percolating/gagging

Question
Hi Dana,
My spayed 4 year old bunny has been percolating on and off for months. She also makes a "gagging" sound. My rabbit savvy vet did a nasal culture when it first started and it came back negative. HE checked her teeth under anesthesia and took head x-rays which showed unclear margins in one of her middle ears. He said is impossible to tell if that is scar tissue or not, but feels the upper respiratory stuff and ear are related. The vet had me nebulize her with saline/gentimycin which worked quickly. YAY! when it happened again, i again nebulized with success. he thinks the percolating is mechanical in nature because when he touches one nostril, he noise stops.
a couple of week ago,she started gagging and percolating again, I nebulized her with no change for 12 days. I just started giving her an antihistamine chlorpheniramine{4mg; 1/2 tab twice per day}   a couple of days ago. It is driving me crazy and I am worried for her.. I'm not sure what to do next. Any advice?
thanks,
Jeanine

Answer
Dear Jeanine,

A chronic upper respiratory situation like this often means that there is, as your vet has said, a mechanical reason.  Often, the roots of a molar or incisor have intruded into the sinus, and this creates a nidus for infection.  Removing the offending tooth may or may not help, as scarring and calcification could already be permanent.

If the maxillary sinus is blocked, for whatever reason, this will also create a chronic schnucky nose.  The only way to permanently fix that is with a drastic surgical procedure, a rhinotomy.  This involves removing facial bones, cleaning out the sinuses, and then sewing bunny back up without the facial bones.  It works, but the vet really has to have the right equipment and lots of experience.  Very few vets have this at the moment.

We've found that a gentle warm saline flush in the affected nostril can really help.  Ask your vet if he thinks this might be a good thing to try, but definitely don't try it without instruction.  You don't want your bunny aspirating bacteria-laden nasal flush.  :(

I know you said the vet checked the molars under anesthesia, but do read this:

www.bio.miami.edu/hare/dental.html

There's also the (rare) chance that something is caught or developing in the throat, such as an abscess, or even a ball of food hanging by a thin bit of fur wrapped around a back molar so as to be just about invisible.  Not likely, but not impossible.  I've heard of it happening.

I hope this helps.

Dana