My rabbit's head tilt hasn't improved, what do I do?

[aph.shadowbunn]

My 5 year old bunny, Shadow, has a severe head tilt from what I believe is an ear infection, but me and the vet I see for him aren't sure if that's the only issue. It started in February, when he had a small head tilt, for an ear infection we had been treating with local antibiotics (tenazym) and after a week, Shadow's balance had become a bit worse and he was a bit wobbly. We went to another vet who said to keep using tenazym, and prescribed more of it, and a week later, Shadow had complete loss of balance and was rolling everywhere. He had, and still has nystagmus, and his head is now basically 90°, and he curls up and keeps still when he loses balance. We went to a new vet when his condition had worsened like that, and they gave him fluids and glucose to give him energy, along with a shot of dexamethasone to help with brain inflammation. We had already been giving Shadow panacur by this point, and he was on new oral antibiotics (enrobactin) which he has been on since February 24th (it's April 30th as I write this).

Shadow is also on some middle ear infection antibiotics for children (sumetrolim) and he gets ear drops on top of that (floxal, three drops in both ears since he had both with infections). Shadow's right ear (the side he's tilted on, the one in worse condition) has a burst ear drum, and I have no idea if it's going to heal. His infections are better now, but Shadow still can hardly walk, and his head tilt hasn't improved at all. The only difference he made was that he rolls less, he's begun to walk a bit but is still wobbly, and he's managed to clean his ears and face a bit. I'm scared because my father keeps telling me to put him down, because he thinks he's suffering, but I know Shadow still wants to live and is still fighting. I'm just worried he's not going to get better. I know head tilt can stay, but from what I've seen it shouldn't bother the bunny, I'm just worried because Shadow can't currently walk well, and struggles to sit balanced, and I don't know if he'll get better or not, not to mention if his kidneys will be able to handle this long-term. He's my best friend, I'm not ready to face the idea of putting him to sleep, I just want to find some way to help him, if there is anything I can still do. I've already researched treatments, and I'm additionally giving him meclizine after waiting a long time for it, since it isn't sold or produced in my country.


Any advice?

 

[Orenoko]

I had a tilty bun who unfortunately didn't improve, he had his head tilt for about 18 months before we had to say goodbye. You seem to be trying everything you can. The only thing I would ask is whether Shadow is on any pain relief? With his burst ear drum that may be helpful. I also did physio exercises with my bun to help his muscles from where he was tilted, along with gentle massage. If you can get a professional to help with this that would be helpful. My boy's physio involved things like using food to encourage him to stand on a very small step with his front legs to help strengthen his back legs and also help with his proprioception (sense of where he was).

Ultimately head tilt is very complicated to treat, it can get worse before it gets better, or it may not improve. I made the decision to use steroid injections as it was the only thing that helped my boy's symptoms. But along with that came the knowledge that that would affect his liver and kidneys and shorten his life. I decided it was worthwhile for his quality of life to do so until such time as it wasn't, and for him I think it was the right decision because without it he would roll a lot but with the injections he could run around normally. Every bun is different and you will know what is best for Shadow, with head tilt I think you have to take it day by day, week by week, and be prepared for setbacks. Hopefully someone else can offer any additional advice.

 

[bunny momma]

I had head tilt bunnies multiple times. It can take time. We used medicam to treat inflammation and pain, and either oral or injectable antibiotics for middle ear infection.
If possible het culture of infection to get correct antibiotic. Some treat for EC too as you are doing. Once infection clears it takes time for the head tilt to improve or for the bunny to adjust to their new perspective and balance.
I agree with doing some physio.

 

[bunny momma]

I had head tilt bunnies multiple times. It can take time. We used medicam to treat inflammation and pain, and either oral or injectable antibiotics for middle ear infection.
If possible het culture of infection to get correct antibiotic. Some treat for EC too as you are doing. Once infection clears it takes time for the head tilt to improve or for the bunny to adjust to their new perspective and balance.
I agree with doing some physio.

