Lump at Base of Ear/Bell's Palsy? UD Abscess returned :-(

I was just stroking Starbuck when I noticed he has a large lump at the base of his left ear. Its about the size of a large marble. About 6 months ago our rabbit vet commented on his glands at the base of his ears being swollen but said as he was fine in himself it was nothing to worry about, just something to keep an eye on.

When he went for his dental a couple of months ago, the same vet pointed this out to my husband again, and he felt it and said it was about the size of a large marble/half the size of a ping-pong ball then. I'm not sure if I knew how big it was then, but again, she said it was nothing to worry about. Around the same time we noticed Starbuck's face had gone lop-sided. She said she had seen it before in rabbits where they get almost like Bell's Palsy in humans - where half of the face droops. Again it doesn't seem to be caused by anything in particular so she said not to worry about it.

Today is the first time I have felt the marble-sized lump for myself, I don't know how I haven't noticed it before because I am sure I felt for the lumps she meant 6 months ago.

Anyway to try to cut this a bit shorter - what should we do? I'm thinking we need to get him back to the vets (the above vet has since left the practice and there is another bunny-savvy vet there).

- to my mind a raised gland means there is an infection of some kind going on....surely this needs some kind of treatment/investigation?
- what if its an abscess/tumour/inner ear infection?
- can a raised gland be related to the lop-sidedness in his face? How?

Thanks for any advice.

I think it is highly likely that he has an abscess in his ear canal. Is he a lop by any chance ?

I would put a hefty wager on a load of pus being in that 'lump'

So yes, vets ASAP and in my experience surgical removal of the abscess offers the best chance of a good outcome.

The facial nerve can be effected by an ear abscess, it causes the face to 'pull up' on the effected side making the face wonky so-to-speak

Thank you Jane.

Yes he is a lop, and abscess was my worry. That pic you have is exactly how Starbuck's face looks - its more like one side has contracted, rather than the other side dropped.

How would an abscess be diagnosed? Would he need x-ray/ultrasound?

I will try to get him to the vets this afternoon.

PS If it was an abscess, would you expect it to have grown in this time?

Also can they do a swab to test for Pasteurella? Could this be linked? I just googled ear abscesses and this came up which suggested they can sometimes be linked to Pasteurella: http://en.allexperts.com/q/Rabbits-703/2009/2/Rabbit-Ear-Abscess-healing.htm

Starbuck has always had weepy eye problems and sometimes has a bit of a wet nose - but clear, no white discharge or anything...so now I am wondering if this should be looked at too?

Yes, Pasteurella is one of the bacteria that can be involved. Skull radiographs may be useful to determine the extent of the infection and swabs for culture and sensitivity testing would be useful too. As I said before, surgical removal of the entire abscess offers the best prognosis. But if this is not feasible then removal of as much as possible. Longterm antibiotic therapy is usually needed and in some cases regular flushing out of the abscess cavity. If the infection is extensive then more major surgery may eventually be required- a lateral ear canal resection/ablation.

Graphic images on this link

http://www.medirabbit.com/EN/Surgery/Ear/ear_surgery.pdf

Thank you so much Jane, I'm going to get him up to the vets this afternoon, will let you know what happens, I may not be able to get on to RU again later today but I will update here tomorrow if I can't do it today.

Thanks for all the advice - will also click on the link (am a bit wary of graphic images).

Just v quick reply as on my phone. It is an abscess, hes had it drained under local anaesthetic and pain relief.
Pasteurella is highly likely and he has been given baytril. He is ti go back in 7-10 days.
Thank you so much Jane.

helgalush said:

Just v quick reply as on my phone. It is an abscess, hes had it drained under local anaesthetic and pain relief.
Pasteurella is highly likely and he has been given baytril. He is ti go back in 7-10 days.
Thank you so much Jane.

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Has the Vet advised you to keep the abscess open and flush it out 2-3 times a day ?

Just draining it and giving Baytril is very unlikely to be curative I am afraid. Especially as this abscess may have been in situ for some time and thus tracked inwards (hence the facial nerve damage). Not meaning to cause you additional alarm, but in my experience ear abscesses need aggressive treatment from the very start as they can be so troublesome.

Just wanted to add that I agree wit Jane completely (as usual when it comes to health topics ) that it would definitely be best to get a culture done asap to determine what the bacterium is so the correct antibiotic(s) can be selected.

What do you think about application of antibiotics into abcess sites Jane? I was having a conversation with someone at the weekend who swears by it after having a slight accident with some ab's and an abcess in the past although admittedly not an ear abcess.

Hi just gate crashing here!!

I would definitely support the idea of culturing and also having some scanning etc done to see how far in it has gone. Parleys ear sometimes looks clean with an otoscope but the abscess is huge in the very inner ear. He too his the atrophied muscles on half the face. We are holding with baytril after trying everything else. Re the beads in the abscess. Not always poss if the abscess is too close to a thin wall of poss affected bone in case they break into the system near the. Brain in inner ear abscess. But have had them in jaw abscess

Thanks for all the advice for Starbuck, I appreciate it very much.

Jane, no the vet did not advise us to keep it flushed out. I am afraid to say that within a matter of hours it has refilled and is back to pretty much the same size as it was yesterday. Sorry I couldn't elaborate more yesterday, I am still getting used to working my phone. He has been put on a high dose of Baytril 0.75mg.

Thank you all for suggesting that more aggressive treatment is needed. We will be taking him back to the vets this evening, and will be asking for him to be booked in for x-rays and surgery (and culturing if that cannot be done tonight). Am I right in thinking that the whole sac needs to be removed? I need to feel clear what I am asking for as opposed to having it just drained.

