Ear infection, meds, no improvement

Hi all, wondering whether anyone has any advice. My 7 year old bunny developed a head tilt about 2 and a half weeks ago. The vet gave us metacam 0.6 ml once a day, panacur one click a day and baytril 0.75 ml twice a day. The vet could see no pus or dirt but thought there was a small tear in one ear drum. The head tilt improved within a few days but then she became very unsteay and wobbly. She now has septrin 1.2 ml once per day instead of baytril. She has moments when her ear is obviously annoying and hurting her, and she desperately wants to scratch it and shake her head, but she cannot as she falls over. She is getting more and more unsteady and disorientated, is falling over and now sometimes lifts her head up as if looking at the ceiling. I have given the septrin 5 days to kick in but nit sure if this is enough.

I really am struggling to see her like this. She is eating normally and everything else seems to be working fine.

Any help, advice very gratefully received. Thanks you

I'm sorry your bun is poorly. Can I ask how rabbit savvy your vet is ?
If there is an inner ear infection then I would want an x ray done and much stronger antibiotics to be honest and metacam twice a day.

bunslave said:

I'm sorry your bun is poorly. Can I ask how rabbit savvy your vet is ?
If there is an inner ear infection then I would want an x ray done and much stronger antibiotics to be honest and metacam twice a day.

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Yes, quite often a more 'heavy duty' antibiotic is needed to treat middle ear infections. Something like an injectable penicillin or azithromycin. Or a combination of abx which may include metronidazole.

Obviously it is not possible to know for certain if there is a middle ear infection without diagnostics, ie skull radiographs. However, as these would require the Rabbit having a GA it is often not appropriate to do them if the Rabbit is already very unwell. So treating symptoms and covering both the possibility of EC and of a bacterial ear infection, as your Vet is doing, is sensible. It just may be that the choice of abx needs looking at again.

With head tilt treatment can need to go on for weeks on end. Any improvements are often slow to occur. Whilst some Rabbits may never lose the head tilt they are able to adjust and live a very happy life inspite of their disability. But of course a few are not able to do so. It's a case of taking things one day at a time really.

These links may be useful to read:

http://www.vettimes.co.uk/article/diagnosis-of-otitis-externa-media-and-interna-in-rabbits/

http://www.vettimes.co.uk/article/treatment-of-otitis-externa-media-and-interna-in-rabbits/

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

http://www.gwexotics.com/wccms-resources/a/5/0/e/77554b90-a660-11e0-a685-0050568626ea.pdf

http://www.rabbitwelfare.co.uk/pdfs/Ecuniculi_Lft.pdf

http://www.medirabbit.com/EN/Neurology/Otit/otitis.htm

Thank you for your reply. I believe she and her colleague are; certainly her colleague was on the RWAF list, which is why I changed to them. I am going back today, and wonder about x rays, but I am so scared of putting her under a ga

Wattywatts said:

Thank you for your reply. I believe she and her colleague are; certainly her colleague was on the RWAF list, which is why I changed to them. I am going back today, and wonder about x rays, but I am so scared of putting her under a ga

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Yes, I can understand that. I am not sure that a great deal more would be achieved as far as treatment options go by risking a GA for Xrays. Your Vet may feel that it is better to treat symptomatically, as I mentioned previously.

I would ask the Vet about a more 'heavy duty' antibiotic protocol. Also, what dose of Metacam is your Rabbit receiving ? Some Vets do tend to prescribe very low doses which may not provide sufficient anti-inflammatory effects. It is inflammation that causes the clinical symptoms ie the head tilt/loss of balance.

Also, some Rabbits with vestibular symptoms benefit from a medication to help control the dizziness. For example Proclorperazine

http://wildpro.twycrosszoo.org/S/00Chem/ChComplex/Procloperazine.htm

Cyclizine

http://wildpro.twycrosszoo.org/S/00Chem/ChComplex/Cyclizine.htm

or Meclizine

http://wildpro.twycrosszoo.org/S/00Chem/ChComplex/Meclizine.htm

Wattywatts said:

Hi all, wondering whether anyone has any advice. My 7 year old bunny developed a head tilt about 2 and a half weeks ago. The vet gave us metacam 0.6 ml once a day, panacur one click a day and baytril 0.75 ml twice a day. The vet could see no pus or dirt but thought there was a small tear in one ear drum. The head tilt improved within a few days but then she became very unsteay and wobbly. She now has septrin 1.2 ml once per day instead of baytril. She has moments when her ear is obviously annoying and hurting her, and she desperately wants to scratch it and shake her head, but she cannot as she falls over. She is getting more and more unsteady and disorientated, is falling over and now sometimes lifts her head up as if looking at the ceiling. I have given the septrin 5 days to kick in but nit sure if this is enough.

I really am struggling to see her like this. She is eating normally and everything else seems to be working fine.

Any help, advice very gratefully received. Thanks you

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I am sorry for your rabbit's head tilt. It really is a most distressing condition.

