Reassurance needed on head tilt

Hi everyone, thank you in advance for reading and any advice or reassurance given.

I shall give you a little background...
Approximately two weeks ago I found my younger rabbit Bugsy in his pen with a head tilt (approx. 45 degrees) and looking very sorry for himself and down. I rushed him to the vets that night to be told he had a severe ear infection and a lot of build up of wax. The vet cleaned out his ears as best as she could, gave him an antibiotic injection and started him on a 7 day course of 0.25ml antibiotics daily. She also prescribed Panacur in case E. Coniculi was also present. However, the vet could not give me an exact diagnosis, it was all very wishy washy. I also had to separate him from my other rabbit Barney because of the risk of E. Coniculi.
4 days after this I felt the tilt was getting worse (now approx. 60 degrees), however he had perked up so I felt this was a good sign. The vet (different to before) agreed the tilt was worse than described on the notes but confirmed it was a good sign he had perked up and that because he was eating and drinking ok I should carry on until the week check. He was beginning to struggle to use his water bottle so the vet suggested using a bowl, which seems to be working as he is urinating. As before no one could give me a diagnosis. They did suggest I start a 9 day course of Panacur for Barney just in case as well. They also told me I could have x-rays or blood tests but that these were expensive and not really worth doing yet as it was so early in to treatment.
At the week check I saw yet another vet, this one terrible, who had no experience with rabbits and had to find her colleague who also didn't seem to know much. However, as Bugsy had made no improvement they quadrupled his antibiotics to 0.5ml twice a day. They also put him on anti inflammatory medication, told me to carry on with the Panacur and increase the 9-day course for Barney to a 28-day course. His head was now tilted at 90 degrees. Still no diagnosis!
At the two week check, which was on tuesday, I finally saw a vet who I felt had some idea of what she was doing. She watched Bugsy walking around and agreed his head tilt had become worse and that his balance was off, although not so bad he was not able to walk, and he wasn't falling much unless he was moved by me. She took him off the anti inflamatories and told me to carry on with the antibiotics and panacur. She also explained to me that an inner ear infection, which Bugsy looks to have) will not show up on xray and I would need an MRI and that the blood test for E. Coniculi is only really effective to rule it out if it is negative. She did say that his ears are still really dirty and that if they haven't improved at the next check in two weeks they can sedate him, clean his ears and see if his ear drums are perforated. This vet also recommended a specialist if I needed any more help.
He is now 2 weeks in to a course of antibiotics which will last between 4 and 6 weeks.

Since tuesday I fell Bugsys balance has got a lot worse, he is now rolling over numerous times an hour and constantly running around in circles. I have tried to adapt his cage by taking out his litter try completely (he kept falling over it) and lining the floor with lots of puppy pads to give good padding. I am worried he seems to have made such a quick decline since tuesday. I am also concerned that I read inner ear infections only show puss in the outer ear if the ear drum is perforated, and that vets should have done a culture of the infection to decide what type of antibiotic is needed or whether it needs anti fungal medication instead, should this have been something I was offered?

I will be calling the specialist recommended to me tomorrow, but my question comes with regards to when do I say enough is enough? When is it no longer fair on him to keep going? I read that they get worse before they get better, does anyone think this is the case? Any other advice with regards to what i should do in his treatment or general care would be greatly appreciated.

I'm really sorry for such a long post and thank you again if you read it all. I just feel so out of my depth and completely confused. I feel the vets (apart from the last one) have been so wishy washy in what they have been saying, giving me to many choices and not enough direction.

What anti-biotics is he on? My little girl was on baytril initially which didn't help at all. At this point it was only a outer ear infection. However as this continued for almost 2 Months, we decided on an ear flush. But only after a CT scan was done. As lead to believe this is the only scan that will give a detailed view of their ears.

Anyway we went ahead with the ear flush as it looked as though both her tympanic ear membranes were in tact. For her one ear, the flush worked really well and completely got rid of the infection. However in the other ear, during the surgery it's likely the membrane did get perforated which caused the infection to be pushed further into the ear causing an inner ear infection. Like your bunny she did develop a head tilt. This was heart breaking! She then went onto 2 further anti-biotics marbocyl (crushing tablet) and pencillin injections daily for 3 weeks. She was also on tramadol as ear infections can be very painful, along with an anti-sickness drug to help with the head tilt and balence. What is your bunny currently on?

