Opportunistic bug

Question
QUESTION: My 5 year old rabbit has had chronic "snuffles" for a couple of years.  Not just sneezing, runny nose, but some really gut wrenching, head shaking sneezes.  They identified the bacteria as an opportunistic bug (antibiotics do not help) that moves in when he is compromised and believe there is an underlying issue as the cause.  They recommend that he goes to Cornell for an mri(cat scan) on his head.  
I was wondering what yours thoughts were.

Thank you.

ANSWER: Dear Susanne

The signs you describe are typical of a bunny who is suffering from a partially blocked or blocked maxillary sinus.  This is often due to intrusion of the molar "roots" farther into the skull than is normal, pinching off the tear ducts and sinuses.  The reduced air flow sets up a very nice environment for opportunists such as Pseudomonas and others.  Antibiotics knock them back, but never really solve the problem.

We've found that gentle, careful nose flushes with warm, sterile saline can really help.  But don't do this without instruction from a rabbit-savvy vet, since you don't want to cause more damage or have him accidentally aspirate bacteria-laden saline.

There is a radical surgery being done in some quarters (rhinotomy) in which the bones of the skull are actually removed to clear out the sinus, and then the skin put back so the rabbit looks normal.  Very gruesome, and it requires very specialized equipment that few vets have.  And few vets have the required skills to do this.  But it has been done with success.

Short of that, it's pretty much a supportive care thing.

I wish I had better news.  :(

Dana

---------- FOLLOW-UP ----------

QUESTION: Dana,
I would not do the rhinotomy, with that being said, should I still go through with the scan?
Would pulling the molars help?
Lastly, if we do nothing, is this condition fatal, or just something we all learn to live with?

Susanne

Answer
Hi, Susanne

A scan won't tell you much except that the sinuses are blocked.  It might help if it's not the molars, and is something that could be surgically removed.  But if it's the molars, there's not much you can do except supportive care (face washes, nose flushes as directed by the vet, etc.).  Removing the molars will not necessarily solve the problem, as scarring and calcification around the base of the tooth might still block the sinuses.  You'd put the bunny through a painful surgery for little or no gain.

The condition isn't fatal.  It's as you say:  something you just live with and occasionally have to knock back with a course of antibiotics when it gets really troublesome to the bunny.

Wish I had better news.  :(

Dana