Vestibular Disease in Cows: Head Tilt, Circling, and Loss of Balance in Cattle

Vestibular disease is a problem affecting the body system that controls balance, head position, and eye movement. In cows, that system can be affected either in the inner ear and vestibulocochlear nerve (peripheral vestibular disease) or in the brain stem (central vestibular disease). When it is not working normally, a cow may hold her head tilted, circle to one side, stumble, lean, or fall.

This is not one single disease. It is a syndrome, meaning a group of signs that can come from different underlying problems. In cattle, two of the most important causes are listeriosis, a bacterial infection that commonly affects the brain stem of ruminants, and otitis media/interna, an infection of the middle or inner ear. Young calves are especially at risk for ear infections, including cases linked with Mycoplasma bovis.

Some cows stay bright and alert despite obvious balance problems, which can point more toward ear disease. Others become depressed, stop eating, drool, or have trouble swallowing, which raises more concern for brain stem disease such as listeriosis. Because these conditions can look similar at first, your vet usually needs to sort out the cause before discussing the best treatment options.

In adult cattle, one of the best-known causes is listeriosis, often called circling disease. This happens when Listeria monocytogenes causes an asymmetric infection of the brain stem. Affected cattle may become depressed, anorexic, disoriented, and circle toward the affected side. They can also develop unilateral facial weakness, head tilt, reduced sensation, and eventually recumbency. Poor-quality or spoiled silage is a classic risk factor, although environmental contamination can also play a role.

Another major cause is middle or inner ear infection. Otitis interna can interfere with cranial nerve VIII and cause peripheral vestibular signs such as ipsilateral head tilt, circling, leaning, falling, and nystagmus. In calves, ear infections may follow respiratory disease, bottle-feeding issues, or spread of bacteria such as Mycoplasma bovis. Some calves also show ear droop, facial nerve deficits, or pain around the ear and jaw.

Less common causes include brain abscesses, meningitis, meningoencephalitis, trauma, toxicities such as lead exposure, polioencephalomalacia, thrombotic meningoencephalitis, and other focal neurologic disease. Because several of these problems can look alike early on, your vet may need to use the full history, feed information, herd pattern, and neurologic exam to narrow the list.

Your vet usually starts with a farm call exam and neurologic assessment. They will look at mentation, gait, head position, eye movements, facial symmetry, swallowing, ear carriage, temperature, hydration, and whether the signs fit a peripheral or central vestibular pattern. Feed history matters too, especially recent silage changes, spoiled feed, or herd-level illness.

Depending on the case, your vet may recommend bloodwork, ear examination, culture or PCR testing, cerebrospinal fluid testing, or imaging. In live cattle, listeriosis can be difficult to confirm definitively, so diagnosis is often based on the pattern of signs and response to treatment. Ear disease may be suspected from cranial nerve deficits, pain, discharge, or concurrent pneumonia in calves. In some cases, skull radiographs, ultrasound of nearby structures, or referral imaging may be considered.

If a cow dies or is euthanized, necropsy and laboratory testing can be very helpful for confirming the cause and guiding herd prevention. That is especially important when multiple animals are affected, when silage is suspected, or when your vet is concerned about reportable or herd-impacting disease.

Prevention depends on the underlying cause. For listeriosis, the biggest management step is feeding good-quality silage and stored feed. Spoiled, moldy, visibly deteriorated, or poorly fermented silage should not be fed. Clean feed bunks and water sources matter too, because Listeria can persist in the environment. If your herd has had neurologic cases after a feed change, ask your vet to review forage handling, storage, and feeding practices.

For ear-related vestibular disease, focus on calf health and respiratory disease control. Good colostrum management, ventilation, reduced crowding, and prompt treatment of respiratory outbreaks can help lower the risk of otitis in young stock. In dairy calves, your vet may also review milk-feeding practices and whether unpasteurized waste milk could be contributing to Mycoplasma bovis exposure.

It also helps to reduce trauma hazards, control access to toxins such as lead-containing materials, and isolate or closely monitor cattle with new neurologic signs until your vet examines them. Because vestibular signs can overlap with several serious diseases, early veterinary evaluation is one of the most practical prevention tools for limiting losses in both the individual cow and the herd.