestibular disease typically improves substantially with time and supportive care helps owners remain calm and seek appropriate care without panic. This awareness is particularly important because the dramatic symptoms of vestibular disease can suggest very serious conditions, and understanding that a benign cause is common provides important perspective. However, veterinary evaluation remains essential to differentiate idiopathic disease from conditions requiring specific treatment.

Daily management of a cat recovering from vestibular disease centers on providing a safe environment and supporting the cat's needs while compensation develops. During the acute phase, cats should be confined to a small, safe area with soft surfaces, away from stairs, furniture they might fall from, and other hazards. Food and water bowls should be placed at a comfortable height and location that minimizes the need for balance-challenging movements. Some cats need assistance eating and drinking initially, with food offered directly or via syringe if necessary. Litter boxes should be low-sided and nearby to prevent accidents. Maintaining a calm, quiet environment reduces stimulation that might worsen vestibular symptoms.

Home environment modifications support safety and independence as cats recover. Providing ramps instead of requiring jumping to access favorite spots accommodates residual balance deficits. Blocking access to stairs and high places prevents dangerous falls. Creating comfortable resting areas at floor level gives cats safe options that don't require climbing. Non-slip surfaces or rugs in areas where cats walk provide traction for unsteady movement. As improvement occurs, gradually expanding access to more of the home allows cats to rebuild confidence while maintaining safety. Some cats with permanent mild deficits benefit from continued environmental modifications.

Maintaining quality of life during and after vestibular disease involves helping cats continue to engage with their environment and family. Gentle interaction and affection provide comfort and security during the frightening experience of vestibular dysfunction. Quiet play with toys that don't require rapid movement allows mental stimulation without exacerbating symptoms. As balance improves, more normal play can resume. Maintaining normal routines as much as possible provides security and predictability. Celebrating improvements, however small, recognizes progress. Most cats recover substantially and return to enjoying normal activities, though they may approach some activities with more caution than before.

Ongoing monitoring helps track recovery and identifies any setbacks or new problems. Noting improvements in balance, reduction in nystagmus, and changes in head tilt over time provides a record of progress. Any worsening of symptoms after initial improvement warrants veterinary consultation, as this could indicate treatment failure, complications, or a different underlying problem than initially suspected. Cats that have experienced vestibular disease should continue to receive regular veterinary care with attention to ear health and neurological status. Any return of vestibular symptoms, even if subtle, should be evaluated promptly.

Caregiver support is important when managing a cat with vestibular disease, particularly given the alarming nature of the initial symptoms. Understanding the condition, including the typical timeline for improvement and the generally good prognosis for idiopathic and peripheral causes, helps reduce anxiety. The intensive care required during the acute phase can be exhausting, and recognizing this challenge and seeking support from family, friends, or veterinary staff helps caregivers maintain their own wellbeing. Online communities and support groups for pet owners dealing with vestibular disease can provide practical advice and emotional support. Open communication with the veterinary team ensures guidance is available throughout the recovery process.

Vestibular disease does not show strong breed predisposition in cats, and the condition can affect cats of any breed or mixed heritage. Unlike in dogs, where certain breeds have recognized predisposition to congenital vestibular disease, cats do not appear to have breed-associated hereditary forms of vestibular dysfunction. The primary risk factors are related to age and underlying conditions rather than breed. This means that all cat owners should be aware of the possibility of vestibular disease and recognize its signs, regardless of their cat's breed.

Certain populations of cats face elevated risk for vestibular disease based on factors other than breed. Older cats, particularly those over ten years of age, have the highest incidence of idiopathic vestibular disease, the most common form of vestibular dysfunction in felines. Cats with chronic or recurrent ear infections face increased risk of infection extending to the middle and inner ear, causing vestibular symptoms. Young cats are more commonly affected by inflammatory polyps that can cause vestibular disease when they extend into or affect the middle ear. Cats with immune-compromising conditions may be more susceptible to infections affecting the vestibular system. Outdoor cats have higher rates of ear mites and other ear problems that can progress to involve vestibular structures.

Screening and prevention recommendations are guided by these risk factors rather than breed. All cats should receive regular ear examinations as part of routine veterinary care, with more frequent monitoring for those with history of ear problems. Young cats with chronic ear problems should be evaluated for polyps. Older cats developing sudden balance problems should receive prompt evaluation to differentiate idiopathic vestibular disease from other causes requiring specific treatment. Owners of all cats should be aware of the signs of vestibular disease and understand that while symptoms are alarming, many cases, particularly idiopathic vestibular disease, carry good prognosis with appropriate supportive care.

Vestibular disease frequently co-occurs with and is commonly caused by ear infections, making otitis media and otitis interna the most important related conditions. Middle ear infection can extend to involve the inner ear where the vestibular apparatus is located, causing vestibular dysfunction alongside or following ear infection symptoms. Cats with vestibular disease should always be evaluated for underlying ear infection, as treatment of the infection is essential for resolving vestibular symptoms. Conversely, cats with chronic ear infections should be monitored for development of vestibular signs indicating extension of infection to the inner ear. The relationship between ear infections and vestibular disease emphasizes the importance of prompt, thorough treatment of ear problems.

Several conditions can cause symptoms similar to vestibular disease and must be differentiated through appropriate diagnostic evaluation. Cerebellar disease, affecting the part of the brain responsible for coordination, causes ataxia and balance problems that can resemble vestibular dysfunction but typically includes characteristic intention tremors and hypermetria not seen in pure vestibular disease. Brain tumors can cause vestibular symptoms when they involve brainstem vestibular centers, often accompanied by other neurological signs. Stroke or other vascular events affecting the brain can cause sudden vestibular dysfunction. Systemic conditions including severe metabolic derangements, toxicities, or cardiac disease can occasionally cause balance problems that might initially suggest vestibular disease. Accurate differentiation is important because treatment and prognosis differ substantially among these conditions.

Complications can develop from vestibular disease or its underlying causes if not properly managed. Severe, persistent nausea and vomiting can lead to dehydration and electrolyte imbalances requiring medical correction. Cats that cannot eat adequately due to vestibular symptoms risk developing hepatic lipidosis, a serious liver condition that occurs when cats do not eat for extended periods. Self-injury from falling or rolling can cause trauma requiring treatment. Progression of underlying ear infections can lead to permanent inner ear damage affecting hearing and balance. Extension of severe ear or brain infections can rarely lead to life-threatening complications. Appropriate treatment of vestibular disease and its underlying causes, along with supportive care during recovery, helps prevent these complications.