Therapy

There are multiple potential therapeutic tar­gets in the acutely vestibular patient. The first thing to consider is nausea. It is always recommended to use veterinary labelled drugs when available.

Another therapeutic target in the severely affected vestibular patient is anxiety. These patients often benefit from some form of anxiolytic therapy. Benzodiazepines (diaze­pam, midazolam) and phenothiazines (ace- promazine, chlorpromazine) can be administered IV for rapid effect in the very anxious, nauseated patient.

Cats should never be administered diazepam PO as an anxiolytic or appetite stimulant. They can develop idiosyncratic hepatic necrosis with enteral administra­tion, but parenteral administration of diaz­epam is safe.

Box 7.3

Cats should never be administered diaze­pam PO due to the potential of idiosyncratic hepatic necrosis.

These patients often also require fluid therapy in the acute phase due to ptyalism, vomiting, panting, and lack of intake.

There is no non-specific maintenance therapy for vestibular dysfunction. Treatments are either symptomatic (for nau­sea or anxiety) or targeted to the specific cause. The only over-the-counter rescue therapy for any vestibular symptom is meclizine. Meclizine will help with nausea associated with vestibular dysfunction, but will not hasten the course of the disease. It is only available in an oral formulation which can be difficult, if not impossible, to adminis­ter to a nauseated patient. The majority of anti-anxiety and anti-emetic medications are prescription-only at this time.

Surgical intervention is only an option for a few vestibular lesions. Namely, chronic, severe otitis media∕interna can warrant a total ear canal ablation and∕or bulla osteot­omy, especially when the ear is no longer responsive to medical management. Otogenic intracranial infections are ideally treated with surgical drainage by bulla oste­otomies along with targeted antimicrobial and anti-inflammatory therapy and these have a good prognosis with treatment.

Prognosis is truly extremely variable and dependent on the underlying disease process.

Quality of Life for Patient and Caregiver

Vestibular dysfunction can cause deficits ranging from mild to severe. Dogs and cats with peripheral vestibular head tilts can live normal lives with no compromise in quality of life. Severely vestibular animals, whether cen­tral or peripheral, are often non-ambulatory and require significant nursing care for an unknown period of time.

Objective measurements for patient quality- of-life assessment can include things like mobility and appetite. If these are chroni­cally compromised and do not respond to medical management, quality of life should be reevaluated.