I am fearful that the abscess may be really deep in for him, especially given how quickly it has refilled and his facial nerve involvement. It is just underneath his ear - if you lift his ear up its just sitting under there. It looks as though its just sitting on the surface of his face but now I am frightened there is so much more to this.

The good thing is that Starbuck in himself is lively & happy and Muesli is taking such great care of him

helgalush said:

Thanks for all the advice for Starbuck, I appreciate it very much.

Jane, no the vet did not advise us to keep it flushed out. I am afraid to say that within a matter of hours it has refilled and is back to pretty much the same size as it was yesterday. Sorry I couldn't elaborate more yesterday, I am still getting used to working my phone. He has been put on a high dose of Baytril 0.75mg.

Thank you all for suggesting that more aggressive treatment is needed. We will be taking him back to the vets this evening, and will be asking for him to be booked in for x-rays and surgery (and culturing if that cannot be done tonight). Am I right in thinking that the whole sac needs to be removed? I need to feel clear what I am asking for as opposed to having it just drained.

I am fearful that the abscess may be really deep in for him, especially given how quickly it has refilled and his facial nerve involvement. It is just underneath his ear - if you lift his ear up its just sitting under there. It looks as though its just sitting on the surface of his face but now I am frightened there is so much more to this.

The good thing is that Starbuck in himself is lively & happy and Muesli is taking such great care of him

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Total removal of the abscess capsule would certainly be the best option. But this is not always possible. It will depend entirely on how extensive the spread of infection is. I am wondering how Rabbit savvy your Vet is ? It's just that first saying that the lump was an 'enlarged gland' and then once realising it was an abscess just draining it and prescribing Baytril is certainly not what I would expect from a Vet familiar with the problematic nature of Rabbit ear abscesses. I do think that a Bunny savvy Vet is an essential here so if in doubt could you request a referral to a specialist ASAP. Especially if surgery is to be undertaken.

Poor boy Sending lots of vibes for Starbuck xx

Also we were going to move Starbuck and Muesli in to a different room in the next weekend or two, we've been doing it up for them ready to move in to as we need to do some work in the room they are currently in, do you think this will be too much stress for Starbuck at the current time? We were going to let them start exploring it before we move them so they get used to the new space, and also they will still have access to their old room until we start the DIY so there will be familar space for them. I just don't want to send Starbuck into stasis or excessively stress him out.

helgalush said:

Also we were going to move Starbuck and Muesli in to a different room in the next weekend or two, we've been doing it up for them ready to move in to as we need to do some work in the room they are currently in, do you think this will be too much stress for Starbuck at the current time? We were going to let them start exploring it before we move them so they get used to the new space, and also they will still have access to their old room until we start the DIY so there will be familar space for them. I just don't want to send Starbuck into stasis or excessively stress him out.

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I would not make any big changes atm

Jack's-Jane said:

Total removal of the abscess capsule would certainly be the best option. But this is not always possible. It will depend entirely on how extensive the spread of infection is. I am wondering how Rabbit savvy your Vet is ? It's just that first saying that the lump was an 'enlarged gland' and then once realising it was an abscess just draining it and prescribing Baytril is certainly not what I would expect from a Vet familiar with the problematic nature of Rabbit ear abscesses. I do think that a Bunny savvy Vet is an essential here so if in doubt could you request a referral to a specialist ASAP. Especially if surgery is to be undertaken.

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Ok thank you for explaining. So we need the x-ray to determine the extent of the infection first really, and then I guess the individual vet will determine at the same time whether they think they can get the whole of it out?

I am not really 100% sure how knowledgeable on rabbit abcesses my vet is. The vet that said it was an enlarged gland has now left the practice, she was very good at rabbit dentals mainly. Its difficult as well as I don't always go to the vets, sometimes Mr Helgalush takes them, and he doesn't always have the information to hand to best know how to advocate for them. I think tonight we will go armed with more information (printed) and a list of questions, so that we can get on the right lines for Starbuck. I have no idea how knowledgeable on abcesses she is & so I will ask for a referral to someone with specialist knowledge in abscesses if need be, thank you for the suggestion.

Jack's-Jane said:

I would not make any big changes atm

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Yes that's what I was thinking thanks, I will get Mr Helgalush to change his annual leave plans then, and do the DIY later on.

Oh poor Starbuck, sending him mega mega vibes. xxx

helgalush said:

Ok thank you for explaining. So we need the x-ray to determine the extent of the infection first really, and then I guess the individual vet will determine at the same time whether they think they can get the whole of it out?

I am not really 100% sure how knowledgeable on rabbit abcesses my vet is. The vet that said it was an enlarged gland has now left the practice, she was very good at rabbit dentals mainly. Its difficult as well as I don't always go to the vets, sometimes Mr Helgalush takes them, and he doesn't always have the information to hand to best know how to advocate for them. I think tonight we will go armed with more information (printed) and a list of questions, so that we can get on the right lines for Starbuck. I have no idea how knowledgeable on abcesses she is & so I will ask for a referral to someone with specialist knowledge in abscesses if need be, thank you for the suggestion.

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You may find this link to be informative, especially diagnostics and treatment options

http://wildpro.twycrosszoo.org/S/00dis/Bacterial/BacterialOtitisMediaInterna.htm

Also to add that ongoing facial paralysis can lead to dental problems as the effected Rabbit does not chew evenly. So I would suggest a thorough Dental examination when he is under GA. If he has had 'conscious dentals' he may well now have some tooth root issues which could be another focal point for abscess formation. Skull radiographs would be helpful to assess this possibility too.