My girl was on this for 3 months, and we very sadly didn't see any improvement, however their are so many other bunnies that do improve. It's just a case of giving them lots of extra care and keeping them on anti-biotic as ear infections are so stubborn.

Sending your little man so many vibes xxx

P.s I would defo take the blood test for ec, If this comes back negative, I would stop the panacur ASAP as only recommended by your vet of course, but I am with specialists and they said that taking panacur can be an inhibiter so basically not helping if the infection is severe. But of course you need to get this ruled out first.

time and

I'm sorry you are both going through this. I've been there too.
I can't stress enough the importance of seeing a rabbit specialist as soon as you can which is usually just the same cost wise as ordinary vets. They will assess him and dependant on this possibly want to x ray. It can be fixed in most cases but does take time and dedication. My rabbit had severe ear infection and the xray showed the damage. She was on injectable and oral meds but after 10 weeks started to recover. It's not easy but I had to do what I could for her.
Good luck x

Your vets seem to have put your rabbit on a fairly standard treatment. Often there is no definitive diagnosis and you are treating a set of symptoms. Antibiotics are given in case of an ear infection, and a 28 day course of Panacur with an anti-inflammatory is given in case of EC. Many rabbits are exposed to the EC parasite so a blood test may not be all that useful. Similarly, it can take some very expensive rests to confirm an inner ear infection. Both may cause the symptoms shown by your rabbit. It is usually more effective (and a lot cheaper) to start treatment for both and see how it goes.

If EC is suspected, all partner rabbits are normally treated with Panacur for 28 days as well. This is to eliminate the parasite. The affected rabbit should have an anti-inflammatory to reduce the neurological symptoms caused by the parasite eg head tilt, hind leg weakness. Panacur on its own will not do this. It will also help with pain from an ear infection.

Symptoms may get intermittently worse, and more than one course of treatment may be needed. It is also essential to bleach or steam clean everything the affected rabbit has come into contact with on days 21 and 28 of the Panacur treatment - this is to break the lifecycle of the EC parasite, which is excreted in urine.

Keep going - things should gradually get better. Make sure he can get to food and water. Bowls (heavy ceramic ones won't get tipped over) are usually easier to drink from than bottles, particularly if there is a severe head tilt or balance problems. You may also need to help keep his bottom clean as he may not be able to do it himself - use a damp cloth or bum bath as necessary. If he is rolling, you can restrict his area and use rolled up towels round the edges to support him.

You are doing all the right things. Just keep going. Keep up with the treatment. Make sure he can eat and drink. Keep him clean and safe. Ask the vet to reinstate the anti-inflammatory. See how he is at the end of the 28 days. Be prepared for things to get worse at times, but over the weeks (or possibly months) he should improve.

There are a few of us on here who have been through this. Many rabbits make a full (or nearly full) recovery. There may be a slight head tilt if it is EC, but they cope well with it. There are a few with more detailed knowledge of ear problems as well and can talk you through the possibilities of further treatment.

Hi, I actually joined the forum under similar circumstances, I arrived home to find my wee one with head tilt and my OH joined here for me to get advice.

Shimmer has given pretty sound advice above

I had a bun with head tilt. It can get worse before it gets better and it is very distressing watching the wee ones fall and roll over. As long as they are eating and drinking, pooing and peeing then they are trying their best to fight this. My Kermit was left with a permanent head tilt but he got better and coped with the head tilt well.

Deffo the best way forwards is to continue with the treatment, the anti-inflammatory is important.

Good luck xx

Thank you so much to all your advice and reassurance.

I shall be taking Bugsy to a specialist next week so hopefully they will be able to help more. I will also be asking him to re instate the anti inflamatories.

In the mean time I have changed around his cage even more and padded it all so when he does role he won't hurt himself. I am slightly worried about him and Barney losing their close bond (which took 5 months of bonding) because of having to be separated, but obviously that is not a priority at the moment.

Thank you again for the replies. It's really nice to know I am not alone in this as that is how I was beginning to feel. I shall keep everyone update