Does your vet advise X Ray's to confirm the diagnosis of ear infection? I say this because there are other causes of head tilt such as e.cuniculi (which your vet is covering for) and a possible stroke amongst others I have had rabbits experience.

Strong and possibly injectable antibiotics would be necessary but only if infection were the cause. If you trust your vet I would go with their advice. Personally I would prefer to know the reason for the tilt and treat accordingly, even if that meant a head X-Ray .

Wishing you loads of luck X

MightyMax said:

I am sorry for your rabbit's head tilt. It really is a most distressing condition.

Does your vet advise X Ray's to confirm the diagnosis of ear infection? I say this because there are other causes of head tilt such as e.cuniculi (which your vet is covering for) and a possible stroke amongst others I have had rabbits experience.

Strong and possibly injectable antibiotics would be necessary but only if infection were the cause. If you trust your vet I would go with their advice. Personally I would prefer to know the reason for the tilt and treat accordingly, even if that meant a head X-Ray .

Wishing you loads of luck X

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Thanks everyone who replied.

My vet spoke to John Chitty who recommended several options; x rays, blood tests, ear swabs. The vet did head x rays and found nothing untoward ie no brain tumour; the swabs came back with nothing; they did not do a blood test as they did all this without sedation and by that point bunny had had enough. In addition, the blood test would only show whether she had ever been exposed to EC... John Chitty has advised my vet that he does not find long term anti biotics useful. This means that the panacur has finished, the septrin will soon finish and will just leave metacam.

I find it so distressing to see my poor girl rolling over. Her head is not tilting, but her balance is gone. She can get around as long as she doesn't turn quickly, she can eat her poo, she has appetite, but I worry about her quality of life. How long can I do nothing? We love our girl to bits and will do everything we can....

If it is E cuniculi rather than an ear infection the rolling will very slowly subside and the bun will slowly slowly re-gain its composure and balance - On my experience this can take a few weeks. In the meantime the Panacur (AT LEAST 4 weeks - sometimes 6 weeks) is essential, as is the metacam - also supportive feeding and fluids.

It sometimes gets worse before getting better - but usually in my experience a very very slight improvement can be seen by week 3. Depending whether the head tilts or not the bun may take months to get totally used to any balance changes resulting from the EC having affected the nervous system and balance. However I have had SEVERAL (probably about 8) buns go on and be completely better again. Some with residual head tilt, some without.

TBH if she is as well as you describe then thats pretty good! Even badly head tilted buns have an excellent quality of life often.

Wattywatts said:

Thanks everyone who replied.

My vet spoke to John Chitty who recommended several options; x rays, blood tests, ear swabs. The vet did head x rays and found nothing untoward ie no brain tumour; the swabs came back with nothing; they did not do a blood test as they did all this without sedation and by that point bunny had had enough. In addition, the blood test would only show whether she had ever been exposed to EC... John Chitty has advised my vet that he does not find long term anti biotics useful. This means that the panacur has finished, the septrin will soon finish and will just leave metacam.

I find it so distressing to see my poor girl rolling over. Her head is not tilting, but her balance is gone. She can get around as long as she doesn't turn quickly, she can eat her poo, she has appetite, but I worry about her quality of life. How long can I do nothing? We love our girl to bits and will do everything we can....

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So I am assuming the X-Rays flagged up no abscess or ear infection either?

I do agree about the unreliability of the E.C. test and these days I wouldn't have it done. It involves two blood tests and it's a lot to ask of a bunny undergoing all that yours has already.

Did John Chitty have any other suggestions of how to cope if the situation doesn't improve post Panacur. Is she on Metacam still, and what is his view about taking that long term?

I'm so sorry for her rolling. I have had head tilt bunnies and I know the distress to both owner and rabbit

parsnipbun said:

If it is E cuniculi rather than an ear infection the rolling will very slowly subside and the bun will slowly slowly re-gain its composure and balance - On my experience this can take a few weeks. In the meantime the Panacur (AT LEAST 4 weeks - sometimes 6 weeks) is essential, as is the metacam - also supportive feeding and fluids.

It sometimes gets worse before getting better - but usually in my experience a very very slight improvement can be seen by week 3. Depending whether the head tilts or not the bun may take months to get totally used to any balance changes resulting from the EC having affected the nervous system and balance. However I have had SEVERAL (probably about 8) buns go on and be completely better again. Some with residual head tilt, some without.

TBH if she is as well as you describe then thats pretty good! Even badly head tilted buns have an excellent quality of life often.

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This is my experience as well. Keep going with panacur and metacam for as long as it is needed. Mine was on it for several months, and then low dose metacam for life. If she is getting around and eating and drinking for herself, she isn't as bad as some - who then go on to make a good recovery. Give it plenty of time, look for gradual improvements week by week, and expect the odd set back.

Are you on Facebook? I highly recommend you join this group if you are https://www.facebook.com/groups/HelpforHeadTiltHoppers/?fref=ts

Some of the advice you have been given (not on here) is questionable.... there is much you can do do help her - including drugs to help her balance. Too much for me to go into here, but please do join the group you will be given lots of support and advice x