tilted head

Question
Hello there,
i'm writing about my son's bunny, i'm not sure what breed he is but he is fairly big and has long ears that reach the all the way down.
Anyway, about 1.5 weeks ago, my sons bunny started to tild his head and lost balance. We took him to the vet. He suspected a ear infection and put him on antibiotic shoots twice a day. After one week, the bunny's head is still tiltet so far that he can look up at the ceiling. His balance is still not good. What else can we do? My son is just so upset.
The bunny is about 5-6 years old.
Thank you for your help


Answer
Hi Nicole,

Torticollis....aka head tilt or wry neck is quite common with vestibular infections.  Lop eared rabbits are very prone to ear infections since there is limited air circulation in those floppy ears so it makes a prime breeding ground for bacteria and/or yeast.  Most tilts are caused by bacterial infections in the middle/inner ear.  It causes vertigo just like in humans.  Problem with a rabbit is that it can't see directly in front of it's face so it can't focus on a fixed point so they tend to spin.

Head tilt is one of my little specialties.  Just so you will know, I am not a licensed vet.  But I do treat these conditions often.  The proper way to treat for an infection is to culture any debris in the ear.  That will identify the pathogen that is causing the concern so it can be targeted with specific drugs.  Most of the time, the infection is caused by a bacterium known as pasteurella multocida...it is carried by many species, including humans, in our respiratory system.  I suspect by giving two shots a day that your vet is using Baytril.  That drug is much more effective when injected.  I also normally use a second antibiotic in conjuction with Baytril.  It really depends on if you can get a growth in a culture.  But Baytril is the most popular drug and is usually effective.  You might ask your vet to prescribe some ear drops.  They need to get in deep in the ear canal to be most effective.  Ear infections are also painful.  We generally use a NSAID for about 4 days and more aggressive meds if necessary for pain.  Ear infections can also cause a high fever.  Keep a watch for that.  It will also help the bunny feel better if you give him sub-q fluids to help with hydration and replenishment of electrolytes lost with a fever.  The "down" eye will also tend to dry out.  I would suggest using a lubricant in that eye several times per day.  We have found that the "gel" type lubricants work better than the fluid type.  These gels can be purchased over the counter at any pharmacy and they are not expensive.  We have had some success with using meclizine to help with the vertigo.  This is the active ingredient in motion sickness pills for humans.  Some rabbit do better and some don't respond at all.  But if the spinning/falling is severe, it might be something worth looking into.

Treating tilt can be a long term issue.  I have treated for as long as 8 months in a stretch.  If the infection is caught early and treated aggressively, it is possible to get correction in the tilt...but it will be slow going.  If the infection gets too deep, you may get partial or no correction.  

My suggestion based on my many experiences with this condition is to treat as aggressively as your vet is comfortable with.  I do use some drugs that are not generally considered for use in rabbits...both for infections and pain meds.  I do this under the guidance and approval of my team of vets....nearly all of them are teaching professors.  Most use some of the protocols I have developed here for tilt.  Keep your rabbit well hydrated.  Remember that greens are mostly water and help with that.  Some suggestions are romaine lettuce, parsley, cilantro, kale and dandelion greens.  Of course, don't overdo the greens as there can be too much of a good thing.  Spend lots of time with your bun.  Give him a reason to fight the infection.  While the neck muscles aren't the problem, they do tend to get sore while in this unusual position.  Give them gentle massages.  Hand feed the greens.  Try to help him reorient by moving the greens around to allow his head to follow the food.  And the most important should the condition not correct....many people consider it to be inhumane to allow a tilter to live.  Nothing could be more incorrent.  We have tilters with varying degrees of tilt that live very happy lives here.  Animals adapt much more readily than humans.  But time, patience and a good treatment plan will give your rabbit the best chance for recovery.  And a side note since we do a lot of educational events with our "special needs"...this could be an excellent educational opportunity for your son and his friends.  Just because your bunny is sick or different...that doesn't change his heart and he can still love you just as much, maybe more, just because he knows you are trying to help him.

I don't normally do this because I am not a vet...but I will since I am so familiar with this condition.  If your vet would like to discuss some of our protocols...I would be willing to discuss it with him/her.  Keep up the treatments...and lots of TLC...will be the the key to recovery.  Best wishes...and don't hesitate to contact me if you have any additional questions.

Randy