 

[Shimmer]

I would keep going with what you are doing. I know it's been a while, but he seems to be showing some slow and steady improvement now.

I've no experience of ear issues in rabbits, but I have with EC and it can take quite a while to stabilise, so I would keep going with the Panacur and anti-inflammatories as well. I had one that took the best part of a year, but she recovered and was worse than Shadow initially.

You can get treatment for nystagmus (I think one of mine had stemetil?).

Weigh him weekly to make sure he is eating OK and do top up feeds if needed. He may also need help to keep his bum clean, which is very important as he will be much more susceptible to flystrike. Check twice a day (or more in the hot weather).

It can be useful to keep a diary so you can see any changes and progress made, especially if it's quite a long, slow journey.

Has your vet mentioned a CT scan to investigate the ear issue?

 

[bunny momma]

In my post I forgot to mention that your vet may be able to prescribe something for dizziness like my vet did.i felt it helped for a short.
Also, handling the bunny can make symptoms temporarily worse, so minimize handling to what is necessary for care.
Sending positive vibes for your bunny.

 

[aph.shadowbunn]

I had a tilty bun who unfortunately didn't improve, he had his head tilt for about 18 months before we had to say goodbye. You seem to be trying everything you can. The only thing I would ask is whether Shadow is on any pain relief? With his burst ear drum that may be helpful. I also did physio exercises with my bun to help his muscles from where he was tilted, along with gentle massage. If you can get a professional to help with this that would be helpful. My boy's physio involved things like using food to encourage him to stand on a very small step with his front legs to help strengthen his back legs and also help with his proprioception (sense of where he was).

Ultimately head tilt is very complicated to treat, it can get worse before it gets better, or it may not improve. I made the decision to use steroid injections as it was the only thing that helped my boy's symptoms. But along with that came the knowledge that that would affect his liver and kidneys and shorten his life. I decided it was worthwhile for his quality of life to do so until such time as it wasn't, and for him I think it was the right decision because without it he would roll a lot but with the injections he could run around normally. Every bun is different and you will know what is best for Shadow, with head tilt I think you have to take it day by day, week by week, and be prepared for setbacks. Hopefully someone else can offer any additional advice.

I would keep going with what you are doing. I know it's been a while, but he seems to be showing some slow and steady improvement now.

I've no experience of ear issues in rabbits, but I have with EC and it can take quite a while to stabilise, so I would keep going with the Panacur and anti-inflammatories as well. I had one that took the best part of a year, but she recovered and was worse than Shadow initially.

You can get treatment for nystagmus (I think one of mine had stemetil?).

Weigh him weekly to make sure he is eating OK and do top up feeds if needed. He may also need help to keep his bum clean, which is very important as he will be much more susceptible to flystrike. Check twice a day (or more in the hot weather).

It can be useful to keep a diary so you can see any changes and progress made, especially if it's quite a long, slow journey.

Has your vet mentioned a CT scan to investigate the ear issue?

Yes @Shimmer , the current vet I'm going to said that it would be best to get a CT, and also to do ear cleaning under anesthesia, but I'm worried because both would require giving Shadow anesthetics and I don't know if he's in good enough condition to handle it.

@Orenoko , Shadow is also on pain relief, I managed to get meloxicam, which I found since it had similar antiinflammatory effects like corticosteroids, along with pain relief.

 

[aph.shadowbunn]

He eats mostly on his own, I used to syringe feed him every three hours but he's refusing recovery food now. I found out I can bring him greens and he'll manage to reach out for them on his own. I tried to let him walk for a bit on a carpet but he sort of just sits, so I let him be when he eats. I started to massage his neck a bit, since he's really tense, and I was worried his neck was cramping, and I think it helped a little. I also recently got some shampoo for him, since his fur was falling out, and so far it has helped it start to grow back.